Health care models guiding mental health policy in Kenya 1965 - 1997

This study was carried out in 1997 to examine the evolution of mental health policy in Kenya between 1965 and 1997 in the context of changing international concepts of health and development. Qualitative content analysis of policy documents was combined with interviews of key policy makers.The study showed that during the period 1965-1997 the generic health policy in Kenya changed from one based on the Medical Model in the 1960s and 1970s to one based on the Primary Health Care Model in the late 1970s and the 1980s and finally to one based on the Market Model of health care in the 1990s. The mental health policy, on the other hand, evolved from one based on the Medical Model in the 1960s to one based on the Primary Health Care Model in the 1990s, but did not embrace the Market Model of health care. This resulted in a situation in the 1990s where the mental health policy was rooted in a different conceptual model from that of the generic health policy under which it was supposed to be implemented. This "Model Muddlement" may have impeded the implementation of the mental health policy in Kenya.Integration of the national mental health policy with the general health policy and other sector policies would be appropriate and is now underway.Mental health policy is needed to set the vision and overall strategy to address the mental health needs within a country, to set a framework for the provision of services and interventions and to give direction and benchmarks against which progress may be measured [1-3].However, the context for mental health policy is complex and includes the general health policies, development polices, and perceived political demands and constraints. Studies in other developing countries such as India [4,5], Tanzania [6,7] and Nigeria [8,9] had demonstrated that the mental health policies in these countries had undergone changes over the decades, with the focus shifting from one policy to the next.This paper reports a project carried out in 1997 to