1. ICIUM 2011 1 Working Together for Mental Health: the Nouadhibou Pilot Experience D. Gérard, A. Ould Hamady, R. Sebbag, F. Bompart ICIUM 2011, Antalya, November 15, 2011 Session 1d. Chronic Care: cross-national and national analyses of access to medicines and quality of care of chronic diseases in LMIC

2. ICIUM 2011 2 Mental illnesses: 2 nd contributor to the GBD *DC = Developing Countries; **LALMIC = Low and Lower-Middle-Income Countries; (1) Mental Health Global Action Program, WHO, 2002; (2) G F Anderson et al. N Engl J Med 356;3, 2007 75 – 90% of patients do not have access to treatment

3. ICIUM 2011 3 Main reasons for the treatment gap ● Mental Health not a health priority ● Population not properly aware of mental disorders ● High levels of stigma ● Few available medical resources ● Medications not accessible

4. ICIUM 2011 4 Mauritania ● General data ● Surface area: 1,080,000 km2 ● 2008 pop.: 3,044,000 < 15 years: 43% ● Life expectancy at birth (m/f): 55/60 ● Health exp./inhab. ($49 in 2005) ● Healthcare organization ● 10 national hospitals ● 5 regional hospitals ● 67 Moughattas ● 511 districts Nouakchott Neuropsychiatric Centre

5. ICIUM 2011 5 Mental healthcare organization Nouakchott Neuropsychiatric Centre Planned organization ● Mental Health facilities in each Wilaya / Province ● Supervised by psychiatrists / technicians from the Nouakchott Neuropsychiatric centre

6. ICIUM 2011 6 Methods (1): a comprehensive program ● Program focused on psychosis ● Objective: to promote access to care and finally rehabilitation ● Pilot program : Nouhadibou area (population ~ 100,000) ● Information- Education-Communication actions dedicated to: Political and administrative decision makers Health care professionals Patients and families Civil society organizations The wider community ● Appropriate drugs sold at cost to MoH Cost recovery : sold at « social price » to patients (at-cost price + 20-25%) ● Actions conducted in liaison with local NGOs, patients, families and the Nouadhibou city services

7. ICIUM 2011 7 Decision Makers Communities WASP Families NGOs Psychiatrists Families & Users’ associations Methods (2): a collaborative approach Rehabilitation Improving care Reducing stigma Ministry of Health Patient Health professionals Nouakchott Neuropsychiatric Centre

8. ICIUM 2011 8

9. ICIUM 2011 9 Educational tools Booklet Nouakchott Neuropsychiatric Centre Poster

10. ICIUM 2011 10 Educational flipchart

11. ICIUM 2011 11 ● Pharmacovigilance ● Assessment Results at 24 months: overview Training 32 health care professionals trained Awareness meetings ● Decision makers ● Civil Society ● General Population ● Families / Patients Evaluation of impact Preferential pricing policy for Chlorpromazine Amisulpride Pipotiazine palmitate Levomepromazine Nouakchott Neuropsychiatric Centre Educational tools developed

12. ICIUM 2011 12 Evolution of the treatment gap -33% % Non treated patients 93% 62,6% Treated patients 0 % 5 10 15 20 25 30 35 40 45 50 7% 37,4% Non treated patientsTreated patients Estimated number of patients with schizophrenia: 1,000 Patients treated at baseline: 70 Patients treated at 30 months: 350 Nouakchott Neuropsychiatric Centre

13. ICIUM 2011 13 Scaling up the Program ● In Mauritania ● 5 Year Public Private Partnership signed June 8, 2011 Extension to the whole country (2-3 new provinces each year) Extension to mood disorders, addictions, anxiety disorders, epilepsy ● Partners’ commitment MoH: Human resources / Follow up / Medicines supply World Association for Social Psychiatry: Training of trainers / Expertise Sanofi: Educational tools / Tiered pricing policy for medications ● To other countries