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NIGER EXPERIENCED TWO MAJOR POLITICAL REFORMS SINCE 1986: A LAND TENURE REFORM, A RURAL CODE, AIMED AT INCREASING SECURITY FOR THE RURAL POPULATION THROUGHA CODIFICATION AND FORMALIZATION OF INDIGENOUS LAND RIGHTS, FOLLOWED BY CONSTITUTIUONAL DEMOCRACY IN THE EARLY 1990S. BOTH REFORMS AIMED AT SECURING SOME BASIC RIGHTS AND WERE EXPECTED TO CONFER LEGITIMACY ON THE STATE. THE CONJUNCTURE OF THE TWO, HOWEVER, UNLEASHED AN INTENSIVE POLITICAL STRUGGE. COMPETITION OVER JURIDSDICATION BETWEEN POLITICO-LEGAL INSTITUTIONS AND THE DECLINE OF LEGITIMACY OF STATE INSTITUTIONS.

Metadata only record ; Since 1986 serious efforts have been made in Niger to prepare for reform of land tenure. This reform, the rural code, has so far not been implemented, yet preparations, scientific and political discussions have made the code a widely known political issue throughout the country. This paper aims to outline some of the problems facing successful implementation of the rural code in Nigeria and to sketch out some of the social and institutional trends which emerged in one part of the country, the arrondissements of Mirriah and Matamye in the Zinder department of eastern Niger. The fieldwork on which this paper is based will be followed by a more extensive period of 5-6 months, the data currently used having been collected during January-February 1993. The paper contains the following sections: (1) a background to the discussion; (2) the emergence of the rural code; (3) its institutional consequences; and (4) a brief examination of old and new traditions. The paper makes the following observations: that the indecision surrounding the code has increased the level of insecurity regarding land tenure; and that the rural code should be based on traditions known and recognized by the people concerned. Also, the paper stresses the need to recognize the political aspects of the approach aimed to give people a recognition of the finite nature of resources. Lastly, the advent of the rural code has has an impact on social trends, causing conflict, migration and also raising questions of how the increasing move toward democracy will mesh with the traditional power of the chiefs.

Parazoa (=Porifera, Spongiae) -- Spongillidae (Süßwasserschwämme) -- Eumetazoa -- Coelenterat -- Coelomata (Cölomtiere) -- Arthropoda (Gliedertiere) -- Mollusca (Weichtiere) -- Allgemeine Bemerkungen -- Namenverzeichnis -- Sach- und Abbildungsverzeichnis.

Background In the context of a growing appreciation for the wellbeing of the health workforce as the foundation of high-quality, sustainable health systems, this paper presents findings from two complementary studies to explore occupational stress and professional quality of life among health workers that were conducted in preparation for a task-shifting intervention to improve antenatal mental health services in Cape Town. Methods This mixed-methods, cross-sectional study was conducted in public sector Midwife Obstetric Units and associated Non-Profit Organisations in Cape Town. Semi-structured interviews and a quantitative survey were conducted among facility-and community-based professional and lay health workers. The survey included demographic as well as effort–reward imbalance (ERI) and professional quality of life (PROQOL) questionnaires to examine overall levels of work-related psychosocial stress and professional quality of life, as well as differences between lay and professional health workers. Qualitative data was analysed using a thematic content analysis approach. Quantitative data was analysed using STATA 12. Results Findings from 37 qualitative interviews highlighted the difficult working conditions and often limited reward and support structures experienced by health workers. Corroborating these findings, our quantitative survey of 165 professional and lay health workers revealed that most health workers experienced a mismatch between efforts spent and rewards gained at work (61.1% of professional and 70.2% of lay health workers; p = 0.302). There were few statistically significant differences in ERI and PROQOL scores between professional and lay health workers. Although Compassion Satisfaction was high for all health worker groups, lay health workers also showed elevated levels of burnout and compassion fatigue, with community-based health workers particularly affected. Conclusions Findings of this study add to the existing evidence base on adverse working conditions faced by South African public-sector health workers that should be taken into consideration as national and local governments seek to 're-engineer' South Africa's Primary Health Care system. Furthermore, they also highlight the importance of taking into consideration the wellbeing of health workers themselves to develop interventions that can sustainably foster resilient and high-quality health systems.

Objective: Stigma plays a major role in the persistent suffering, disability and economic loss associated with mental illnesses. There is an urgent need to find effective strategies to increase awareness about mental illnesses and reduce stigma and discrimination. This study surveys the existing anti-stigma programmes in South Africa. Method: The World Health Organization's Assessment Instrument for Mental Health Systems Version 2.2 and semi-structured interviews were used to collect data on mental health education programmes in South Africa. Results: Numerous anti-stigma campaigns are in place in both government and non-government organizations across the country. All nine provinces have had public campaigns between 2000 and 2005, targeting various groups such as the general public, youth, different ethnic groups, health care professionals, teachers and politicians. Some schools are setting up education and prevention programmes and various forms of media and art are being utilized to educate and discourage stigma and discrimination. Mental health care users are increasingly getting involved through media and talks in a wide range of settings. Yet very few of such activities are systematically evaluated for the effectiveness and very few are being published in peer-review journals or in reports where experiences and lessons can be shared and potentially applied elsewhere. Conclusion: A pool of evidence for anti-stigma and awareness-raising strategies currently exists that could potentially make a scientific contribution and inform policy in South Africa as well as in other countries.

BACKGROUND: There is a dearth of information on how to scale-up evidence-based psychological interventions, particularly within the context of existing HIV programs. This paper describes a strategy for the scale-up of an intervention delivered by lay health workers (LHWs) to 60 primary health care facilities in Zimbabwe. METHODS: A mixed methods approach was utilized as follows: (1) needs assessment using a semi-structured questionnaire to obtain information from nurses (n = 48) and focus group discussions with District Health Promoters (n = 12) to identify key priority areas; (2) skills assessment to identify core competencies and current gaps of LHWs (n = 300) employed in the 60 clinics; (3) consultation workshops (n = 2) with key stakeholders to determine referral pathways; and (4) in-depth interviews and consultations to determine funding mechanisms for the scale-up. RESULTS: Five cross-cutting issues were identified as critical and needing to be addressed for a successful scale-up. These included: the lack of training in mental health, unavailability of psychiatric drugs, depleted clinical staff levels, unavailability of time for counseling, and poor and unreliable referral systems for people suffering with depression. Consensus was reached by stakeholders on supervision and support structure to address the cross-cutting issues described above and funding was successfully secured for the scale-up. CONCLUSION: Key requirements for success included early buy-in from key stakeholders, extensive consultation at each point of the scale-up journey, financial support both locally and externally, and a coherent sustainability plan endorsed by both government and private sectors.

Background: Material and social environmental stressors affect mental health in adolescence. Protective factors such as social support from family and friends may help to buffer the effects of adversity. Aims: The association of violence exposure and emotional disorders was examined in Cape Town adolescents. Method: A total of 1034 Grade 8 high school students participated from seven government co-educational schools in Cape Town, South Africa. Exposure to violence in the past 12 months and post-traumatic stress disorder (PTSD) symptoms were measured by the Harvard Trauma Questionnaire, depressive and anxiety symptoms by the Short Moods and Feelings Questionnaire and the Self-Rating Anxiety Scale. Results: Exposure to violence was associated with high scores on depressive (odds ratio (OR)=6.23, 95% CI 4.2-9.2), anxiety (OR=5.40, 95% CI 2.4-12.4) and PTSD symptoms (OR=8.93, 95% CI 2.9-27.2) and increased risk of self-harm (OR=5.72, 95% CI 1.2-25.9) adjusting for gender and social support. Conclusions: We found that high exposure to violence was associated with high levels of emotional disorders in adolescents that was not buffered by social support. There is an urgent need for interventions to reduce exposure to violence in young people in this setting. Declaration of interest: None. Copyright and usage: © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.

BACKGROUND: There is evidence for benefits of psychological treatments in low-resource countries, yet few government health systems include psychological services. AIM: Evaluating the clinical value of adding psychological treatments, delivered by community-based counselors, to primary care-based mental health services for depression and alcohol use disorder (AUD), as recommended by the mental health Gap Action Progamme (mhGAP). METHOD: Two pragmatic randomized controlled trials, separately for depression and AUD. Participants were randomly allocated (1:1) to mental health care delivered by mhGAP-trained primary care workers (psychoeducation and psychotropic medicines when indicated), or the same services plus individual psychological treatments (Healthy Activity Program for depression and Counselling for Alcohol Problems). Primary outcomes were symptom severity 12 months post-enrolment, using the Patient Health Questionnaire (PHQ-9) for depression, the Alcohol Use Disorder Identification Test for AUD, and functional impairment using the World Health Organisation Disability Assessment Schedule (WHODAS). RESULTS: Participants with depression in the intervention arm (n=60) had greater reduction in PHQ-9 and WHODAS scores compared to participants in the control arm (n=60) (PHQ-9: M=−5.90, 95%CI −7.55 to −4.25, β=−3.68, 95%CI −5.68 to −1.67, p<0.001; Cohen's d = .66; WHODAS: M=−12.21, 95%CI −19.58 to −4.84, β=−10.74, 95%CI −19.96 to −1.53, p=0.022; Cohen's d = .42). For the AUD trial, no significant effect was found when comparing control (n=80) and intervention participants (n=82). CONCLUSION: Adding a psychological treatment delivered by community-based counsellors increases treatment effects for depression compared to only mhGAP-based services by primary health workers 12 months post-treatment. Trial registration: ISRCTN72875710 (protocol available: https://www.isrctn.com/)

The aim of this study was to explore health care providers' attitudes towards people with mental illness within two districts in Zambia. It sought to document types of attitudes of primary health care providers towards people suffering from mental illness and possible predictors of such attitudes. This study offers insights into how health care providers regard people with mental illness that may be helpful in designing appropriate training or re-training programs in Zambia and other low-income African countries. Method: Using a pilot tested structured questionnaire, data were collected from a total of 111 respondents from health facilities in the two purposively selected districts in Zambia that the Ministry of Health has earmarked as pilot districts for integrating mental health into primary health care. Results: There are widespread stigmatizing and discriminatory attitudes among primary health care providers toward mental illness and those who suffer from it. These findings confirm and add weight to the results from the few other studies which have been conducted in Africa that have challenged the notion that stigma and discrimination of mental illness is less severe in African countries. Conclusion: There is an urgent need to start developing more effective awareness-raising, training and education programmes amongst health care providers. This will only be possible if there is increased consensus, commitment and political will within government to place mental health on the national agenda and secure funding for the sector. These steps are essential if the country is improve the recognition, diagnosis and treatment of mental disorders, and realize the ideals enshrined in the progressive health reforms undertaken over the last decade.

Objective: This paper aims to explore the options available for developing community-based care and improving the quality of care in psychiatric hospitals in Ghana. Method: Semi-structured interviews (SSIs) and focus group discussions (FGDs) were conducted with a cross-section of stakeholders including health professionals, researchers, policy makers, politicians, users and carers. The SSIs and FGDs were recorded digitally and transcribed verbatim. Apriori and emergent themes were coded and analysed with NVivo version 7.0, using a framework analysis. Results: Psychiatric hospitals in Ghana have a mean bed occupancy rate of 155%. Most respondents were of the view that the state psychiatric hospitals were very congested, substantially compromising quality of care. They also noted that the community psychiatric system was lacking human and material resources. Suggestions for addressing these difficulties included committing adequate resources to community psychiatric services, using psychiatric hospitals only as referral facilities, relapse prevention programmes, strengthening psychosocial services, adopting more precise diagnoses and the development of a policy on long-stay patients. Conclusion: There is an urgent need to build a credible system of community-based care and improve the quality of care in psychiatric hospitals in Ghana.