The availability of essential medicines for mental healthcare in Sofala, Mozambique

Figures & data

Table 1 Characteristics of 24 health facilities surveyed for availability of mental health medications, Sofala Province, Mozambique, July to August, 2014

Characteristic	All facilities, n (%) unless noted	Facilities providing specialized mental health services, n (%) unless noted
Total facilities	24 (100)	12 (50.0)^a
Rural facility location	20 (83.3)	8 (66.7)
No. of general outpatient consultations in 2013 (mean, SD)	54,728 (46,904)	87,519 (45,240)
Availability of mental health treatment manual	9 (37.5)	8 (66.7)
Type of health facility
Central Hospital	1 (4.2)	1 (8.3)
Urban Health Center – Type A	2 (8.3)	2 (16.7)
Rural Hospital	4 (16.7)	4 (33.3)
Rural Health Center – Type 2	11 (45.8)	0 (0)
Rural Health Center – Type 1	6 (25.0)	5 (41.7)
Number of patients referred for mental health issues in last 30 days (mean, SD)	0.17 (0.48)	0.33 (0.65)
0	21 (87.5)	9 (75.0)
1	2 (8.3)	2 (16.7)
2	1 (4.2)	1 (8.3)
Number of patients referred for suicidal thoughts in last 30 days (mean, SD)	0.17 (0.57)	0.33 (0.65)
0	20 (83.3)	11 (91.7)
1	2 (8.3)	0 (0)
2	2 (8.3)	1 (8.3)
Number of professionals who can prescribe medications for mental health (mean, SD)	1.7 (0.98)	3.1 (2.5)
0	1 (4.2)	0 (0)
1	8 (33.3)	4 (33.3)
2	9 (37.5)	3 (25.0)
3 +	6 (25.0)	5 (41.7)

^aPercentages out of total number of facilities (24).

Table 2 Availability of non-expired mental health medications at district-level warehouses and health facilities, stratified by level of health facility, and whether a given facility has specialist mental health staff, Sofala Province, Mozambique, July to August, 2014

Medication category	Specific medication*	On Ministry of Health ‘essential drug’ list	Lowest-level provider allowed to prescribe^a	District-level warehouse availability n (%)	Overall facility availability n (%)	Facility with specialist mental health staff n (%)	Rural type 2 n (%)	Rural type 1 n (%)	Urban type A n (%)	Rural hospital n (%)	Central hospital n (%)
	Total			12 (100.0)	24 (100.0)	12 (50.0)^b	11 (45.8)^b	6 (25.0)^b	2 (8.3)^b	4 (16.7)^b	1 (4.2)^b
Antipsychotics	Haloperidol	Y	M.D. or Specialist	5 (41.7)	8 (33.3)	7 (58.3)	0 (0)	4 (66.7)	1 (50.0)	2 (50.0)	1 (100.0)
	Chlorpromazine	Y	M.D. or Specialist	5 (41.7)	8 (33.3)	8 (66.7)	0 (0)	3 (50.0)	1 (50.0)	3 (75.0)	1 (100.0)
	Fluphenazine	Y	M.D. or Specialist	3 (25.0)	5 (20.8)	5 (41.7)	0 (0)	2 (33.3)	1 (50.0)	1 (25.0)	1 (100.0)
	Trifluoperazine	Y	M.D. or Specialist	2 (16.7)	6 (25.0)	6 (50.0)	0 (0)	2 (33.3)	1 (50.0)	2 (50.0)	1 (100.0)
	Thioridazine	Y	M.D. or Specialist	5 (41.7)	9 (37.5)	8 (66.7)	0 (0)	3 (50.0)	2 (100.0)	4 (100.0)	0 (0)
	Risperidone	N	n/a	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)
	Decanoate of fluphenazine	Y	M.D. or Specialist	0 (0)	4 (16.7)	4 (33.3)	0 (0)	0 (0)	1 (50.0)	2 (50.0)	1 (100.0)
Antidepressants	Amitriptyline	Y	M.D. or Specialist	10 (83.3)	12 (50.0)	9 (75.0)	2 (18.2)	5 (83.3)	2 (100.0)	2 (50.0)	1 (100.0)
	Imipramine	Y	M.D. or Specialist	3 (25.0)	7 (29.2)	7 (58.3)	0 (0)	3 (50.0)	1 (50.0)	2 (50.0)	1 (100.0)
	Maprotiline	Y	M.D. or Specialist	0 (0)	1 (4.2)	1 (8.3)	0 (0)	0 (0)	0 (0)	0 (0)	1 (100.0)
	Fluoxetine	Y	M.D. or Specialist	0 (0)	1 (4.2)	1 (8.3)	0 (0)	0 (0)	0 (0)	0 (0)	1 (100.0)
Benzodiazepines	Diazepam	Y	CHW	9 (75.0)	18 (75.0)	11 (91.7)	6 (54.6)	5 (83.3)	2 (100.0)	4 (100.0)	1 (100.0)
	Midazolam	N	n/a	0 (0)	1 (4.2)	1 (8.3)	0 (0)	0 (0)	0 (0)	0 (0)	1 (100.0)
	Chlordiazepoxide	Y	Nurse	0 (0)	0 (0)	1 (8.3)	0 (0)	1 (5.6)	0 (0)	0 (0)	0 (0)
Antiepileptics and	Carbamazepine	Y	M.D. or Specialist	11 (91.7)	14 (58.3)	10 (83.3)	3 (27.3)	5 (83.3)	2 (100.0)	4 (100.0)	0 (0)
mood stabilizers	Lithium carbonate	N	n/a	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)
	Sodium valproate	Y	M.D. or Specialist	8 (66.7)	7 (29.2)	7 (58.3)	0 (0)	2 (33.3)	2 (100.0)	2 (50.0)	1 (100.0)
	Phenytoin	Y	M.D. or Specialist	0 (0)	2 (8.3)	2 (16.7)	0 (0)	0 (0)	0 (0)	1 (25.0)	1 (100.0)
	Phenobarbital	Y	Med. Technician	6 (50.0)	15 (62.5)	9 (75.0)	5 (45.5)	4 (66.7)	2 (100.0)	4 (100.0)	0 (0)
Anticholinergics and	Promethazine	Y	M.D. or Specialist	8 (66.7)	11 (45.8)	11 (91.7)	0 (0.0)	5 (83.3)	1 (50.0)	4 (100.0)	1 (100.0)
Antihistamines	Biperiden	Y	M.D. or Specialist	2 (16.7)	6 (25.0)	6 (50.0)	0 (0.0)	1 (16.7)	2 (100.0)	2 (50.0)	1 (100.0)
	Chlorpheniramine	Y	CHW	6 (50.0)	19 (79.2)	10 (83.3)	8 (72.7)	6 (100.0)	1 (50.0)	3 (75.0)	1 (100.0)
	Diphenhydramine	Y	CHW	8 (66.7)	17 (70.8)	11 (91.7)	5 (45.5)	6 (100.0)	2 (100.0)	4 (100.0)	0 (0)
At least one of each category			7 (58.3)	11 (45.8)	10 (83.3)	0 (0)	5 (83.3)	2 (100.0)	3 (75.0)	1 (100.0)

*Availability of medication refers to the current and non-expired availability of any formulation of medication delivery, whether tablet, injection, or other.

^aM.D. or Specialist = Medical Doctor, psychiatrist, or psychiatric technician; CHW = Community Health Worker; ^bPercentages are out of total number of facilities (24) for all percentages excluding the column for district-level warehouse availability, where there were 12 district warehouses surveyed. For clarification purposes, there were 24 total facilities and 12 district warehouses included in the sample. Twelve of the overall 24 facilities had trained specialist mental health staff present (either a psychiatric technician or psychiatrist). Eleven of the 24 were rural type 2, 6 of the 24 were rural type 1, and so on across the other facility classifications. Rural type 2 facilities serve catchment areas of 7,500–20,000 population, have an average of 4 healthcare staff, and conduct outpatient, prenatal, well-child, and maternity services. Rural type 1 facilities serve catchment areas of 16,000–35,000, have an average of 13–16 healthcare staff, and conduct outpatient, prenatal, well-child, and maternity services. Urban type A facilities serve catchment areas of 40,000–100,000, have 26–36 health staff, and conduct all main primary health care services, including x-ray capabilities, oral healthcare, emergency care including first-aid and minor surgery, and inpatient beds. Rural hospitals serve catchment areas of 150,000–900,000, have 60–100 healthcare staff, and provide specialized care including an advanced laboratory, radiology capabilities, blood banks, and major surgical wards. Central hospitals serve catchment areas of over 2 million, have a large staff of healthcare workers including specialists, and provide quaternary-level healthcare with specialized care such as neurology, cardiology, neuro-surgery, oncology, psychiatry, etc.

Table 3 Stock-outs of essential mental health medicines when available at district distribution point, Sofala Province, Mozambique, July to August, 2014

Medication category	Specific medication	No stock at facilities providing specialized mental healthcare when available at district level, n (%)
	Total	12 (50)^a
Antipsychotics	Haloperidol	1 (8.3)
	Chlorpromazine	2 (16.7)
	Fluphenazine	1 (8.3)
	Trifluoperazine	0 (0)
	Thioridazine	1 (8.3)
	Risperidone	0 (0)
	Decanoate of fluphenazine	0 (0)
Antidepressants	Amitriptyline	2 (16.7)
	Imipramine	2 (16.7)
	Maprotiline	0 (0)
	Fluoxetine	0 (0)
Benzodiazepines	Diazepam	0 (0)
	Midazolam	0 (0)
	Chlordiazepoxide	0 (0)
Antiepileptics and mood stabilizers	Carbamazepine	2 (16.7)
	Lithium carbonate	0 (0)
	Sodium valproate	4 (33.3)
	Phenytoin	0 (0)
	Phenobarbital	0 (0)
Anticholinergics	Promethazine	1 (8.3)
	Biperiden	1 (8.3)
	Chlorpheniramine	0 (0)
	Diphenhydramine	0 (0)

^aPercentage out of total number of facilities (24).

Fig. 1 Map of health facilities assessed for availability of essential medicines for mental healthcare and referral networks, Sofala Province, Mozambique, July to August 2014.