This Zambian Independence Day, we are reflecting on the status of mental health support in the country – and evaluating where our programmes fit in.
Zambia is a nation as rich in history as it is beautiful. For long decades of its recent history, from the late 19th century to the middle of the 20th century, Zambia was a British colony. A minority white British ruling class in the guise of the British South Africa Company, that only relinquished control to majority rule in 1964 when the Republic of Zambia was created. Whilst the transition to independence was not fraught with the same levels of violence experienced by Zambia’s neighbours, upon independence the country faced huge challenges – with few domestically trained and educated Zambians capable of running the government leaving the economy largely dependent on foreign expertise. The collapse of the copper mining industry in the mid- to late-1970s brought a serious strain on the fledgling nation. By the 1990s, Zambia’s per capita foreign debt was noted as amongst the highest in the world.
By the 2000s the fractured economy of Zambia had stabilised, with trade increasing and investor confidence surging amidst a blossoming of political constancy brought forth by the introduction of multi-party elections in the early 1990s. However, the country is once again facing huge challenges with a volatile currency, high inflation, growing poverty levels and an economy so damaged by COVID-19 lockdowns that The World Bank does not expect it to reach pre-pandemic levels until 2025. Perhaps it is no surprise then that the management of health services, and in particular, mental health services, has struggled in this uncertain economic environment. A World Health Organisation member state profile notes that in a population of roughly 17 million people, the state portions only 0.5 Kwacha (which is exchanged at around 0.04% of Pound Sterling) expenditure towards mental health services per person. In fact, the primary focus of the Zambian health system is focused on fighting malaria and the HIV/AIDS epidemic, as well as resisting a significant growth in non-communicable diseases.
The governance of mental health in Zambia is stuttering at the implementation stage. Plans are in place, but academic and institutional reporting indicates that there is a lack of mental health services at the primary and secondary care level, with mental health support largely limited to tertiary care.
Let’s break this down. Primary care is the first point of contact for health care for most people and is centred in the community accessed through hospices, general practitioners and doctors’ clinics. Secondary care relates to hospitals and tertiary care for specialist treatment, such as complex mental health disorders. As of 2018, there are a total of six tertiary hospitals across Zambia, servicing a population of 17.8 million people. Less than 800 state-employed mental health professionals care for millions of people, across diverse cultural backgrounds and more than 70 ethnic groups. There are no state-employed child / adolescent psychiatrists. The World Health Organisation also notes that there are no community-based, non-hospital mental health outpatient facilities, meaning that mental health care is simply not available at the primary level.
It is evident that mental healthcare in Zambia is overlooked, or simply beyond the current reach of the state. How, then, can we help? How can mental healthcare be bolstered to reach more Zambian people?
ZOA’s psychosocial support programme
Zambia Orphan Aid UK (ZOA) is a charity that is helping to facilitate progress on the ground and reach elements of society that the state cannot.
Our programmes aim to assist vulnerable children to access school and complete their education – by addressing key barriers. Our research found that children who experience adverse childhood experiences are more likely to have poor mental health that can lead to high absenteeism. Absenteeism causes many children to drop out of education, which can mean their families remain in poverty: a circumstance linked, understandably, to poor mental health. So, the cycle continues.
To address this issue, we looked at the research. The World Health Organisation recommends psychosocial support as a scalable intervention in countries facing chronic poverty. Recent studies provide evidence to support its effectiveness – showing that its favourable effects remain significant during follow-up periods. This comprehensive review of another psychosocial support programme, treating adult women, indicates that this type of mental health intervention may be one of the most cost effective in the world.
With this in mind, ZOA has created its own psychosocial support programme, specifically targeted at vulnerable children. We provide training to teachers and other frontline workers who are already working with vulnerable children, who are then equipped to provide Psychosocial Counselling to students in need. The use of non-specialists to deliver the programme, makes it cheap and fairly straightforward to scale.
As such, since we first piloted this approach in 2019, we have reached more than 2,000 children with school-based counselling services.
The initial results have been extremely promising. By 2021, we recorded a significant fall in absenteeism and Grade 7 pass rates increased from 54% to 100%. This outcome was linked with several key improvements in the mental health of the children who were surveyed, including decreased suicidal thoughts and an increased ability to reach out and ask for help.
Furthermore, after receiving counselling…
- More students were happy. Happiness at school increased by 8%.
- Suicidal thoughts went down by 51%.
- More students cried, but fewer felt stressed and anxious, indicating the students learnt how to manage difficult emotions.
- School attendance went up by 41%.
- Pass rates went up. 100% of the students in this programme passed their Grade 7 exams – up from 54% before the programme.
Mary, one of the young people who benefitted from the programme, said: “I was always sorrowful and thought of committing suicide… With the counselling I have been receiving, it has helped me to understand myself and [I] am happier.” Mary is now training to be a nurse.
Going forward
This is an innovative programme, and the evidence in support of it is growing. The World Health Organisation has expressed an “urgent need” for research into the effects of psychosocial support on adolescences exposed to poverty. It is internationally recognised as a promising area of work.
We will continue to test, learn and improve the programme, as we scale it to provide mental health support to more and more vulnerable young people.
Today, Zambia stands proud as a resilient nation, which has overcome great challenges after experiencing difficulties in the decades since independence. There remain many challenges ahead, but we are proud to play whatever role we can, in supporting the young people who will create Zambia’s future.
If you would like to donate to support our psychosocial support programme,