Leadership and management training for African psychiatrists in the era of task-sharing

25 January, 2020

This paper in The Lancet Psychiatrist argues that 'leadership training for psychiatrists in Africa is imperative and urgent' as they are increasingly responsible for large programmes involving CHWs and other cadres. Citation, selected extracts and comment from me below.

CITATION: Leadership and management training for African psychiatrists in the era of task-sharing

Chido Rwafa-Madzvamutse et al.

The Lancet Psychiatry

Published:January 20, 2020

DOI: https://doi.org/10.1016/S2215-0366(19)30529-2

'Psychiatry education in most of Africa occurs primarily in tertiary-level units, and it places a greater emphasis on clinical expertise than exposure to primary care and community-based work. However, owing to the shortage of specialists, many African countries have introduced task-sharing programmes to increase patient access to basic mental health services outside of specialist institutions. Task-sharing models often involve a stepped-care approach, in which non-specialist workers, such as community health workers, non-specialist nurses, and general practitioners, manage patients with mental health disorders and refer complex cases to higher levels of care, all with training and supervision from specialists. As a consequence of this shift, early career psychiatrists with little management experience might have to enter into challenging leadership and supervision roles...

We argue that leadership training for psychiatrists in Africa is imperative and urgent...

As psychiatrists and internists, and based on our experience of working with leaders and researchers in mental health systems in Africa, we suggest that some key elements of training programmes include: planning and financing of mental health policies; quality improvement and leading clinical change through a mentored quality improvement project; understanding mental health systems at provincial and national levels through field placements in government agencies; mentorship in how to lead clinical services, including training and supervision of non-specialists; and developing skills in community engagement and advocacy...'

Comment (NPW): This paper raises an issue that we have not yet explored on HIFA and that is especially relevant as health systems move to engage CHWs and other cadres in the community. The need for leadership and management skills applies not only to mental health, but to all areas of health. What is being done to support this, across Africa and elsewhere?

Best wishes, Neil

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org