The Tanzania Link is a partnership between CNWL and Mirembe Hospital, Tanzania's national referral hospital for patients with mental health and substance use problems & the Mirembe School of Nursing.
Launched in 2009, the Link's initial focus was to develop a mutually beneficial relationship with a health service in a low or middle-income country. Tanzania is a low-income country with a critical shortage of mental health professionals and only 34 psychiatrists to serve a population of 50 million people. Furthermore, mental health is neglected in Tanzania because of high levels of stigma and lack of awareness and considerable competing health demands. Of the 10 to 13 per cent of the Tanzanian GDP spent on health generally only 6 per cent of the total health budget is spent on mental health. This results in very limited resources for people with mental health problems, so that practically all services are hospital-centred and there is little support for patients in the community.
From the outset, the Link aimed to build the skills and capacity of staff at Mirembe Hospital and School of Nursing. However, both CNWL and Mirembe recognised that the Link was mutually beneficial and could make a significant difference to and impact on their services and staff.
The Tanzania Link project has now been running successfully for 10 years and has gained recognition at the level of the Department for International Development (DfID) and the Tanzanian Ministry of Health, Community Development, Gender, Elderly & Children as a model of good practice.
In 2008, CNWL began to investigate the possibilities of linking with, and supporting a mental health related project in a low-income country. Simultaneously Mirembe Hospital and Nursing School and the Tanzanian Ministry of Health, were actively seeking a Link partner to support its national mental health hospital. The Link was officially launched in March 2010 with both partners feeling this was mutually beneficial and could make a significant difference to and impact on their services and staff.
Mirembe Hospital is based in Dodoma, the legislative capital of Tanzania, and opened in 1926. It is Tanzania’s national referral psychiatric hospital with provision for general and forensic inpatients and a rehabilitation village. During the period of our partnership with Mirembe there have been up to 700 patients at the hospital with just two psychiatrists and 250 staff from a range of professions. There were commonly two, but sometimes only one nurse to 60 patients on a ward which may only have bed capacity for 25 patients. This was an unacceptable level of over-crowding that resulted in many difficulties in managing vulnerable patients. More recently Mirembe has managed to recruit more staff and there are now four psychiatrists working at the hospital and they have managed to significantly reduce the bed occupancy at the hospital so there are now only 350-400 patients. This has greatly improved the capacity of Mirembe to develop the quality of its services and the therapeutic relationship between staff and patients.
Since 1973 the School of Nursing also has provided a limited training in mental health for their student nurses. It offers a diploma course in general nursing, an advance diploma in mental health nursing and short continuing professional development courses. The school has also recently established a training curriculum for Community Health Workers and the Link is currently working with them to test the feasibility of setting up a mental health and substance use module for that training course.
Through the Link, Trust staff have been able to enhance and gain new knowledge and skills, including project management, problem solving, fundraising, budgeting, writing grant applications, working through interpreters, designing and delivering training packages, managing resources efficiently, and generally practising skills that might otherwise lay dormant in their day to day work. Staff who have been fortunate to visit Mirembe often return with renewed vigour and enthusiasm and a more flexible approach to working with less resources. It has also been an opportunity for staff to improve leadership skills through innovative and creative ways of working. Staff have further gained a greater understanding of global mental health and service delivery in low-income countries.
Since the Link was established, much work has taken place to create good working relationships and develop on the originally agreed set of planned priority areas. These included: therapeutic management of violence and aggression training, supporting the opening of a substance misuse (SMS) centre, IT development, developing the Occupational Therapy provision, and building nursing capacity and practice.
At the November 2014 summit conference it was agreed to maintain these priorities except for IT development as it was felt CNWL did not have much to offer and since then Mirembe have made considerable advances in developing an electronic patient record system and using mobile phone technology. The main focus of priority at that point was to develop the substance misuse services at Mirembe as this was also seen as a top national health development priority, which has culminated in the opening, in April 2018, of the Itega Substance Use Unit at Mirembe. As part of this project to develop the substance use service to make sure that staff were comprehensively trained to deliver the service, there were three sub projects – community engagement, Peer Support, and income generation and work-skills development and these will undoubtedly have spin-offs in other areas.
There are various ways in which you can get involved in the Link:
- Helping with various elements of funded projects
- Fundraising for the Link and specific initiatives at Mirembe
- Contributing to developing training materials
- Translating documents and articles into Kiswahili
- Buddying with a member of the Mirembe staff
- Hosting visitors from Mirembe when they are in the UK through your workplace
- Helping out with the social programme for Tanzanian visitors
- Assisting with monitoring and evaluation of the project
- Conducting research to help Mirembe
- Developing working tools
- Helping Mirembe to develop its Peer Support programme
- Working with Mirembe to develop their income generation schemes and commercial developments
- Assisting with monitoring and evaluation of projects and writing reports
There are various working groups that you could become a member of:
- Developing community based services and engaging with local communities
- Developing peer support, occupational therapy and rehabilitation
- Developing clinical and management leadership, staff supervision and support, risk and safety management
- Publicity and promotion, fundraising, general administrative support
- Monitoring and evaluation, research, education and training
Groups one to three in the above list also include training and education, monitoring and evaluation and research.