Mental Health and Psychosocial Support Advisor (M/F) – Uganda

For almost 40 years, Médecins du Monde, a campaigning medical organisation committed to international solidarity, has been caring for the most vulnerable populations at home and abroad. It has continued to highlight obstacles that exist in accessing health care and has secured sustainable improvements in health-for-all policies. Those working for this independent organisation do not solely dispense care and treatment but condemn violations of human dignity and rights and fight to improve matters for populations living in precarious situations.

MdM currently works in more than 35 countries across all continents where it focuses on 5 priority areas: emergency and crisis, sexual and reproductive health, harm reduction, migrants and displaced populations (health rights), health and environment.

Since 2015, MdM has been supporting Most At-Risk Populations (MARPI) through grants and training. Since 2009, MARPI has been running a health facility located in the Mulago national referral hospital, which provides free and friendly health services to the key populations, including Lesbian, Gay, Bisexual, Transgender, and Intersex (LGBTI) people. MdM provided MARPI staff with training in proctology, while providing basic equipment and consumables. Between 2016 and 2017, MARPI has started expanding their activities to a few regional referral hospitals. MdM wishes to support MARPI in the scaling-up of their activities through possible EU funding (response awaited in July 2019).

In July 2017, a fact-finding mission was conducted in the South Sudanese refugee settlement of Bidibidi in the district of Yumbe, West Nile sub-region, northern Uganda, where the French section of MSF has been present since 2016. The fact-finding mission has led to an intervention proposal to progressively take over all the MSF activities at Bolomoni HC III (Health Centre level as well as their outreach activities in Bidibidi refugee settlement). The handover was completed in January 2019. Then, a 3-year intervention with partnership with Human Rights Awareness and Promotion Forum (HRAPF) aims at reducing mortality and morbidity rates. It includes:

  • The running of all OPD and IPD activities at the Bolomoni HC III
  • The preparation of the progressive handover of the Bolomoni HC III to the health district of Yumbe through capacity building of MoH staff
  • A close collaboration with the local population and the empowerment of communities
  • A strong focus on mental health and psychosocial support, while developing a mental health community approach and covering some gaps identified
  • The strengthening of the GBV levels of intervention through covering some gaps identified
  • A socio-anthropological analysis of community organisation, community coping mechanisms and expression of emotion within the refugee settlements

MHPSS component

The quality of MHPSS services is one of the 4 intervention objectives. The MHPSS component has been managed by two Psychiatrist Clinical Officers (PCOs), one psychologist and two counsellors. From 15 July 2018 to 30 November 2019, 6,832 MHPSS consultations have been carried out: 52% by the PCOs, 34% by the counsellors and 14% by the psychologist. Epilepsy represents the first motive for consultation (42%), followed by depression (30%) and psychotic disorders (15%). Most epileptic cases are under Carbamazepine.

Concerns on over-prescriptions and more generally on the quality of MHPSS services have been raised on a number of occasions. The 2 PCO are medication-focused vs. psychological intervention or support alone. Out of the 1,159 patients in the excel patient file, many are on medication for chronic disorders (e.g. epilepsy) or depression. Even though the patient database is not fully reliable (e.g. not up to date and including many defaulters), approximately 700 patients are under Carbamazepine and 450 under Fluoxetine. A significant number of patients are receiving multiple medications because they have been diagnosed with multiple disorders, e.g. epilepsy and depression or epilepsy and psychotic disorder.

At both project and HQ level, there has been limited supervision and support due to lack of mental health professionals and capacity within MdM. This makes it difficult to monitor and minimize the potential unnecessary prescriptions of multiple medications.

In addition, the current stand-alone specialized services (i.e. support to chronic mental health disorders) have limited sustainability in a HC level III setting, hence the need for evaluating referral possibilities to nearby Level IV health facilities or NGOs (e.g. TPO).

The fact that one of the PCOs submitted his resignation seems a good opportunity to re-evaluate the human resources needed in the context of downsizing activities. Based on observations, the patient flow in the MHPSS does not seem very high and since the services will be available during week days only, having one PCO seems sufficient. Nevertheless, a mechanism should be developed to assess the accuracy of prescriptions and monitor the prescriptions and consumptions trends (e.g. via monthly randomised checks on prescription), especially as it relates to Carbamazepine and Fluoxetine. Both the Pharmacist and the medical doctors should play a more pro-active role in good dispensing and safe medication practices.

TASKS AND RESPONSIBILITIES:

Under the responsibility of the medical coordinator, the MHPSS Advisor provides technical expertise to national staff (MHPSS and medical doctors) and collaborates with MdM medical staff to construct a multidisciplinary approach to patient care.

More specifically, the 2-month support will include the following:

Case management:

  • Oversee the diagnosing and treating of mental health illnesses according to the 2016 national guidelines for management of common conditions
  • Support the PCO with cleaning and updating the existing data base (e.g. defaulters for more than 2 months)
  • Re-evaluate each patient condition and develop a treatment and discharge plan
  • Develop a mechanism to assess the accuracy of prescriptions and monitor the prescriptions and consumptions trends (e.g. via monthly randomised checks on prescription)
  • Ensure proper handling of patient information and confidentiality
  • Participate in team meeting and case discussion

Training:

  • Identify the training needs of the MHPSS staff and organize on-going training and workshop to improve their practice in case management

Referrals

  • Map and evaluate existing MHPSS services, including referral pathway for chronic disorders in particular
  • Develop a referral pathway for acute and chronic mental health disorders

CONDITIONS OF EMPLOYMENT:

Status : Employee Contract : Fixed-term contract

Duration : 2 mois

Starting date: ASAP
Gross monthly salary: 2816 euros
Premium equal to one month salary paid in two instalments – minimum of 6 months seniority required
Expatriation bonus (10% gross salary per month)
Transportation cost, vaccines and visas covered
Guesthouse housing
22.5 RTT (recovery days) per year
5 weeks of paid leaves per year
Health insurance (60% covered by MdM and 40% by the employee)
Insurance (repatriation…)

Médecins du Monde promotes trainings and internal mobility
Single posting

SKILLS AND EXPERIENCE NEEDED:

MD degree, specialized training in psychiatry

Essential working experience as a psychiatrist
Previous experience in a low resource setting and a humanitarian context (e.g refugee context)
Experience in training and supervision will be an asset

Desirable computer literacy (word, excel)
Capacity to work in a multidisciplinary team
Strong communication and organizational skills

Languages: fluent english is mandatory
You are committed to MdM’s values as an organisation and motivated by its non-statutory, NFP model.

TELEPHONE APPLICATIONS WILL NOT BE ACCEPTED
Médecins du Monde reserves the right to fill the vacancy before the closing date for applications.
MdM stands up for the integration of people living with disabilities and fights against discrimination.

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