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Training, attitudes and practice of district health workers in Kenya

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Abstract

Background

The 1994 mental health policy in Kenya was rooted in the concepts of Primary Health Care articulated at Alma Ata, and required that mental health care be decentralized to all levels of the health care system, and delivered by all cadres of health staff rather than just mental health specialists. However, effective implementation of this policy was likely to be influenced by the degree to which the training, attitudes and practice of health staff was consistent with and supportive of the mental health policy.

Objective

This article therefore reports a study conducted in 1997, which examined the training, attitudes and practice of district level health staff in relation to mental health care and compared them with the national mental health policy of 1994.

Method

A semi-structured questionnaire was sent to the medical superintendents of all district hospitals in Kenya, for distribution to respondents from each cadre of health staff. A total of 148 health workers from 28 districts out of 44 eligible districts (63%) responded.

Results

District health workers did not think general health workers ought to manage most psychiatric patients, even if they were capable of doing so, preferring a system where these patients were managed by specialists and were not admitted into general wards. They also tended to equate mental illness with psychosis.

Conclusion

Despite their training in mental health care and their theoretical knowledge of the principles of Primary Health Care, the attitude and mental health care practice of most health workers were in keeping with a more medical model of health care, emphasising pharmacological treatment and expecting psychiatric patients to conform to the standard Sick Role. This orientation, being at variance with the orientation of the 1994 mental health policy, may have contributed to difficulties in implementation of the policy.

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Notes

  1. A clinical officer is a health worker who holds a 3-year diploma in medicine (as opposed to the 6 year training of a medical doctor) and is registered to carry out clinical duties. The clinical officer is neither a doctor or nurse, but lies in between in terms of rank and responsibility.

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Authors and Affiliations

  1. University of Papua New Guinea, Port Moresby, Papua New Guinea

    Florence A. Muga

  2. WHO Collaborating Centre, Institute of Psychiatry, King’s College London, De Crespigny Park, London, SE 5 8AF, UK

    Rachel Jenkins

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  1. Florence A. Muga
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  2. Rachel Jenkins
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Correspondence to Rachel Jenkins.

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Muga, F.A., Jenkins, R. Training, attitudes and practice of district health workers in Kenya. Soc Psychiat Epidemiol 43, 477–482 (2008). https://doi.org/10.1007/s00127-008-0327-z

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