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1.Community based approach for mental health: Zimbabwe model (Down to Earth)

2.Wages of being a legislator (The Hindu)

 

1.Community based approach for mental health: Zimbabwe model (Down to Earth) 

Synoptic line: Lay workers are being trained to help Zimbabwe manage mental issues in communities. The model is being to be successful so far. (GS paper III)

Overview

  • In Africa, epidemics are associated with outbreaks like cholera and measles or HIV and tuberculosis. Mental health would possibly be the last item on anyone’s list of big health challenges.
  • But mental disorders, like depression, are a leading cause of mental and physical disability in sub-Saharan Africa.

Depression a major challenge

  • Mental disorders, like depression, are a leading cause of mental and physical disability in sub-Saharan Africa.
  • There are other reasons that depression shouldn’t be ignored. The main one is that it’s known to worsen the treatment and management of HIV, TB, hypertension and diabetes.
  • Research shows that about 30% of people living with HIV are diagnosed with depression. If left untreated there’s likely to be an increase in people developing opportunistic infections which in turn complicates HIV. This leads to longer hospital stays, more expensive treatment and sometimes death.
  • Lack of adequate mental health specialists to take care of the growing burden of psychiatric diseases in Africa complicates effective and efficient treatment. Most African countries have a worryingly low ratio of psychiatrist or clinical psychologists to the general population. The average is about one specialist to a million people.

Friendship bench model

  • It involves lay health workers in local communities as well as the use of digital platforms. Over the last four years the initiative has reduced the waiting time for patients needing treatment. The referral rate for patients has also been significantly reduced by using text messages, WhatsApp and voice calls.
  • Clients at a health facility are screened for mental illness symptoms at clinics using a locally developed tool called the Shona Symptom Questionnaire. This first step is to establish whether someone has a mental illness, and if so what they’re suffering from.
  • Patients diagnosed with a mental health issue are referred to the friendship bench where they are met by a trained community counsellor who offers them counselling. The benches are located in a discreet area of the health facility.
  • Counsellors adopt a non-judgemental and practical approach, allowing the client to discusses their challenges and talk through possible solutions.
  • The counsellors use basic cognitive therapy concepts, such as encouraging clients to identify what’s troubling them and to work on their attitudes and beliefs. If the client’s mental health issue is not solved after four sessions at the wooden bench, they are referred one level up to a district health promotion officer.
  • The friendship bench approach has gained attention locally as well as internationally. It is active in over 70 primary health care facilities across Zimbabwe. Last year 30 000 adults received mental health services.
  • The programme has grown due to immense support from local city health authorities and the ministry of health. Over 400 lay health workers have been trained to provide the therapy. In Zimbabwe, 80% of those who received therapy reported six months later that they were free of mental illness symptoms. They also said that their quality of life and income had improved because they had become more productive.

Way ahead

  • Governments should consider this model to deal with mental health issues. The community initiative model has made mental health services more accessible to the people who really need them.
  • Government should also work via three-pronged approach:
  • Speaking to the communities living near facilities to create awareness about mental health and to encourage them to own the project.
  • Collecting data to support the treatment approach.
  • Developing culturally appropriate screening tools.

Question– Friendship bench model of Zimbabwe can be adopted across India to work on Non-communicable diseases. Critically analyse the India-centric adjustments which will be needed.

 

2.Wages of being a legislator (The Hindu) 

Synoptic line: It throws light on the need of independent body to determine parliamentary salaries. (GS paper III)

Overview

  • Recently the Tamil Nadu Assembly recently voted to double the salaries of its legislators against the backdrop of a group of farmers from the State who are still on protest and demanding for the drought relief package and loan waiver for farmers from the State. There have been proposals to raise the salaries of ministers and MLAs in many state assemblies.
  • The idea of paying a salary has always been closely linked to remunerating public representatives.  However, such remuneration can go overboard sometimes. For example public representatives in developing countries in Africa and Asia are routinely paid far above per capita GDP. Even in developed countries such as Italy, a skewed political culture can result in high cost to the state when it comes to politicians.

Wages for representative in India

  • India has start which has faded now, in the first cabinet meeting entire Cabinet take a collective decision not to avail of their salaries for six months, given the enormous economic suffering in India then.
  • Other political giants such as Biswanath Das from Odisha chose to draw only ₹25 a day instead of ₹45 a day that he was entitled to, by saying that he did not need any more. The erstwhile Madras Assembly saw V.I. Muniswami Pillai move a successful motion in 1949 to impose a voluntary cut of ₹5 per diem, in recognition of the suffering of farmers.
  • The today’s scenarios have changed, now parliamentary representatives have arrogated the authority to increase their own fiscal compensation by 1,250% over the last two decades, a case of questionable moral rectitude.
  • Usually such allowances should be in proportion to the services that they have rendered to the nation, but in the past two decades, Parliament has seen less than 50% of Bills being scrutinised by parliamentary committees, defeating the very purpose of a deliberative Parliament.
  • According to the survey of parliamentary salaries conducted in 2013 by the Inter-Parliamentary Union (IPU) across 104 Parliaments across 138 parliamentary chambers, has highlighted that salaries in about 55% are linked to a structured scale, typically linked to the civil service (like in France, Japan) or ministerial salaries.
  • We can learn from UK’s example. From the history of expense scandals, the U.K. has since 2010, instituted the Independent Parliamentary Standards Authority (IPSA), which is responsible for the regulation and payment of expenses to the Members of the House of Commons.

Way ahead

  • We also need an external, independent body to determine parliamentary salaries. Self-regulation is simply not enough. Salary reviews should be conducted through an institutionalised process. It’s not that MPs should not receive or expect increments, but such increments should be determined through a transparent and accountable process.

Question– Do you think that parliamentary perks that are provided to legislators are in consonance with the work they perform?