13. November 2017

Informationen zur Gesundheitsversorgung für psychisch Erkrankte

Luana Giardinelli, klinische Psychologin und Expertin zu Programmen für psychische Gesundheit und psychosoziale Unterstützung, schreibt im Oktober 2017 in einem Beitrag zu vom Konflikt betroffenen Gebieten in Nordostnigeria für das Magazin des britischen Think Tanks Overseas Development Institute (ODI), dass das Versorgungssystem für mentale Gesundheit in Nigeria vernachlässigt sei und Probleme psychischer Gesundheit negativ angesehen und selten diskutiert würden. Es gebe in Nigeria keine verfügbaren Daten zur Qualität und Effizienz von psychischen Gesundheitsdiensten, es sei aber anzunehmen, dass die beschränkte Anzahl von PsychiaterInnen ,PsychologInnen, BeraterInnen und SozialarbeiterInnen nicht ausgebildet oder vorbereitet sei, den durch die Krise im Nordosten ausgelösten erhöhten Bedarf zu decken:

„In Nigeria, where the mental health care system is neglected and mental health problems are still negatively perceived and seldom discussed, especially in the more conservative areas of the country, people affected by conflict-related violence are unlikely to find proper care. The main risks are that the suffering of the affected person is initially underestimated by mental health staff, the affected individual themselves and their friends and family, and help is sought only when their symptoms worsen to the point where family and community members fear they are ‘crazy’, or they are wrongly diagnosed and incorrectly treated. Although in Nigeria there is no available data on the quality and efficacy of mental health services, it is reasonable to assume that the limited number of psychiatrists, psychologists, counsellors, social workers and community workers in the country are not trained or prepared to deal with the increased needs the crisis is generating.“ (Giardinelli, Oktober 2017, S. 28-29)

Ein Autorenteam bestehend aus zwei Psychiatern und einem Ergotherapeuten aus Nigeria und dem Vereinigten Königreich schreibt in einem Beitrag in einem wissenschaftlichen Fachjournal vom August 2017, dass es laut einem Bericht der WHO und des nigerianischen Gesundheitsministeriums von 2006 schwierig sei, Informationen über das Niveau der psychischen Gesundheitsversorgung in Nigeria zu erstellen. Es gebe keine systematische Sammlung von Daten. Staatlich finanzierte Dienste beinhalteten selbständige psychiatrische Spitäler und psychiatrische Einheiten in allgemeinen Krankenhäusern. Es gebe Zentren, die auf Initiative religiöser Organisationen mit Unterstützung aus dem Ausland entstanden seien, diese würden Gemeinden Dienste anbieten, die weit weg von den städtischen Zentren seien, wo sich die staatlichen Spitäler befänden:

„The WHO-AIMS report (WHO & Ministry of Health, 2006) on mental health services in Nigeria states that information about the level of mental health services in Nigeria is difficult to assimilate. Systematic data gathering is non-existent. Government-funded services include stand-alone psychiatric hospitals and psychiatric units located in general hospital settings. Since the catchment areas are not strictly defined, it is impossible to determine the population for which the facilities cater. […]

Government-funded mental healthcare in Nigeria consists of hospital-based services that cater for patients who are brought there, irrespective of their home location. There are no government-funded community residential facilities. Centres like Edawu have grown out of the initiative of religious organisations, with overseas support. These centres provide mental health services to a community that is far removed from the urban centres where the state-funded hospitals are situated.” (Chakraborty/Erinfolami/Lucas, August 2017, S. 66-67)

In einem thematischen Bericht des humanitären Unterstützungsprojekts ACAPS mit Sitz in Genf zur Gesundheitsversorgung im Nordosten Nigerias vom Mai 2017 wird erwähnt, dass das System zur psychischen Gesundheitsversorgung in Nigeria sehr eingeschränkt sei, es gebe nur acht spezialisierte Einrichtungen zu psychischer Gesundheit und 4.000 Betten im ganzen Land:

„The mental health system in Nigeria is very limited, as only eight mental health facilities with 4,000 beds exist in the entire country. In 2012, there were 13 psychiatrists and two psychologists in the northeast, corresponding to 0.069 and 0.01 per 100,000 people respectively – far below the national average (Jidda et al., 2012; WHO 2011). A large proportion of IDP households have pronounced mental health needs stemming from traumatic experiences associated with the insurgency and displacement (UNHCR 11/2016). Many IDPs have sustained severe injuries and they also face a heightened risk of violence, discrimination, social exclusion and other barriers to essential services. All of this impacts on their mental health (WHO 28/02/2012; Racey 2002). People living with chronic illnesses also need mental health support. Misconceptions and lack of awareness about mental health ailments and treatments also hinder access and help seeking behaviour.” (ACAPS, 24. Mai 2017, S. 3)

Der Mental Health Atlas 2014 der Weltgesundheitsorganisation (WHO) gibt die Anzahl psychiatrischer Spitäler in Nigeria mit 8 und die Zahl von psychiatrischen Einheiten in allgemeinen Krankenhäusern mit 36 an. Es habe 5.946 behandelte Fälle von ernsthaften psychischen Störungen gegeben. Die Hauptquelle der Finanzierung zur Behandlung von psychischen Störungen seien die Haushalte:

„Main source of funds for care of severe mental disorders: Households […]

Mental hospitals: 8

Psychiatric units in general hospitals: 36 […]

Treated cases of severe mental disorder: 5,946” (WHO, 2014)

Al Jazeera berichtet im Juni 2015, dass von den 20 Millionen NigerianerInnen, die unter psychischen Erkrankungen leiden würden, viele keine professionelle Hilfe in Anspruch nehmen würden. Es gebe nur 130 PsychiaterInnen in einem Land mit 174 Millionen EinwohnerInnen. Die WHO schätze, dass nur drei Prozent des Gesundheitsbudgets in psychische Gesundheit gehen würden. Psychiatrische Behandlungen seien teuer, viele PatientInnen hätten keine andere Wahl, als sich an traditionelle HeilerInnen zu wenden:

„An estimated 20 million Nigerians suffer from mental illness. But many go without professional help. There are only 130 psychiatrists in Nigeria, which has a population of 174 million. The World Health Organisation estimates that only about three percent of the health budget goes to mental health. Psychiatric treatments are expensive, so many patients have no choice but to turn to traditional healers.” (Al Jazeera, 7. Juni 2015)

Weitere Informationen bzw. Quellen zum Thema finden Sie in folgenden Dokumenten:

·      Abdulmalik, J. et al.:Mental health system governance in Nigeria: challenges, opportunities and strategies for improvement, in: Global Mental Health, Volume 3, 2016, e9, 2016 (verfügbar auf: Cambridge Core)
https://www.cambridge.org/core/journals/global-mental-health/article/div-classtitlemental-health-system-governance-in-nigeria-challenges-opportunities-and-strategies-for-improvementdiv/83A75BDE8829B48BBAE487758C1AC1A1/core-reader

·      Federal Ministry of Health, Nigeria: National Policy for Mental Health Services Delivery Nigeria, August 2013 (verfügbar auf Centre For Health Ethics Law and Development)
http://cheld.org/wp-content/uploads/2015/02/national_policy_for_mental_health_service_delivery__2013_.pdf

·      Landinfo - Norwegian Country of Origin Information Centre: Nigeria: Psykisk helsevern, 23. Juni 2017 (verfügbar auf ecoi.net)
http://www.ecoi.net/file_upload/1788_1498480301_nigeria.pdf

·      SFH - Schweizerische Flüchtlingshilfe: Nigeria: Psychiatrische Versorgung, 22. Jänner 2014 (verfügbar auf ecoi.net)
http://www.ecoi.net/file_upload/1002_1391265297_document.pdf#

 

 

Informationen zur Behandlung von Schizophrenie finden Sie in folgenden Dokumenten:

·      Adeosun, Increase Ibukun et al.: The Pathways to the First Contact with Mental Health Services among Patients with Schizophrenia in Lagos, Nigeria, in: Schizophrenia Research and Treatment Volume 2013, 2013 (verfügbar auf Hindawi)
https://www.hindawi.com/journals/schizort/2013/769161/

·      Afe, Taiwo Opekitan et al.: Perception of service satisfaction and quality of life of patients living with schizophrenia in Lagos, Nigeria, in: J Neurosci Rural Pract. 2016 Apr-Jun; 7(2): 216–222, 2016 (verfügbar auf National Center for Biotechnology Information)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4821928/

·      Effiong, Jombo Henry et al.: Pathways to Psychiatric Care among Patients with Schizophrenia in Uyo, Nigeria, in: International Neuropsychiatric Disease Journal 5(4): 1-10, 2016, 2016 (verfügbar auf Sciencedomain international)
http://www.sciencedomain.org/download/MTE5NThAQHBm.pdf

 

Folgende Dokumente enthalten Informationen zum nigerianischen Gesundheitssystem im Allgemeinen:

·      Africa Check: Could Nigeria build 774 health centres with seized US 9.2m? Minister’s math off, 5. Mai 2017
https://africacheck.org/reports/could-nigeria-build-774-health-centres-with-seized-us9-2m-ministers-math-off/

·      AHO - African Health Observatory: Comprehensive Analytical Profile: Nigeria, ohne Datum
http://www.aho.afro.who.int/profiles_information/index.php/Nigeria:Index

Stigmatisierung

Aishatu Yushau Armiyau vom Department of Psychiatry am Jos University Teaching Hospital in Jos. Plateau state, Nigeria, schreibt in einem Beitrag der Fachzeitschrift Journal of Clinical Case Reports im Jänner 2015, dass bei einer Studie in einem Dorf in Nordnigeria aus dem Jahr 2004 bei fast der Hälfte der Befragten negative Gefühle gegenüber psychisch Kranken dokumentiert worden seien. Bei einer weiteren Studie aus dem Jahr 2005 seien über geringes Wissen bezüglich der Ursachen psychischer Krankheiten und über weit verbreitete negative Einstellungen gegenüber den Erkrankten berichtet worden. In einer Studie aus dem Jahr 2013 seien als Ursachen psychischer Erkrankungen von fast allen Befragten unter anderem Angriffe von Geistern, Bestrafung für böse Taten und der Missbrauch psychoaktiver Substanzen genannt worden. Auch negative Einstellungen gegenüber psychisch Kranken, die zu Diskriminierung führen, seien von vielen ausgedrückt worden. Der Beitrag geht auch auf Strategien des Staates im Bereich psychischer Gesundheit ein:

„A study in Karfi village in northern Nigeria by Kabir et al. [Fußnote 15: Kabir M, Iliyasu Z, Abubakar IS, Aliyu MH (2004) Perception and belief about mental illness among adults in Karfi village Northern Nigeria. BMC International Health and Human Rights 4: 3.] reported most common symptoms proffered by respondents as manifestations of mental illness include aggression/destructiveness (22.0%), loquaciousness (21.2%), eccentric behavior (16.1%) and wandering (13.3%). Drug misuse including alcohol, cannabis, and other street drugs was identified in 34.3% of the responses as a major cause of mental illness, followed by divine wrath/ God’s will (19%), and magic/spirit possession (18.0%). About 46% of respondents preferred orthodox medical care for the mentally sick while 34% were more inclined to spiritual healing. Almost half of the respondents harbored negative feelings towards the mentally ill. Literate respondents were seven times more likely to exhibit positive feelings towards the mentally ill as compared to non-literate respondents. Gureje et al. [Fußnote 16: Gureje O, Lasebekan VO, Ephraim-Oluwanuga O, Olley B, Kola L (2005) Community study of knowledge of and attitudes to mental illness in Nigeria. British Journal of Psychiatry 186: 436-441.] studied to determine the knowledge and attitudes of a representative community sample in Nigeria and reported poor knowledge about the causes of mental illness with wide spread negative views about the mentally ill people; 96.5% of their studied sample believed that people with mental illness are dangerous because of their violent behaviours. Sociodemographic predictors for both knowledge and intolerant attitudes were few in their study. A report by Audu et al. [Fußnote 17: Audu IA, Idris SH, Olisah VO, Sheikh TL (2013) Stigmatization of people with mental illness among inhabitants of a rural community in Northern Nigeria. Int J Soc Psychiatry 59: 55-60.] in a rural community in Northern Nigeria found widespread ignorance about causation, mode of transmission and remedies available for mental illness as a cause for stigmatizing the mentally ill, with only 0.9% of respondents attributing mental illness to brain disease. The others attributed mental illness to spiritual attack, punishment for evil doing and illicit psychoactive substance use, among other things. Negative views about the mentally ill were also widely expressed resulting in discriminatory practices.

There is wide spread stigma and discrimination among the mentally ill in Nigeria even in population that are expected to be enlightened in this aspect. Although the national survey reported less strong negative views, it appears to correlate with period of exposure to psychiatry training period. The wide spread belief in supernatural causation of mental illness is likely to add to the difficulties of designing an effective anti-stigma psycho-education programme in Nigeria. There is need to develop strategies in Nigeria to change stigma attached to mental illness both institutional and at the community level.

[…] In Nigeria, mental health services are not readily available to the citizens, due to their concentration in the urban areas with majority of the Nigerian populace residing in the rural areas. The first mental health policy was formulated in 1991 in Lagos, Nigeria which is yet to become a policy. In 2007, the World Health Organization reported that 20 percent of Nigerians suffer from mental disorders, which means 30 million people are suffering from mental disorders in a country with a population of 160 million which is quiet huge.

Despite these huge rates of mental disorders, little has been done to raise awareness about such issues or to address the stigma and discrimination associated with mental illness. For this reason Beautiful Mind and Wellness Foundation (BMWF) was established as a nongovernmental/ non-profit organization to provide awareness on mental health issues in Ghana and Nigeria, with its location in West Africa. This organization provides awareness through advocacy, education, and evidence-based treatment interventions. BMWF is the forefront on mental health prevention and intervention through education and training with efforts to increase awareness and reduce stigma and discrimination in Nigeria and Ghana. The foundation is client focused and tailored towards cultural preference of those it serves. The program started in December 2012, and it offers anti-stigma and social inclusion education through seminars to train families, communities and general population on mental health symptoms, management, and prevention. Community based mental health education, group sessions and training for community and traditional leaders is also provided.

In its bid to ensure the mental well-being of its citizens, the Lagos state government in Nigeria has committed to a mental health policy which seeks to combat stigma and discrimination against groups and individuals with mental health problems. Part of the recommendation is the expansion and improvement of the current systems of mental health delivery in Lagos state, provision of cost effective interventions and effective care, enhancing human resources, establishing national health policies, programmes and legislation. Encouraging communities, families and users to be involved and engaged in the reduction of stigma and discrimination.

In Edo state, Nigeria efforts are made through using radio and television to provide friendly platforms for people so as to interact, with the intention of sensitizing and mobilizing others to collectively or individually support social causes of mental illness. Though their potentials are yet to be explored fully in terms of programming, social responsibilities as well as maintaining good public outlook, the media assists a lot in the fight against stigma in this state. Efforts are made to carefully design programmes on radios and televisions so as to encourage and support the mentally ill individuals and NGO’s caring for such individuals. Managers working in media houses in Edo state and other parts of Nigeria are also encouraged to design and mount interactive programmes on radio and television with the aim of reducing mental health stigma. Individuals are also encouraged to “speak up and speak out” about mental health challenges they or their loved ones may be facing or visit mental health services for assistance.” (Armiyau, 26. Jänner 2015)

Dr. Olawale Olagunjoye, Psychiater und Exekutivdirektor des privaten psychiatrischen Krankenhauses The Retreat in Ikorodu, Lagos State, wird in einem Interview der nigerianischen Zeitung The Guardian im Oktober 2017 mit der Aussage zitiert, dass psychische Krankheit ein heikles Thema in der Gesellschaft sei und dass es eine Kultur des Schweigens dazu gebe:

„[Consultant psychiatrist and Executive Director of the foremost private psychiatric hospital in Nigeria and West Africa, The Retreat, located in Ikorodu, Lagos State, Dr. Olawale] Olagunjoye further explained: ‘This is obviously a very sensitive issue in our society with potential adverse outcomes including loss of job and inappropriate use of the disclosed information. This is further compounded by the general culture of silence in our society when it comes to talking about mental health issues or how it impacts us.’ The psychiatrist said stigma surrounding the topic does not make it an easy conversation to have, with many employees not used to disclosing their mental health or even seeking help for fear of being stigmatized, discriminated or even ostracized.” (The Guardian (Nigeria), 10. Oktober 2017)

Oliver Lewis, Direktors des Mental Disability Advocacy Center (MDAC) und in London ansässiger Menschenrechtsanwalt schreibt in seinem Blog im März 2013 über den Zusammenhang zwischen Stigmatisierung, psychischer Gesundheitsversorgung und traditionellen und spirituellen HeilerInnen in Nigeria:

„Traditional and spiritual healers deliver the bulk of mental health ‘services’ in Nigeria, Africa’s most populous country. They profit from the populist belief that madness is caused by demonic possession. As a result people labelled as mad are hyper-stigmatised and families urgently want to rid the devil from their afflicted relative. Within this delusional belief system, beatings, lashings, burnings and rapes drive out the evil spirits. The colonial lunacy law provides precisely zero protections against arbitrary internment, chemical and physical restraints, and non-consensual electroshock in psychiatric hospitals. The tiny amount of psychiatrists are hospital-based and overstretched. Mental health services are largely absent from primary healthcare, save in some EU-funded pilot projects. Both the psychiatric and the traditional healing industries are unregulated, unmonitored and susceptible to corruption. Ill-treatment is carried out with impunity because perpetrators are never punished.

[…] This is the context in which I spent three days in humid and car-jammed Lagos, the second city of Nigeria. With Krassimir Kanev, esteemed colleague from the Bulgarian Helsinki Committee, I was co-delivered a two-day workshop to NGOs and lawyers on how to combat torture and ill-treatment against people with disabilities. On day three I participated in a roundtable with disability activists, representatives from the prison service, the attorney general’s office, the ministry of justice and others. The workshop was part of an EU-funded project coordinated by the London-based Equal Rights Trust in conjunction with the Legal Defence and Assistance Project, a Nigerian NGO.

Participants of the workshop gave numerous examples of how people with disabilities are discriminated against in various settings, including by their own families at home, in healthcare facilities, on the streets, in police lock-ups and in prisons. In this piece I want to share my thoughts on the duel challenges of traditional beliefs to madness and a defective mental health system.

Widely-held beliefs

Workshop participants were unanimous in their view that even educated people in Nigeria believe that madness is caused by the devil (I use the term ‘mad’ rather than using illness or disability terms to avoid either the suggestion that madness is viewed by the average Nigerian as a medical defect or a social phenomenon). People who have mad thoughts or exhibit mad behaviour are thought to be possessed by evil spirits, and thus the cure is to ensure that the spirits leave the possessed person’s body. Spiritual healers therefore beat the affected person to drive out the evil spirit, or shackle the person and deprive them of food or water. The fact that this practice involves inflicting physical and mental violence on another human being is seen, at best, as a minor inconvenience.

A 2008 article in the African Journal of Psychiatry gives some examples of how traditional healers treat people in Nigeria, claiming that in one church 40% of the ‘treatment’ for mental illness constitutes beating. Beatings are expensive: families spend significant amounts of money on the services of traditional healers.

I heard in Lagos stories of five year old children with disability who was believed to be a witch, a popular belief pedalled (and cured – for money!) by the church for many children, not just those with disabilities or behavioural problems. If the child’s parents are convinced that their child is demonised the child is abandoned by their family and at risk of being beaten, starved and killed by the community. For more on this epidemic of child abuse, watch this video and read this article.

Service deficiencies

Services for people with psycho-social disabilities in Nigeria are few and far between. A psychiatrist at the main hospital in Lagos told workshop participants that the country has around 160 psychiatrists, roughly one psychiatrist for a million potential patients (WHO data from 2011 doesn’t give the actual number but says there are 0.06 psychiatrists for every 100,000 people, and data from 2005 puts it at 0.09). Primary healthcare services do not deliver mental health care, despite a policy from 1991 which sets out that they should. According to a 2006 World Health Organization report 91% of mental health expenditure is directed to hospitals. From what I know from workshop participants, these hospitals ain’t pleasant places.

Such establishments are not inspected by any independent body, despite Nigeria’s commitments under Article 16(3) of the UN Convention on the Rights of Persons with Disabilities, which sets out that the state needs to ensure that an independent monitoring body inspects all facilities and services designed for people with disabilities.

The Lunacy Act of 1958 regulates detention and involuntary treatment. This colonial relic allows for a doctor and a magistrate to detain ’lunatics‘ a definition which include ’idiots‘ and people of ’unsound mind‘.” (MDAC, 6. März 2013)

Weitere Informationen zum Thema finden Sie in folgenden Dokumenten:

·      Nigeria Health Watch: Nigeria: 'A Beautiful Mind - Opening Up About Mental Health' At Social Media Week Lagos, 19. Jänner 2016 (verfügbar auf AllAfrica)
http://allafrica.com/stories/201601201275.html

·      Oyedeji, Aderemi / Choon, Anja: Stigmatization of mental health problems in Nigeria, 2. September 2016
http://blogs.bmj.com/bmj/2016/09/02/aderemi-oyedeji-and-anja-choon-stigmatization-of-mental-health-problems-in-nigeria/

·      Premium Times: Increased rate of mental disorder among Nigerians worries experts, 25. Oktober 2015
http://www.premiumtimesng.com/news/headlines/192121-increased-rate-of-mental-disorder-among-nigerians-worries-experts.html

Kosten, Informationen zum Krankenversicherungssystem

In einem in der Fachzeitschrift Healthcare in Low-resource Settings veröffentlichten Beitrag der in Nigeria tätigen Mediziner Olugbile, Coker und Zachariah vom März 2013 wird auf die Kosten im Gesundheitswesen eingegangen:

„In Nigeria, there are several barriers to access to effective mental healthcare, e.g. cost, distance to the mental health facility, social stigma, cultural beliefs, attitudes and taboos.

[…] The monthly cost of treatment of patients from the Department of Psychiatry compared to patients with physical ailments from the medical outpatients’ clinic was found to be significant vis à vis the average income of average Nigerians. Contrary to expectations, the mean cost of drug treatment borne by medical outpatients was much higher (N=2549.07 vs N=1904.5) (P<0.05) than that of patients attending the psychiatric outpatients’ clinic. However, the expensive cost for the psychiatric patients far exceeded the expensive costs for the medical patients. The findings from this study showed that the average monthly cost of treatment of patients attending the psychiatric clinic was lower than patients from the medical outpatients’ clinic. However, the most expensive cost for psychiatric patients far exceeded the most expensive cost for medical patients. This study also revealed that there is no free health program covering psychiatric treatment anywhere in Nigeria and mental health drugs are funded from personal and family expenses.

[…] In Nigeria, there is little acknowledgement of mental illness at the primary health care level, which is run by the local government. Local studies have shown that doctors at primary care levels show little interest or aptitude for diagnosing mental disorder or carrying out interventions. Other identified factors preventing access to mental health care by patients in LAMICs include cultural perception about the nature and origin of mental disorder, social stigma attached to mental illness and the logistics of travelling long distances to the few general hospitals with psychiatric facilities or specialist psychiatric hospitals.

However, the most reported important barrier to mental health care is finance. In a country such as Nigeria and many other sub-Saharan countries, evidence shows that about 45% to 60% of the population lives below the poverty line. Therefore, it stands to reason that if individuals suffering from mental disorders in LAMICs cannot relatively afford quality mental health care, it is expected that governments from these countries should provide free mental health care services or subsidize the cost of mental health care. Previous studies from other parts of the world show that patients with mental health conditions receive special consideration to relieve the cost burden of their care. That may not be the case in Nigeria, where the National Health Insurance Scheme (NHIS) does not provide coverage for people with mental health disorders. This means that the cost of mental health treatment by patients is from personal or family expenses. The explanation for this may not be far-fetched. Mental health disorders, especially the severe forms, are regarded as problems for the society.

[…] The study was a cross-sectional descriptive and comparative survey carried out at the Department of Psychiatry and Medicine of the Lagos State University Teaching Hospital (LASUTH) (Ikeja, Nigeria) from April to June 2010. The LASUTH is a tertiary health institution situated in Ikeja, Local Government Area of Lagos State. It was formerly known as Ikeja General Hospital. It is a multi-disciplinary tertiary hospital and it has a total bed space of 520 beds. It has many specialists’ clinics; it runs 24 hour-accident and emergency services and inpatient care services. The hospital also provides clinical services in internal medicine, general surgery, obstetrics and gynecology, community health, family medicine, radiology, clinical pathology, hematology and blood transfusion, pediatrics, psychiatry, dentistry, and orthopedics and trauma, among others. Although the hospital is a tertiary centre, it also serves as a primary, secondary and tertiary centre. For this reason, its services are affordable because consultation and other services are rendered free of charge and only prescription medicine and laboratory investigations are paid for by the patients. However, children under the age of 12 and adults above the age of 60 are not supposed to pay for their prescribed medications. […] The average national minimum monthly income in Nigeria is 18,000 Naira (N), an equivalent of $110 US Dollars per month. The currency used in the study is the Nigerian Naira. It has an equivalent of N160 Naira to $1.

[…] In Nigeria, where the poverty rate is high, access to quality mental health care is achieved by travelling long distances, which could also be disincentive to treatment. Due to the nature of mental disorders that run a long course, individual with chronic mental disorders may find it relatively difficult to continue to pay for the costs of their medications. In Lagos State and perhaps in the whole Nigeria, psychiatric patients may possibly not be getting the best possible treatment for their psychiatric illnesses and this should be evaluated by future studies.” (Olugbile/Coker/Zachariah, 13. März 2013)

Bitte beachten Sie auch folgende ZIRF-Anfragebeantwortung von IOM vom April 2017 zur Versorgung psychischer Erkrankungen und den Kosten:

·      IOM - International Organization for Migration: Lagos –Medizinische Versorgung, (ZIRF-Counselling) ZC78/28.04.2016/], 3. April 2017 (verfügbar auf ZIRF/BAMF)
https://milo.bamf.de/milop/livelink.exe/fetch/2000/702450/698578/704870/698704/8628861/18033382/Lagos_-_Medizinische_Versorgung_28.04.2016.pdf?nodeid=18163471&vernum=-2

 

Weitere Informationen zum Thema Krankenversicherungssystem in Nigeria finden Sie in folgenden Dokumenten:

·      Medical World Nigeria: Health Insurance in Nigeria by Dr. Lawumi Adekola, 19. Februar 2015 (verfügbar auf Google Cache)
https://webcache.googleusercontent.com/search?q=cache:1NohuTV974UJ:https://www.medicalworldnigeria.com/2015/02/health-insurance-in-nigeria-by-dr-lawumi-adekola+&cd=1&hl=de&ct=clnk&gl=at#.WKr5v3rcgTo

·      NHIS - National Health Insurance Scheme, ohne Datum
https://www.nhis.gov.ng/home/

·      Oxford Business group: Nigeria set to reform health care system, 29. Juni 2016
http://www.oxfordbusinessgroup.com/news/nigeria-set-reform-health-care-system

 

Folgende Dokumente enthalten Informationen zur Lage im Bundesstaat Abia bzw. im Nigerdelta:

·      Izibeloko, O.; Uys, L.: Barriers to mental health services utilization in the Niger Delta region of Nigeria: service users’ perspectives, 24. April 2013 (veröffentlicht von The Pan African Medical Journal)
http://www.panafrican-med-journal.com/content/article/14/159/pdf/159.pdf

 

Die Liste der Unentbehrlichen Arzneimittel von 2010 des nigerianischen Gesundheitsministeriums findet sich unter folgendem Link:

·      Federal Ministry of Health, Nigeria: Essential Medicines List (Fifth Revision 2010) – Nigeria, 2010
http://apps.who.int/medicinedocs/en/d/Js19018en/

 

 

Quellen: (Zugriff auf alle Quellen am 13. November 2017)

·      Abdulmalik, J. et al.:Mental health system governance in Nigeria: challenges, opportunities and strategies for improvement, in: Global Mental Health, Volume 3, 2016, e9, 2016 (verfügbar auf: Cambridge Core)
https://www.cambridge.org/core/journals/global-mental-health/article/div-classtitlemental-health-system-governance-in-nigeria-challenges-opportunities-and-strategies-for-improvementdiv/83A75BDE8829B48BBAE487758C1AC1A1/core-reader

·      ACAPS: Nigeria: Health in the Northeast, 24. Mai 2017 (veröffentlicht von ReliefWeb)
http://reliefweb.int/sites/reliefweb.int/files/resources/20170524_acaps_thematic_report_health_in_northeast_nigeria.pdf

·      Adeosun, Increase Ibukun et al.: The Pathways to the First Contact with Mental Health Services among Patients with Schizophrenia in Lagos, Nigeria, in: Schizophrenia Research and Treatment Volume 2013, 2013 (verfügbar auf Hindawi)
https://www.hindawi.com/journals/schizort/2013/769161/

·      Afe, Taiwo Opekitan et al.: Perception of service satisfaction and quality of life of patients living with schizophrenia in Lagos, Nigeria, in: J Neurosci Rural Pract. 2016 Apr-Jun; 7(2): 216–222, 2016 (verfügbar auf National Center for Biotechnology Information)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4821928/

·      Africa Check: Could Nigeria build 774 health centres with seized US 9.2m? Minister’s math off, 5. Mai 2017
https://africacheck.org/reports/could-nigeria-build-774-health-centres-with-seized-us9-2m-ministers-math-off/

·      AHO - African Health Observatory: Comprehensive Analytical Profile: Nigeria, ohne Datum
http://www.aho.afro.who.int/profiles_information/index.php/Nigeria:Index

·      Al Jazeera: Traditional healers fill Nigeria mental healthcare gap, 7. Juni 2015
http://www.aljazeera.com/news/2015/06/traditional-healers-nigeria-mental-healthcare-psychiatric-150606161409127.html

·      Armiyau, Aishatu Yushau: A Review of Stigma and Mental Illness in Nigeria. In: Journal of Clinical Case Reports, Volume 5, Issue 1, 26. Jänner 2015
https://www.omicsonline.org/open-access/a-review-of-stigma-and-mental-illness-in-nigeria-2165-7920.1000488.php?aid=40679

·      Chakraborty, N.; Erinfolami, A.; Lucas, A.: Edawu: a journey from in-patient rehabilitation to community-based treatment and rehabilitation in Nigeria. In: BJPSYCH International, Volume 14, Issue 3, August 2017 (veröffentlicht von Royal College of Psychiatrists)
http://www.rcpsych.ac.uk/pdf/PUBNS_IPv14n3_66.pdf

·      Effiong, Jombo Henry et al.: Pathways to Psychiatric Care among Patients with Schizophrenia in Uyo, Nigeria, in: International Neuropsychiatric Disease Journal 5(4): 1-10, 2016, 2016 (verfügbar auf Sciencedomain international)
http://www.sciencedomain.org/download/MTE5NThAQHBm.pdf

·      Federal Ministry of Health, Nigeria: Essential Medicines List (Fifth Revision 2010) – Nigeria, 2010
http://apps.who.int/medicinedocs/en/d/Js19018en/

·      Federal Ministry of Health, Nigeria: National Policy for Mental Health Services Delivery Nigeria, August 2013 (verfügbar auf Centre For Health Ethics Law and Development)
http://cheld.org/wp-content/uploads/2015/02/national_policy_for_mental_health_service_delivery__2013_.pdf

·      Giardinelli, Luana: Mental health and psychosocial needs and response in conflict-affected areas of north-east Nigeria. In: Humanitarian Exchange Magazine No. 70 - Special feature: The Lake Chad Basin: an overlooked crisis? (veröffentlicht von Overseas Development Institute, ODI), Oktober 2017
http://odihpn.org/wp-content/uploads/2017/10/he-70-web.pdf

·      IOM - International Organization for Migration: Lagos –Medizinische Versorgung, (ZIRF-Counselling) ZC78/28.04.2016/], 3. April 2017 (verfügbar auf ZIRF/BAMF)
https://milo.bamf.de/milop/livelink.exe/fetch/2000/702450/698578/704870/698704/8628861/18033382/Lagos_-_Medizinische_Versorgung_28.04.2016.pdf?nodeid=18163471&vernum=-2

·      Izibeloko, O.; Uys, L.: Barriers to mental health services utilization in the Niger Delta region of Nigeria: service users’ perspectives, 24. April 2013 (veröffentlicht von The Pan African Medical Journal)
http://www.panafrican-med-journal.com/content/article/14/159/pdf/159.pdf

·      Landinfo - Norwegian Country of Origin Information Centre: Nigeria: Psykisk helsevern, 23. Juni 2017 (verfügbar auf ecoi.net)
http://www.ecoi.net/file_upload/1788_1498480301_nigeria.pdf

·      MDAC - Mental Disability Advocacy Center: Nigeria’s lunatic laws and evil spirits: what place for human rights?, 6. März 2013
http://www.mdac.info/en/olivertalks/2013/03/06/nigerias-lunatic-laws-and-evil-spirits-what-place-human-rights

·      Medical World Nigeria: Health Insurance in Nigeria by Dr. Lawumi Adekola, 19. Februar 2015 (verfügbar auf Google Cache)
https://webcache.googleusercontent.com/search?q=cache:1NohuTV974UJ:https://www.medicalworldnigeria.com/2015/02/health-insurance-in-nigeria-by-dr-lawumi-adekola+&cd=1&hl=de&ct=clnk&gl=at#.WKr5v3rcgTo

·      NHIS - National Health Insurance Scheme, ohne Datum
https://www.nhis.gov.ng/home/

·      Nigeria Health Watch: Nigeria: 'A Beautiful Mind - Opening Up About Mental Health' At Social Media Week Lagos, 19. Jänner 2016 (verfügbar auf AllAfrica)
http://allafrica.com/stories/201601201275.html

·      Olugbile, Olufemi B., Coker, Ayodele O., Zachariah, Mathew P.: Cost of Treatment as a Barrier to Access and Continuity of Healthcare for Patients With Mental Ill-Health in Lagos, Nigeria. In: Healthcare in Low-resource Settings, Volume 1, No 1, 13. März 2013
http://www.pagepressjournals.org/index.php/hls/article/view/hls.2013.e8/5466

·      Oxford Business group: Nigeria set to reform health care system, 29. Juni 2016
http://www.oxfordbusinessgroup.com/news/nigeria-set-reform-health-care-system

·      Oyedeji, Aderemi / Choon, Anja: Stigmatization of mental health problems in Nigeria, 2. September 2016
http://blogs.bmj.com/bmj/2016/09/02/aderemi-oyedeji-and-anja-choon-stigmatization-of-mental-health-problems-in-nigeria/

·      Premium Times: Increased rate of mental disorder among Nigerians worries experts, 25. Oktober 2015
http://www.premiumtimesng.com/news/headlines/192121-increased-rate-of-mental-disorder-among-nigerians-worries-experts.html

·      SFH - Schweizerische Flüchtlingshilfe: Nigeria: Psychiatrische Versorgung, 22. Jänner 2014 (verfügbar auf ecoi.net)
http://www.ecoi.net/file_upload/1002_1391265297_document.pdf#

·      The Guardian (Nigeria): Nigeria: Scaling Up Mental Health in Workplace, 10. Oktober 2017
http://allafrica.com/stories/201710100144.html

·      WHO - World Health Organization: WHO Mental Health Atlas 2014 - Nigeria, 2014
http://www.who.int/mental_health/evidence/atlas/profiles-2014/nga.pdf?ua=1