An evaluation of community mental health services at Kariobangi North city council clinic, Nairobi province, Kenya

Abstract

Following the World Health Assembly declaration at Alma-Ata in 1978 in which 8 key elements of Primary Health Care were identified, Kenya added mental health to the list. This basic element requires particular emphasis since it has not received adequate attention in the past, and yet it is becoming increasingly an important public health problem. The main objective of the study was to evaluate the community mental health services delivered at Kariobangi Health Clinic so as to establish the level of utility of the service, the relationship between social economic and cultural factors of the clients and the utility of the services and also identify the service delivered system. The study was a cross-sectional descriptive study in which natural observation in uncontrolled setting without manipulation of variables was used. Informal ands formal interviews and activity studies were carried out. Thirty semi-structured and structured questionnaires were distributed among health care workers at Kariobangi Health Clinic and Community Psychiatry Department of Mathare Hospital. One hundred and fifteen questionnaires were also distributed to clients and the relatives of the clients who utilise the Community Mental Health Services at Kariobangi. Home visits to clients' homes were made and evaluated. Fourteen administrators were interviewed from the Ministry of Health, City Council Health Department, Mathare Mental Hospital and Kariobangi clinic. Data was analysed using Statistical Package for Social Sciences (SPSS) and Kruskal Wallis and Mann Whitney U statistical tests of significance were used to test for significance between variables. The results of the study showed that the Community Mental Health Services (CMHS) at Kariobangi utilisation were significantly influenced by the socio-economic and cultural factors. The clients had come from all the Divisions of Nairobi Province with the majority (47.12%) coming from Kasarani Division. Forty-seven point one two percent (47.12%) were single, divorced and married were 22.12% in each category, 41.35% had not completed primary education, while none had gone beyond Secondary education, 62.5% were unemployed and 91.35% had an income bracket of 0 - 3,000 Ksh. Lack of resources had no significant relationship with effective service delivery. Among the problems identified as affecting the utilisation of the services in order of priority were: shortage of staff, transport, shortage of drugs, lack of space, security while home visiting, work overload, lack of support from other health workers, infrastructure, training in psychiatry, and clients defaulters. The duration in years that the clients have used the Community Mental health services and home visits had a significant relationship with attitude towards mental illness. Eighty-five point seven percent (85.7% of the health care workers felt that the best place of care of the mentally ill was in a community setting as opposed to Institutional Care. All the clients/patients and relatives (100%) involved in the study preferred Kariobangi Community Mental Health Services instead of Mathare Mental Hospital outpatient clinic and 99% strongly agreed to integration of mental health services into other health-care services. Fifty percent (50%) of the health workers rated the level of utilization of community mental health services at Kariobangi North Health Clinic as very well utilized, 46% as just utilized and 4% as not utilised. Ninety point three eight percent (90.38%) of the clients/patients had received mental health talks, 65.4% had not had home visits and 30% had used the clinic for over seven years. The health administrators and policy makers can use the results of this study to improve the provision of quality community mental health services to Nairobi people and Kenyans at large