title: The core competencies for mental, neurological, and substance use disorder care in sub-Saharan Africa.
abstract: The 2010 Global Burden of Disease Study points to a changing landscape in which non-communicable diseases, such as mental, neurological, and substance use (MNS) disorders, account for an increasing proportion of premature mortality and disability globally. Despite evidence of the need for care, a remarkable deficit of providers for MNS disorder service delivery persists in sub-Saharan Africa. This critical workforce can be developed from a range of non-specialist and specialist health workers who have access to evidence-based interventions, whose roles, and the associated tasks, are articulated and clearly delineated, and who are equipped to master and maintain the competencies associated with providing MNS disorder care. In 2012, the Neuroscience Forum of the Institute of Medicine convened a meeting of key stakeholders in Kampala, Uganda, to discuss a set of candidate core competencies for the delivery of mental health and neurological care, focusing specifically on depression, psychosis, epilepsy, and alcohol use disorders. This article discusses the candidate core competencies for non-specialist health workers and the complexities of implementing core competencies in low- and middle-income country settings. Sub-Saharan Africa, however, has the potential to implement novel training initiatives through university networks and through structured processes that engage ministries of health. Finally, we outline challenges associated with implementing competencies in order to sustain a workforce capable of delivering quality services for people with MNS disorders.
authors.affiliation: Office for Research on Disparities and Global Mental Health, National Institute of Mental Health, Bethesda, MD, USA; pamela.collins@nih.gov.
authors.forename: Pamela Y
authors.initials: PY
authors.lastname: Collins
authors.affiliation: Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Seggane
authors.initials: S
authors.lastname: Musisi
authors.affiliation: Department of Health Policy, The George Washington University, Washington, DC, USA.|Department of Global Health, The George Washington University, Washington, DC, USA.
authors.forename: Seble
authors.initials: S
authors.lastname: Frehywot
authors.affiliation: Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, London, UK.|Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India.
authors.forename: Vikram
authors.initials: V
authors.lastname: Patel
mesh_terms: D017954:Africa South of the Sahara; D003695:Delivery of Health Care / Q000592:standards*; D003906:Developing Countries; D006282:Health Personnel / Q000592:standards*; D006801:Humans; D008605:Mental Health Services / Q000592:standards*; D009422:Nervous System Diseases / Q000628:therapy*; D011361:Professional Competence / Q000592:standards*; D019966:Substance-Related Disorders / Q000628:therapy*
keywords: Africa; capacity-building; core competencies; human resources; mental health care; neurology; task sharing