Abstract
BackgroundThe burden of substance use disorders in sub-Saharan Africa has been projected to increase by an estimated 130% by 2050. Despite this, little is known about the substance use disorder treatment and prevention systems in the region.ObjectivesThe objective of this review is to describe the public sector substance use disorder treatment and prevention systems in Kenya guided by the World Health Organization health systems framework model, with the aim of informing decision-making.MethodsWe reviewed official government documents obtained from hand-searching the websites of relevant governmental organizations including: Ministry of Health, National Authority for the Campaign Against Alcohol and Drug Abuse, Parliament of Kenya, Ministry of Treasury & National Planning, National Law Reporting Council, Kenya National Bureau of Statistics, the National Non-Governmental Organization (NGO) Coordination Board and the 47 County Governments. We augmented those searches with official documents that the authors were aware of by virtue of being practitioners in the field. Draft and retired documents were excluded. The findings of the search are presented as a narrative review.DiscussionThe Mental Health Act 1989, the main legislative framework governing substance use disorder treatment and prevention, focuses on institutional care only. While there are only three public health facilities offering substance use disorder treatment in Kenya, several non-public sector actors are involved in SUD treatment and prevention activities. Unfortunately, there is limited cross-sector collaboration. The Ministry of Health has no specific budget for substance use disorder treatment and prevention, while the National Authority for the Campaign Against Alcohol and Drug Abuse has an annual resource gap of about US$ 5,000,000. The substance use disorder workforce in Kenya has not been characterized.ConclusionWe propose five key strategies for strengthening substance use disorder treatment and prevention systems in Kenya including: (1) Enactment of the Mental Health (Amendment) bill 2018. (2) Integration of substance use disorder treatment and prevention into primary health care to increase access to care. (3) Utilization of money from taxation of alcohol, tobacco and betting to increase funding for substance use disorder treatment and prevention. (4) Characterization of the substance use disorder workforce to inform planning. (5) Enhanced collaboration between the government and non-state actors in order to increase access to SUD treatment and prevention.
Highlights
The burden of substance use disorders in sub-Saharan Africa has been projected to increase by an estimated 130% by 2050
We propose five key strategies for strengthening substance use disorder treatment and prevention systems in Kenya including: (1) Enactment of the Mental Health (Amendment) bill 2018
Substance use disorder (SUD) treatment and prevention systems in the region remain under-resourced [2] and the treatment gap is as high as 87% [3]
Summary
The burden of substance use disorders in sub-Saharan Africa has been projected to increase by an estimated 130% by 2050. For example in 2016, despite lower levels of alcohol consumption compared to elsewhere, the region had the highest age-standardized alcohol-attributable deaths and agestandardized alcohol-attributable Disability Adjusted Life Years (DALYs) (70.6 deaths per 100,000 people and 3043.7 per 100,000 people respectively) [5]. Further compounding this situation, is the fact that SUDs are associated with social costs as high as I$ 800 per head [6], emanating from their impact on productivity, crime and health systems [7]. In sub-Saharan Africa where the burden of SUDs is high and countries are struggling to end poverty, it is important that governments place priority on strengthening their SUD treatment and prevention systems
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