Factors Associated with Successful Establishment of Independent Mental Health Self-Help Groups in West Africa Presented by:

Maxwell Akandem Program Coordinator, Presbyterian CBR Sandema, Ghana 28 th October, 2010

 Research Officer, Kintampo Health Research Centre (KHRC), Ghana  Program Coordinator, Presbyterian Community Based Rehabilitation Program-Sandema  Principal Investigator, Mental Health and Poverty Project (MHAPP), Ghana  Mental Health Advisor, CBM, West Africa 2

 Background  Objectives  Self-Help Groups  Methods  Results  Conclusions 3

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KHRC

-is one of three health research centres in Ghana, under the Ghana Health Service 

MHAPP

– DFID sponsored research consortium, aimed at developing and evaluating national-level mental health policy interventions in poor countries in Africa 

CBM

: CBM is an international Christian development organisation, committed to improving the quality of life of persons with disabilities in the poorest countries of the world mostly through partnerships with other organisations  The Presbyterian

CBR programme-Sandema

first started in 1991 as an Agricultural Rehabilitation Project for the blind (ARB) and then changed into Community Based Rehabilitation in 1995.

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 Mental health services skewed towards the disease model  Less emphasis on issues such as:  Social exclusion ,Poverty ,Multiple discrimination  Human Rights abuses etc  Exclusion from social protection strategies and exemptions for the poor: Poverty alleviation funds Disability grants : require groups, association and a proposal -National Health Insurance Schemes (NHIS) exemptions 5

Main objectives

 The overarching objectives of the study is to explore the factors that promote or obstruct the effective operation of self-help groups in Sandema and Kintampo  Gather evidence to feedback and strengthen these groups and to design a study on a larger scale.

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COMMUNITY SELF-HELP GROUP

: is an informal/formal grouping of people who come together to pursue a common interest or to resolve common problems or to engage in productive activities.

 In the context of mental health a, SHG, refers to a group of people with mental illness and people with epilepsy and primary care-givers.

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MEMBERSHIPS

People with mental illness, people with epilepsy and primary care givers  Other public spirited persons/benevolent bodies are free to become affiliated members  Membership is voluntary 

LEADERSHIP STRUCTURE

  Individual , community level , district , National level Leaders of the various SHG’s are elected by a simple majority to occupy the following positions:  Chairperson, Vice chairperson, secretary, treasurer and organizing secretary 8

 Campaigns and Advocacy  Fundraising  Finance and Administration  Socio-Economic and Gender issues  Ad-hoc Committees

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FUNCTIONS OF ASSOCIATION /SHG’S

 Discuss and decide matters of common interest to all members in the District and other matters referred to it by their SHG’s and National Delegates conference  Receive and collate reports, resolutions and motions from the Community Self- Help Groups and submit final drafts to the national conference  Embark on advocacy issues that affect mental health.

 Elect delegates to the National conference 10

 Monthly contributions of dues by members  Opening of bank accounts to facilitate access to loans  Local fundraising  Effective collaboration with governmental/non governmental organizations  Engagement in productive livelihood ventures, revolving fund 11

 Social support  Advocacy role  Financial support/contributions  Health ( Hiv/Aids, HINI pandemic, Family planning etc )  Literacy programmes  Income generation projects 12

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 High levels of poverty  Migration  Presence of successful self-help groups.

Map of Ghana Showing the study sites Upper East Region Brong Ahafo Region 15

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24 successful self-help groups were identified

Eighteen Self help groups from Sandema facilitated by CBR  Four such self help groups established as part of the Mental Health and Poverty Project.  Groups were formed based on the principles of encouraging self-advocacy and empowerment  Each autonomously carrying forward an agenda set by its own members which, includes peer support, advocacy, and providing economic integration through micro-finance schemes etc 16

 Exploratory Qualitative Study  Four Focus Group Discussions (FGD) conducted for self help groups &Six key informants, in-depth interviews, using interview guides  Initial themes to explore were informed by consultations with local expects in the field and literature review.

 Interviews were conducted using local dialects and transcribed and translated into English.

 Thematic analysis of data was employed using QSR Nvivo software to categorize the data into themes and discern patterns emerging from the themes.

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  Favorable perception of most stakeholders, although medication took precedence over all other benefits of the self-help groups.

Before the CBR came, we were doing ‘basabasa’ meaning they were seen as useless people by society and people were laughing at us everyday….but now that we have come together and things are getting better (recovering) when you are sitting and people are passing they even greet you.(person with psychosocial disability)

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with these people now forming an association/SHG’S it is now possible to even help them fight for their rights such as their share of the common fund.(a village chief)

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Factors that engender strong and sustainable self-help groups.

Management structures that encouraged financial sustainability and community involvement.

Good initial basic training in the principles of running self-help groups.

Forming strong alliance and synergies with other stakeholders On-going support from interested non-governmental organisation. E.g CBR, MHAPP , Basic-Needs , Minds Freedom etc. 19

Major Challenges to sustainability which must be addressed  Poverty – absolute poverty  High levels of disability  Unreasonable expectations  Unwilling/unprepared attitudes of key stakeholders 20

Self-help groups can be established with success, even in resource-poor settings without a well established user movement in existence.

These groups can have a significant impact in advocacy efforts, and might have a positive impact on quality of life for their members However, to ensure longer term sustainability, there is need for a conducive legal frame work. e.g In Ghana, the mental health bill must be passed The need for in-depth research, employing both qualitative 21 and quantitative outcome measures.

 Working with self-help groups afford one the opportunity to identify their potentials to engage them in productive ventures.  Finally, working with self-help groups creates an enabling environment to build their capacities in certain crucial issues for effective advocacy work and social integration.

Thank you

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