Abstract

The world is undergoing a rapid health transition, with an ageing population and disease burden increasingly defined by disability. In Sub-Saharan Africa the next 40 years are predicted to see reduced mortality, signalling a surge in the impact of chronic diseases. We modelled these epidemiological changes and associated mental health workforce requirements. Years lived with a disability (YLD) predictions for mental and substance use disorders for each decade from 2010 to 2050 for four Sub-Saharan African regions were calculated using Global Burden of Disease 2010 study (GBD 2010) data and UN population forecasts. Predicted mental health workforce requirements for 2010 and 2050, by region and for selected countries, were modelled using GBD 2010 prevalence estimates and recommended packages of care and staffing ratios for low- and middle-income countries, and compared to current staffing from the WHO Mental Health Atlas. Significant population growth and ageing will result in an estimated 130% increase in the burden of mental and substance use disorders in Sub-Saharan Africa by 2050, to 45 million YLDs. As a result, the required mental health workforce will increase by 216,600 full time equivalent staff from 2010 to 2050, and far more compared to the existing workforce. The growth in mental and substance use disorders by 2050 is likely to significantly affect health and productivity in Sub-Saharan Africa. To reduce this burden, packages of care for key mental disorders should be provided through increasing the mental health workforce towards targets outlined in this paper. This requires a shift from current practice in most African countries, involving substantial investment in the training of primary care practitioners, supported by district based mental health specialist teams using a task sharing model that mobilises local community resources, with the expansion of inpatient psychiatric units based in district and regional general hospitals.

Highlights

  • The recent Global Burden of Disease Study (GBD 2010) is the largest systematic assessment of disease and injury-specific epidemiology undertaken since its 1990 predecessor [1]

  • The GBD methodology incorporates the years of life lost through premature mortality (YLL) and years lived with disability (YLD) into a single metric (the Disability Adjusted Life Year (DALY))

  • The most notable of these is that the world has undergone a rapid health transition over the 1990 to 2010 period – populations have aged, infectious and childhood diseases are making way for non-communicable and chronic disorders, and disease burden is increasingly defined by disability rather than premature death [2]

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Summary

Introduction

The recent Global Burden of Disease Study (GBD 2010) is the largest systematic assessment of disease and injury-specific epidemiology undertaken since its 1990 predecessor [1]. Improvements in life-expectancies have trailed other regions, largely due to the HIV/AIDS epidemic, maternal deaths, and child mortality caused by infectious diseases and malnutrition. These trends are at a turning point and the 40 years are predicted to see significant reductions in child mortality and lowering mortality from HIV/AIDS and malaria, signalling the inevitable health transitions we have seen across the rest of the globe and a surge in the impact of chronic and non-communicable diseases, defined by long-term disability [3,4,5,6]

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