Implementing Community Care in Large Cities and Informal Settlements: An African Perspective

Abstract

Africa, the poorest World Bank region, is a continent with high levels of migration and rapid urbanization. In a transitional state, a growing middle class and changes in traditional culture are taking place alongside the persistence of severe poverty and underdeveloped rural areas. Cities absorb migrants into sprawling informal settlements. In the southern sub-Saharan region, the escalating prevalence of interpersonal violence and substance use compounds other public health concerns. With pressing public health issues, mental health care is largely neglected. Community mental health care, together with promotive and preventative mental health care, is central to the objectives of theWorld Health Organization’s Mental Health Action Plan for low- and middle-income countries. Although African countries have adopted the principles of community-based care in mental health policy and legislation, implementation is poor. There are multiple competing priorities, particularly in the cities with their rapidly expanding informal settlements and lack of basic infrastructure. Multiple urgent health conditions take priority, together with an increasingly fragmented society.