Key Drivers and Challenges

There are a number of key drivers that have helped BasicNeeds sustain the impact of its programmes. First is the use of the MHD operational model that is wide in scope and inclusive of affected persons, carers and family, community, government and other key stakeholders. Secondly, offering clinical services and opportunities for work/income generation, which are facilitated through government and other local facilities and resources, helps build infrastructure and skills locally as well as generate positive attitudes for continuing service provision. Organising and building capacities of affected persons to self-advocate ensure sustained demand and pressure for effective provision of services (WISH 2013).

Equally there are many challenges. In each programme site, the everyday delivery of the model involves the execution of a planned set of interventions that translate into myriad activities carried out jointly by several agencies. This comes with innumerable problems, a spectrum of logistics, pooling resources, planning and coordination all operating under one umbrella—but made up of multi-disciplinary approaches, mindsets and conflicting priorities. This can result in compromises in order ‘to get things moving’. A first casualty here could be quality of the services provided since in many locations services are introduced for the first time with the start of the model implementation. Furthermore, often there is no policy or legislative backing that binds this collaborative work. In fact, creating that backing is a compelling part of the rationale for collaboration and scale up.

Other more specific challenges relate to keeping pace with demand and the acute needs of affected individuals and families while working through government and other existing local resources—an approach important for longterm sustainability. Persistent and skilled negotiations are required in working with psychiatric and health personnel as a majority of them are not familiar with the concept of a community-based approach. The non-availability of psychotropic medicines in the health systems to meet the increased demand generated from the community is a serious challenge in all countries of operation and often requires creative local solutions. Again, sufficient and consistent allocation of funds and other required resources from government are far from forthcoming, and successes here can often be small and piecemeal.

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