International Handbook on Mental Health Policy

solution to the problems he mentions. But are these real problems? It is unrealistic to think of mental health service provision in terms of the total coverage described, while the fact that mental health workers devote some part of their time to general work could be converted into an advantage if they can include a training and supportive function and demonstrate that all health problems include psychological and social components. The policy issue is that of establishing the range of duties to be expected of various workers and the means of ensuring that this policy is carried out by suitable supervision and other means of monitoring.

A final question: Has the input from the major international organizations been of value? The answer must be equivocal in the sense that many of the proposals made by visiting consultants appear to have been based more on current theory than on practical experience of implementation and evaluation. The World Health Organization might claim that it does try out its ideas practically, but an examination of the resources given to these experiments almost always demonstrates a quite unrealistic level of funding and personnel; how often have the experiments been followed up, some five or ten years later, when the research teams have left long before? WHO must be prepared to face this challenge. In Zambia's case we have had to implement our programs with minimal resources, looking occasionally with envy at neighboring countries where several million dollars have been made available from donor countries, and we have been pleased to see many of our ideas adopted elsewhere. This is not to say that we will not be happy to collaborate in further experiments, should some kind donor wish to join us, but we will insist upon our own ideas being given due consideration.

Grateful acknowledgment is made for the help given by S. K. Chileshe, J. Mukupo, and P. Chita, members of the staff of the National Mental Health Resource Center, Lusaka.

Banda W. W. ( 1988). Constraints affecting the administration of mental health services in Zambia. Unpublished M.P.A. thesis, University of Zambia.

Federal Ministry of Health. ( 1960). Federal Ministry of Health Annual Report. Lusaka: Author.

Guiness E. A. ( 1992). "Patterns of mental illness in the early stages of urbanization". British Journal of Psychiatry, 160(suppl. 16), 4-72.

Haworth A. ( 1980). "Geography, demography, and mental health services". In A. Kiev, W. J. Muya, & N. Sartorius (Eds.), The future of mental health services (pp. 51- 65). Amsterdam: Excerpta Medica.

Nunn C. ( 1969). Comments. Lusaka: Ministry of Health.

Republic of Zambia. ( 1992). National health policies and strategies. Lusaka: Government of the Republic of Zambia, Planning Unit.

-474-