Mental, neurological, and substance use (MNS) disorders are a leading cause of burden of
disease as measured using disability-adjusted life years (DALYs) in Kenya. There is a
dramatic shortage of human and other resources to effectively care for these disorders.
Furthermore, stigma greatly limits access to care and decreases quality of life for individuals
affected by MNS disorders. Traditional and faith healers play an important role in provision
of care for MNS disorders as many patients attribute disease causality and the development of
pathology to a spiritual dimension.
We chose three priority conditions for the purposes of this demonstration project:
depression, epilepsy, and alcohol abuse. We focused initially on these disorders because they:
(1) result in a high burden of disease in Kenya, (2) are not currently being addressed through
other initiatives, (3) have existing evidence-based algorithms for diagnosis, treatment, and
care, and (4) synergies exist in developing community-based interventions using laypersons
or non-specialist health workers for these disorders.
We propose several key components for this demonstration project (see Figure E-6) based
on evidence-based principles:
1. A decentralized, patient-centered, collaborative, stepped-care approach to care that is
evidence based and locally relevant
a. Strengthening of referral networks, including community-based referral and
partnerships with traditional and faith-based healers
b. A supportive supervisory framework and referral pathways, including increased
numbers of lay and health care providers at various levels trained in the
diagnosis, care, and appropriate referral of individual MNS disorders
2. Promoting health literacy and community engagement through a model of social
inclusion, self-help, and human rights for MNS disorders
3. Strengthening of existing infrastructure for distribution of essential drugs
4. Strengthening and expansion of existing information systems infrastructure for MNS
disorders