Prior to the Alma-Alta declaration, an Expert Committee on Mental Health was convened by the World Health Organization (WHO) in 1974.[ 3] This committee recognized the scarcity of trained mental health professionals and the need for a tiered approach to treatment that is grounded in communities served by nonspecialized health workers and primary care nurses and physicians linked to specialist resources. Epidemiological research and programmatic development over the last 25 years have been guided by these findings.
Delivery of health care in developing countries varies with needs and resources, as well as with the availability of various types of medical professionals. However basic the staff and facilities, primary care represents the point of entry for the vast majority of people seeking medical care—and for many people, their sole access to medicine. Thus, primary care is the logical setting in which brain disorders can begin to be addressed. Including care for brain disorders in the primary care agenda represents the surest way to promote their prevention, early detection, and timely treatment.[4,6,7]
The incorporation of neurological and psychiatric care into the public health system is widely recognized as a way to improve coverage by providing a low-cost, accessible service that involves families and the community in patient care.[8,9,10 and 11] The integration of neurological and psychiatric services with primary health care is already a significant policy objective in developed and developing areas of the world.[12,13,14,15,16,17 and 18] Examples of this integration are found in low-income countries; one such example is described in Box 3-1. Other programs organized at both the national and local levels have been developed in India, Colombia, China, Iran, Malaysia, Tanzania, and Brazil.[19,20,21,22,23 and 24]
Additional features of primary health care systems contribute to their potential for reducing the impact of neurological, psychiatric, and developmental disorders. As noted in Chapter 2, very few medical specialists practice in developing countries (see Figure 2-2). In China, for example, there are approximately 10 psychiatrists for every million people, 5 psychiatrists are available for the 30 million people of Tanzania,[ 25] and in Ethiopia, about 10 neurologists serve a nation of more than 53 million. Most of these specialists practice in urban settings, further reducing their availability to rural populations. Thus, most people in need of treatment for brain disorders must receive it at community health centers.
As the gateway to health services in most middle- and low- income settings, primary care centers are well placed to recognize brain disorders and facilitate diagnosis and treatment of coexisting diseases. Research indicates that people with severe mental illness suffer higher-than-average rates of mortality from cardiovascular and respiratory diseases, cancer, and—in low-income countries—infectious diseases.[26,27,28,29,30 and 31] Additionally, findings show that patients