3 April 2023

CNWL received a small grant from Health Education England (HEE) last year to help Mirembe Hospital, Tanzania’s national mental health hospital, develop a community based mental health care service.

Chris Bumstead, Coordinator for CNWL International Healthcare Partnerships, is out in Tanzania until April, delivering training and advocating for the resources and policies required to build this initiative. This is the third of several blogs Chris will share about his progress in Tanzania. 

Check out Chris’ first blog post about his time in Tanzania here.

Late March 2023

Sara Edwards and Paulina Diaz-Barriga Yanez (My companions from CNWL) returned to the UK 4 weeks ago, having helped our colleagues at Mirembe Hospital begin the development of a new community based mental health service. I have stayed on to continue working with our colleagues in areas that their training has flagged up as needing additional work. To accomplish this, four working groups were set up to address supporting clinical practices, infrastructures, and training needs for the service of the community.

The documentation group has been designing some forms which can be used by the community service and hospital in- and out-patient services to facilitate information sharing and coordination of care. At present, Mirembe has no commonly used information sharing or comprehensive patient record keeping vehicle. As a result, there is no multi-disciplinary care planning – care plans don’t really exist! This group designed simple versions of an initial assessment form, a care and support plan, a risk assessment form, and a pre-discharge checklist – all of which everyone can contribute to and have access. The agreed plan is that these forms will be translated into Kiswahili and uploaded as templates on to the electronic patient record system which is used across Mirembe. This will, apart from providing a better co-ordinated package of care for patients, also enable Mirembe to obtain a better quality of care at the hospital – they scored poorly at the last inspection due to inadequate record keeping.

We have set up a group that are looking at referral criteria for the new community service. From the patients, they have suggested a number of priority groups that could be picked up by the community service, including:

  • Those at medium to high risk
  • Those with a history of frequent relapses
  • Those who require more frequent follow up and multi-disciplinary input.

Though Mirembe takes referrals from all over Tanzania, the plan is for the service to operate initially within the Dodoma region (an area almost the size of England!), as a realistic response to the capacity of the team. The 24 team members work in the community one day a week each. As more data is collected about the impact of the service in terms of hospital admissions and perceived quality of care, discussions can take place regarding enhanced funding and resources.

Another group, looking at operational issues for the community service, addressed logistical issues such as:

  • the team base and the equipment needed,
  • referral allocation,
  •  team coordination and management,
  • safe practice,
  • communication,
  • re-establishment of a triage telephone line and links to out-of-hours cover

They came up with a proposed budget at least for the first year of operation.

The training group has devised an annual programme of training events and budget to cover the costs. This will include training for Mirembe staff, district hospitals, health centres, schools, and local communities. Before training begins at Mirembe a training needs analysis will be conducted amongst all staff to focus the training appropriately. There are now potentially 30 staff at Mirembe who are identified as trainers by the Training and Research Directorate who can deliver this package. They will work in pairs, providing training in areas where they have particular expertise, and link stronger trainers with less strong, so that there is a built-in learning process and greater chances of sustainability.

The budgets for the community team operations and training programme have yet to be agreed. Chris is hoping to have further discussions before he leaves with the Mirembe Hospital Director to discuss this and other details about the plan of action for initiating the service.

The working groups will form the basis of the mentoring groups that Chris will set up between CNWL and Mirembe staff. If you’re interested please contact Chris on c.bumstead@nhs.net

Beyond the above, I have been working with Mirembe as a member of their working group planning events for World Autism month. This has involved brainstorming about different types of events and a couple of visits to a local school with whom Mirembe wants to collaborate and support. This initiative is being overseen by the Head of Non-Communicable Diseases at the Ministry of Health, Dr. Ubuguyu (in whose department mental health and substance use sits). In the car we were talking about our project at Mirembe and he said that developing a community service was just what was needed. He then asked if I could review and comment on the draft of the 2022-2027 National Mental Health & Substance Use Strategy, which I have now almost completed. It’s a very comprehensive and ambitious programme which, if fully supported, will transform mental health care in Tanzania. Its implementation will impact the quality of care for patients and the level of public awareness of mental health, well-being, and substance use.

I only have three weeks to go before I have to return home – where did all the time go?! I will miss being here in Tanzania amongst some of the most “can-do” people I have ever met. I hope to return soon, hopefully with another funded project!