Big4 agenda

Glimmer of hope for the mentally-challenged as Universal Health Coverage (UHC) beckons

by Wagema Mwangi

In the brooding bush of Kirumbi village in Sagalla, a shack stands isolated; some 100 meters away from the main house.
The shack is in a sorry state; walls are crumbling and the rusty roof is leaky. Wild growth, weed and unkempt bush grow around it unchecked, giving the place a neglected and haunted feel.
Seated on a dirty mattress, worn wafer-thin, from years of use, on the floor of the shack is a young man in a stripped T-shirt.
A filthy lesso is wrapped around his waist. Around his right ankle is a thick steel chain clamped in place with a large padlock. The other end of the chain is tied to one of the termite-eaten poles holding up the roof.
Mama Clarence Manga, 77, stares long at the chained young man. Her old wrinkled face betrays decades-old mother’s pain, silent grief and love.
“We chain him for his own safety. There is nothing else we can do,” she explains, the anguish in her voice, well-concealed.
Her son, Pallo Mwanjamba (not his real name), 33, has mental challenges. He has been chained for over 16 years; the only way of keeping him from wandering into the bush.
Mama Manga says it is too risky to leave him alone. The village is often overrun with elephants, wild pigs and other deadly wild animals from the nearby Tsavo National Park.
The chain keeps him safe. Her son’s life revolves around the wooden post with a freedom as long as the length of his chain.
Born in 1986, the son had a normal childhood. He attended a local primary school and was active in Sunday school activities. It was not until the 90’s that he developed mysterious collapsing fits.
It was all downhill from there. Years of struggle to find a cure for his strange ailment bore no fruits. Fatigued by the futile search for medical help, the family decided to take care of him the best way they could: chains.
Mzee Everson Marando, 78, the father, says his son was too violent and had become a danger to others especially given that they were living under the same roof. He would break furniture, utensils and his bed into pieces. Concerned for the safety of others, a separate house was built for him.
“But it was not enough. He brought it down; the wall and the roofs. We had to build this one far away from the main house but you can see he has brought it down,” said the distraught father.
Ropes could not hold him back as he would untie himself and wander through elephant-infested bush. His father admits he never sleeps at night when elephants invade the region fearing for his son’s safety in his dilapidated shack.
Mama Manga’s tribulations cast a spotlight on the economic burden for poverty-stricken families in rural area who look after their mentally-challenged kin.
In most cases, victims of mental illnesses are locked up and live in deplorable conditions because families cannot afford quality health care.
The situation is made worse by outdated beliefs in closed-up communities in rural areas that mental challenges are associated with witchcraft.
To avoid social stigma, families keep victims locked up away from public scrutiny. But it is the economic burden of looking after the mentally challenged that poses the greatest threats to rural empowerment initiatives by government and other development partners.
Ms. Rachael Skajerpe, a community development expert, notes that the burden of managing mental ailments at home for poor families further contribute to rural families’ impoverishment.
She says members of such families ultimately become victims of vicious cycle of poverty because they are permanent minders for their ailing relatives. To them, caring for mentally ill at household level is a full time job.
“The bulk of these patients need 24-hour care and watch. Their caretakers are compelled to stay at home and will not go to work and earn a living unlike patients admitted in institutions” she said.
To free themselves from such obligations, some families dump their sick kin in far-away urban centers and towns leaving them to loiter and scavenge in rubbish dumps.
She points out that mental disorders are elbowed to the periphery when disability issues are being debated. The result is denying this form of disability the attention it deserves especially on economic burden it places on poor families.
Mama Manga aptly captures this perspective when she admits she rarely leaves her son’s side. She fears that if he collapses face-down, he will suffocate to death.
“I always stay around to ensure he doesn’t hurt himself,” she says. In the few instances she leaves his side, she assigns her daughter the duty of watching over him. There is also a requirement that feeding him is done by at least three family members just in case he is violent and needs restraining.
In Kenya, the most concrete step to address mental-health challenges came after the launch of Kenya Mental Health Policy 2015-2030. The policy was to reform a neglected mental health system in Kenya through establishment of mental health councils at the county level and lobby counties to recognize mental health as an area that require attention. The policy also advocates for inclusion of psychotropic drugs in Kenya’s Essential drug list.
Sadly, the policy remains an alien document in most counties and is yet to be incorporated in County Integrated Development Plans (CIDPs) for planning purposes. Most counties also do not have a separate budget for treatment of mental ailments; a key proposal under the policy.
Hope for addressing such challenges lies in the Universal Health Coverage (UHC) program. This program, under Health pillar in the Big 4 Agenda, promises to come to the aid of poor families with mentally-ill kin. To actualize this agenda, the government aims to have 33.5 million Kenyans enrolled with National Hospital Insurance Fund by 2019. This figure will rise to 41.6 million in 2020 and 51.6 million beneficiaries by 2022.
Mr. Charles Mutua, a NHIF official in Taita-Taveta, says mentally-challenged people whose family members have valid NHIF cover can access medical service regardless of their age.
All that is required is a letter from a doctor confirming the mental disability and a valid NHIF cover from either a parent, a sibling or a relative of the patient.
“Such people can be treated under the NHIF cover of their family members. The requirement is a medical report from a doctor about his or her status and the patient will be included amongst the list of beneficiaries,” he explained.
UHC aims at having all Kenyans access medical services at the minimum of costs. The first phase which was in 2018 targeted the counties of Machakos, Nyeri, Isiolo and Kisumu. The second phase will be rolled out to the remaining counties. Once done, thousands of poor families can have the burden of shouldering the cost of treatment for their kin taken away.
In Taita-Taveta, the county government has partnered with AMREF to train 175 Community Health Volunteers on how to assess social status of families in readiness for enrolment in UHC. The assessment is classified under health financing where the ability of families to pay the monthly rate of sh 500 is evaluated. The county also will pay one-year NHIF premiums for most vulnerable population in the county to allow them access health services.
Ms. Mariam Wakio, a health worker, said during that one-year, the county and stakeholders will introduce economic strengthening programs for vulnerable families.
“This will ensure continuity of the cover as families will be able to pay the required monthly fee after the expiry of the paid-up one year by county government,” she explained, adding that families with mentally-ill kin will benefit from this program.
Ms. Skajerpe notes said by treating mental health, government would be freeing up large number of rural families to engage in gainful employment. She adds that such initiatives can alleviate suffering for the poor who bear the brunt of mental ailments. She however warns that unless massive awareness campaign is conducted on rural populations, most people might not know the benefits of such programs.
“It’s killing two birds with one stone. By treating the sick, the government will create opportunity for other family members to earn a living,” she said.
Ms. Eddah Kirombo, a counselling psychologist at Moi County Referral Hospital in Voi, says mental disorders are misunderstood by most people. She says that such disorders are treatable and often victims recover from such through careful management and administration of drugs.
“People recover from mental illness and resume their normal lives but they must get treatment first,” she advised.
She noted that the drugs had to be administered from a health facility because a mental health specialist needed to examine a patient to determine the severity of the condition. The condition results from drug abuse and hereditary factors amongst other causes. Mild cases are often easy to handle but severe cases might call for a referral to mental institutions for specialized treatment.
The major challenge remains lack of data on mental illness. However, a 2011 report by Kenya National Human Rights Commission (KNHCR) cited in the Kenya mental health policy stated that 25 per cent and 40 per cent of people in out-patient and in-patient had some mental condition that needed medical attention. World Health Organization (WHO) notes that mental, neurological and substance use disorders are common and affect 25 per cent of all people at some point during their lifetime.
In 2004, a research for Global Burden Disease found that four out of every five people with mental disorders in developing countries do not receive mental health services. In Kenya, most mental disorders are related to depression, substance abuse, stress and anxiety disorder.
Kenya remains amongst 28 per cent of World Health Organization (WHO) member states who do not have a separate budget for mental health.