Mental health problems are readily becoming recognized as a critical challenge in the health sector that hinders global development outcomes. Lack of proper delivery of health and social services in any country across the world is posing a great threat to the development plans as it poses a difficult to challenge to the health workers and stakeholders in Namibia. The Ministry of Health and Social Services in Namibia has embarked on a serious path to design and establish a proper framework forms aimed at reforming the health sector. Despite the launch of various health reforms in 1990, Namibia's mental health policy framework has since received low priority due to lack of leadership in the country. As discussed in this paper, Namibia requires proper leadership at the national level to promote substantive change in the mental health policy through the adoption of the decentralized health policy system.
Health care services in Namibia are provided by both the government and the private sector. These services include preventive, curative, rehabilitative as well as promotive services (Ashipala, 2013). According to Ashipala (2013), Namibia's Ministry of Health and Social Services is divided into 13 operational regions, which represents the 13 delimited political as well as administrative regions. The 13 regions are further divided into 34 districts. Each of these districts is managed by District Coordinating Committees, which are responsible for the provision of health care services at the local levels. However, as Ashipala et al. (2016) explain mental health policy in Namibia has never received the highest priority that it should. The authors cite numerous challenges in the health sector that have derailed the mental health policy in the country; for instance, limited resources, which compel the government to direct all the resources to communicable and life-threatening diseases (Ashipala et al., 2016).
This paper proposes that the national government should adopt the decentralized system of health policy implementation to ensure that all the people in the country get the primary health care including mental health services. Lack of leadership at the national level has significantly inhibited substantive change in the mental health policy in Namibia. This has driven away from the resources that could be channeled to deal with the mental health challenges in the country. Shumba and Moodley (2018) provide a historical insight of the health care provision in Namibia arguing that Namibia inherited the fragmented and curative based health system, which created a deficit and imbalance in the delivery of health and social care services to the rural dwellers. Mannan et al. (2013) agree that formulation and implementation of a policy and plan that controls and navigates the mental health systems is one of the critical steps towards delivering a judicious as well as comprehensive mental health care in a country. In accordance with the World Health Organization, mental health policy serves a critical role in defining the version for the country's future mental health of the general population. Such policy specifies the framework which needs to be implemented to control, manage and prevents mental health problems (World Health Organization, 2018). In case of Namibia, ensuring that there is effective leadership at the national level is an important way to ensure that there is a substantive change in mental health policy. This is because most of the decisions regarding the mental health policies are made at the national level and the local or regional administrative officers are left to implement it. Effective leadership at the national level will ensure that there is policy coordination between the national and the regional authorities. With good and effective leadership at the national level, both governments can work together to create a blueprint of effective healthcare practices. Rensburg and Fourie (2016) agree that mental illness is a global problem but the low and middle-income countries are the most victims die to unlimited resources and poor leadership, which is characterized by poor nature and strategic forms of integrated mental health care in those countries. World Health Organization (2005) cites that by 2005 when the first mental health policy was launched, Namibia had a population of 2.011 million with no mental health resources. There was no national mental health program as well as mental health budget. The budgetary allocations are done by the national government. Namibia is classified as a middle-income country and yet it lacks the most important strategic forms that can help deal with the mental health problems. According to Ashipala (2013), for many years, Namibia has lacked proper mental health policy because the government has been focused on the urban areas despite over 60% of the country's population residing in the rural areas. Ashipala et al. (2016) argue that it is important to communicate with the policymakers to build their support for the implementation of the mental health policy in Namibia. According to the Ministry of Health and Social Services (2010) of Namibia, approximately 5.6% of the Namibian population is suffering from mental health conditions. However, only 3.8% of the population with mental health conditions has gone for treatment. Mannan et al. (2013) acknowledge the efforts that the Namibian government has employed in an attempt to deal with the mental health problems. However, over 58% of the population is still considered the vulnerable group for policy coverage. The goal of the Namibian national policy for mental health is to prevent, control and maintain the high standards of mental health as well as the well-being of its people (Mannan et al., 2013). As Mannan et al. (2013) explain the government has enacted policies including developing a comprehensive community based mental health services with the aim of improving the coverage of health and social care services in the country. However, this has not been able to bear fruit because of little involvement of the national government. Changing the nature and strategic forms towards mental health policy in Namibia should begin with the involvement of the national government. The involvement of the national authority more will ensure practical steps towards effective decentralization of the mental health policy.
Changing the system from the current centralized system to decentralized system will ensure that many Namibians suffering from mental health conditions access rehabilitation services. Shumba and Moodley (2018) explain the potential impacts of decentralized policy system. For example, Namibia has few rehabilitation service centers due to low budget allocation. Further, the delivery of rehabilitation services has been inhibited by insufficient staff as majority get attracted to the private sector. The national government has the power to change all this. The government can address the shortages and gaps that need to be filled to ensure that the majority of the population continues to access rehabilitation services freely.
The proposed approach will further ensure that majority of Namibians access to assistive and medical care is significantly improved. Shumba and Moodley (2018) suggest that lack of adequate budgetary allocation by the Namibian government has resulted in poor health care services and a shortage of care facilities that can help support the implementation of any health policy. It does not matter whether a policy is enacted because when there is no implementation plan it cannot work. Ashipala et al. (2016) explain that due to the curative-based health system in Namibia, many people are forced to travel all the way to the urban areas to access medical services. Attempts by the government to improve access to medical care for the mentally ill may be effective but not appropriately fitting the locals. Such attempts include the establishment of postgraduate mental health courses at the local university in Namibia as well as sending students outside the country to get more training. All these plans and strategies can be effective if there is a strong policy that supports them. Ashipala et al. (2016) explain the importance of decentralized mental health policy system. According to the authors, decentralized system has proven successful in other middle-income countries like Uganda where mental health facilities are now located at the regional levels. According to Ashipala et al. (2016), before mental health units were decentralized in Uganda, most people had little understanding of the effects of mental health conditions. However, with the establishment of the mental health units near people, most of the challenges associated with mental health disorders have been significantly contained. The same can be applied in Namibia through a decentralized system where leaders become more involved in the mental health policy enactment and implementation.
Decentralized health system ensures that the local people are empowered and more involved in health and social care services. World Health Organization recommends three main policy changes that can assist countries to deal with a policy framework and service planning. The recommendations include developing strategic plans to deinstitutionalize the mental health care, integrate mental health into the general health care, and develop a community-based mental health service (World Health Organization, 2018). Namibia can effectively implement these three recommendations through a decentralized system where more resources will be taken to the regional areas where many people can feel the impact. This will also facilitate the stakeholders' consultation within the country. Making all the decisions at the national level ensures that the mental health services remain available in the urban areas while the majority of the population who reside in the rural areas lack access to primary health care which is their constitutional right.
In conclusion, mental health conditions continue to be recognized as a serious health problem and an impediment to social and economic development across the world. For the low and middle-income countries, the problem poses a great threat to future development. In case of Namibia, lack of effective leadership that ensure decentralized of health care services has significantly reduced the chances to deal with the mental health problems. This paper has proposed that the government can decentralize the mental health policy and services as a way to enhance the process of reducing the effects of mental illnesses. As shown in the discussion, Namibia does not prioritize on mental health policies. As a result, the country lacks proper mental health programs or sufficient budgetary allocation. A decentralized system will ensure that all the stakeholders from the national to regional levels are actively involved in drafting and implementing mental health policies.
Ashipala, D. O., Wilkinson, W., & van Dyk, A. (2016). Mental health policy implementation as an integral part of primary health care services in Oshana region, Namibia. Journal of Nursing Education and Practice 11(6), 53-59.
Ashipala, D. O. (2013). Mental health policy implementation as an integral part of primary health care services in Oshana region, Namibia (Doctoral dissertation). University of Namibia. Retrieved from http://repository.unam.na/bitstream/handle/11070/838/ashipala2013.pdf?sequence=1&isAllowed=y
Mannan, H., ElTayeb, S., MacLachlan, M., Amin, M., McVeigh, J., Munthali, A., & Van Rooy, G. (2013). Core concepts of human rights and inclusion of vulnerable groups in the mental health policies of Malawi, Namibia, and Sudan. International journal of mental health systems, 7(1), 7.
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