The challenges of human resources in mental health in Kenya

Abstract

Objective: Africa faces a skills shortage, in spite of training suitably qualified professionals. This is particularly evident in the discipline of psychiatry. An analysis of the distribution .and availability of psychiatrists in Kenya was thus conducted and findings compared with specific other African countries (Uganda and Zimbabwe). Method: Questionnaire, emailed to Heads of Academic Departments within the SP!3Cified countries. Results: In 2004, there were a total of 53 psychiatrists practicing in Kenya, for a population of 31.5 million. The country has about 4,000 medical practitioners, with psychiatrists constituting 0.013% of the total number of medical practitioners. This is equivalent to a psychiatrist: population ratio of 1:594,339; doctor: population ratio of 1:7,875; a psychiatrist: overall doctors' ratio of 1:75.5, that is only 1.325% of Kenyan doctors are psychiatrists. When the psychiatrist population ratios are considered on the basis of the provinces, then the ratios vary from 1: 63, 007 in the capital city of Nairobi to 1:4 ,393,l~ in other provinces" with one without a psychiatrist for a population of 962,143. The ratios decline further when psychiatrists available for clinical work in public facilities are considered, Up to 34% (n= 18) of all Kenyan psychiatrists were in private practice. The remaining 66% (n=35) were in the public sector, of whom more than 20 were in full time administrative or academic positions and therefore not available for full time clinical work in the public sector. Locally trained psychiatrists, compared with foreign trained psychiatrists, fared better on: non-migration to other countries, working in rural rather the urban areas, working in. public rather than private sector and in overall academic achievements. Conclusion: In the fore-seeable future in Kenya it will not be possible to achieve a psychiatrist: population ratio equivalent to that in Western countries, path in terms of overall ratio for the country, and more importantly; for the average distribution within the country. For the needs of Kenya, and other developing countries, local training of psychiatrists is superior to foreign training in several parameters. If Kenya and other similar developing countries in Africa are to achieve realistic mental health service delivery in the foreseeable future, alternative non-specialist training in mental health~ required. Conflict of interest: None. This study was conceptualized by DMN. It formed the basis of the Key Note speech at the WHO Regional Conference of Psychiatrists, Arusha, Tanzania aQ04'. It was funded by the Africa Mental Health Foundation (.AMID).