title: The availability of essential medicines for mental healthcare in Sofala, Mozambique.
abstract: OBJECTIVE
  We assessed the availability of essential medicines for mental healthcare (MH) across levels of the public healthcare system to aid in future systems planning.
  
  
  METHODS
  Non-expired MH medications were assessed in 24 public health facilities and 13 district warehouses across Sofala Province, Mozambique, from July to August 2014. Medication categories included: antipsychotics, antidepressants, benzodiazepines, antiepileptics and mood stabilizers, and anticholinergics and antihistamines.
  
  
  RESULTS
  Only 7 of 12 (58.3%) district warehouses, 11 of 24 (45.8%) of all health facilities, and 10 of 12 (83.3%) of facilities with trained MH staff had availability of at least one medication of each category. Thioridazine was the most commonly available antipsychotic across all facilities (9 of 24, 37.5%), while chlorpromazine and thioridazine were most common at facilities providing MH care (8 of 12, 66.7%). The atypical antipsychotic risperidone was not available at any facility or district warehouse. Amitriptyline was the most commonly available antidepressant (10 of 12 districts; 12 of 24 overall facilities; 9 or 12 MH facilities). Despite being on the national essential drug list, fluoxetine was only available at one quaternary-level facility and no district warehouses.
  
  
  CONCLUSIONS
  Essential psychotropic medicines are routinely unavailable at public health facilities. Current essential drug lists include six typical but no atypical antipsychotics, which is concerning given the side-effect profiles of typical antipsychotics. Ensuring consistent availability of at least one selective serotonin reuptake inhibitor should also be a priority, as they are essential for the treatment of individuals with underlying cardiovascular disease and/or suicidal ideation. Similar to successful task-sharing approaches used for HIV/AIDS, mid-level providers could be retrained and certified to prescribe and monitor first-line psychotropic regimens.
authors.affiliation: Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA.|Health Alliance International, Seattle, WA, USA; wagenaarb@gmail.com.
authors.forename: Bradley H
authors.initials: BH
authors.lastname: Wagenaar
authors.affiliation: Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA.|Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA.|Global Medicines Program, University of Washington, Seattle, WA, USA.
authors.forename: Andy
authors.initials: A
authors.lastname: Stergachis
authors.affiliation: Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA.|Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
authors.forename: Deepa
authors.initials: D
authors.lastname: Rao
authors.affiliation: Health Alliance International, Beira, Mozambique.|Beira Operations Research Center, Ministry of Health, Beira, Mozambique.
authors.forename: Roxanne
authors.initials: R
authors.lastname: Hoek
authors.affiliation: Department of Mental Health, Ministry of Health, Beira, Mozambique.|Psychiatric Services, Department of Medicine, Beira Central Hospital, Beira, Mozambique.
authors.forename: Vasco
authors.initials: V
authors.lastname: Cumbe
authors.affiliation: Beira Operations Research Center, Ministry of Health, Beira, Mozambique.
authors.forename: Manuel
authors.initials: M
authors.lastname: Napúa
authors.affiliation: Health Alliance International, Seattle, WA, USA.|Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Sherr
mesh_terms: D018954:Drugs, Essential / Q000600:supply & distribution*; D006801:Humans; D008605:Mental Health Services; D009073:Mozambique; D011619:Psychotropic Drugs / Q000600:supply & distribution*; D012111:Residence Characteristics
chemical_list: D018954:Drugs, Essential; D011619:Psychotropic Drugs
keywords: Mozambique; delivery of mental healthcare; health planning; mental health systems; pharmaceutical services