Monitoring and accountability will improve with Health going to the provinces-Sara Afzal Tarrar

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Monitoring and accountability will improve with
Health going to the provinces - Sara Afzal Tarrar

Instead of building new institutions, we need to
strengthenĀ the existing ones first

LAHORE: After the 18th constitutional amendment, health and education have gone to the provinces and it will definitely improve their monitoring and accountability. This was stated by Mrs. Sara Afzal Tarrar Federal Health Minister. She was addressing the eminent mental healthcare professionals from Pakistan and overseas attending the recently held Asia Pacific Conference on Psychosocial Rehabilitation during a special session arranged for interactive discussion. Office bearers of Pakistan Psychiatric Society, Faculty of Psychiatry in College of Physicians and Surgeons Pakistan were also present.
Continuing she said that it also provides an opportunity to the provinces to compete with each other in provision of healthcare delivery. At present all the provincial governments and federal government are on same page and there is no trust deficit. We hope to make a difference in the health sector, she remarked. WHO does not interact with the provinces directly? The federal government can give guidelines and leave the implementation to the provinces. Of course we need to improve our implementation. She assured that mental health legislation will be expedited in all the provinces. She further opined that instead of making new institutions, what we need is to strengthen the existing medical institutions and healthcare facilities. Public sector healthcare facilities are the last hope for the poor and they should not be disappointed. Though some people feel that transferring health and education to the provinces is un-constitutional but we have no intention to interfere in provincial affairs and would provide them all the help and assistance which they require to improve health services. Importance of mental health care has not been adequately emphasized with the result that even donors are prepared to donate for cancer but not for improving mental healthcare. Federal Mental Health Authority will be constituted as per your suggestions, she added.

Organizers of Asia Pacific Conference on Psychosocial Rehabilitation had arranged a special session
of eminent foreign delegates and Faculty Members of Psychiatry in CPSP with the Federal Health Minister
Mrs.Sara Afzal Tarrar to discuss important issues related to mental health. Group photograph
taken on the occasion shows some of these delegates with the Health Minister.

Earlier Brig. Mowadat Rana, Dean Faculty of Psychiatry at CPSP requested for more funding for research. Prof. Khalid Mufti emphasized the importance of changing human attitude and creation of Mental Health Forum. Prof. Sultan said that federal government should issue guidelines to the provinces for allocating special funds for mental healthcare. Most of the funds are utilized for maintaining law and order, hence very little is left for health. A delegate from USA Dr. Taintor pointed towards hospitals overwhelmed with admissions and felt that there is a need to have catchment areas for different healthcare facilities. To improve mental healthcare we need political will, good laws and good knowledge supplemented with funding. Dr. Levent Kuey Secretary General of WPA from Turkey said that health services are too much compartmentalized. A doctor should be able to take care of mental as well as physical health looking at the patient as a whole. Delegate from Thailand Prof. Pichet Udomratan remarked that it was important to first find out the epidemiology of mental disorders before one can plan treatment. Collaboration between the faith healers and mental healthcare professionals was also emphasized as many patients first go these faith healers. In Thailand we educated the Monks and it had good results, Prof. Pichet Udomratan remarked.
Importance of appointing psychiatric nurses in hospitals was also emphasized. Four to six months training to nurses in mental healthcare is enough to training psychiatric nurses whih will make a lot of difference. Setting up a psychiatric unit at DHQ Hospital with one psychiatrist with three to four members including psychologist and psychiatric nurses was also suggested.
Prof. Gholam Rabbani said that we have a department of psychiatry in all the seventy six public and private medical colleges in Bangladesh. General physicians are also imparted training in mental healthcare. There are some treatment gaps and media can be utilized to promote mental healthcare. Child psychiatry units should be established so that mental disorders in children can be identified early as they are our future. Prof. Iqbal Afridi said that money spent on mental health will not be wasted. If people can be educated to wear helmets to avoid head injuries and trauma, it will reduce the patient workload related to trauma in hospitals.
Prof. Norman Sartorius from Switzerland opined that we need to identify GPs interested in mental health who can be trained to teach the general practitioners while psychiatrists can be present as resource person. Same is the case with nurses. Teachers need to be trained to identify children with hearing problems so that early intervention can be planned. Bonus and special payment to government staff linked with the improvement in KPI and filling up the vacant posts were also highlighted.

Session with Punjab Health Secretary

Later Mr. Babar Hayat Punjab Health Secretary also joined the deliberations. He was requested to make provincial task force for mental health. It was emphasized that mental health coverage was not good in the province. We need to train human resource to look after the mental health. Family support is most important in rehabilitation of mentally ill. Family members should be trained to look after those with mental disorders in the family. Institutional structure for mental health needs to be improved. We need to prepare a mode of treatment for mentally ill patients besides training of GPs and Nurses.
Mr. Babar Hayat the Punjab Health Secretary said that a child development center has been established at Children Hospital Lahore. We are supporting this and wish to make a team. Brain drain of healthcare professionals to Middle East is a problem that we are facing. We wish that at this center, a child having any problem should be diagnosed immediately and then treated. Once this center is fully functional, more such child development centers could be established. At present due to lack of training, many such children are not picked up early. Once the healthcare team is trained, they will be able to identify these children early and then start interventions, he added.

Amarant sponsored Session

Dr. Mian Iftikhar Hussain chaired the session devoted to Role of Aimethyl folate in major depressive disorders which was sponsored by Amarant Pakistan during the Asia Pacific Conference on Psychosocial Rehabilitation held here recently. The speakers included Dr. Sadaf Rasheed and Dr.Tipu Sultan.
During the discussion it was pointed out that phenobarabitone are good drugs for neonates but they should not be used in infancy. But it is not easily available. Efforts should be made to ensure their availability. Long term use of CBZ could lead to brain damage seeds; hence some other suitable drugs should be used. For the treatment of infantile spasm, Prednisolone is the first choice while Valporate is also safe and effective. Phenobarabitone are good drugs but do not use them in adults. CBZ and Valporate both are very effective drugs for all types of seizures and they have very little contraindications. It is useful to use them in combinations. Drug levels and toxicity monitoring for both the drugs is essential. More recent drugs are effective with little side effects but they are quite expensive and they can be prescribed if the patients can afford them.

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