Employing a public private partnership (PPP) to treat mental anguish in the massively traumatized population in northern Uganda

Background: Northern Uganda endured two decades of war. Thirty thousand children were kidnapped by the Lord's Resistance Army and 1.7 million people interned in internally displaced persons camps. Up to 70% of the population developed traumatic depression and PTSD. The mental health care (MHC) system, overwhelmed by disease burden, collapsed. PPPs have been used to establish health care services in resource-constrained societies around the world. In 2006, Peter C. Alderman Foundation and the Ugandan government formed a PPP to deliver sustainable MHC and for the massively traumatized population in the North. Aims: To provide sustainable, universal, effective MHC to northern Uganda and to bring MHC to scale by enabling the government to integrate it into its package of primary health care. Methods: The PPP established psycho-trauma clinics in five districts in northern Uganda and training programs for indigenous mental health professionals. Quantitative/qualitative methodology was employed to determine demographics, clinic outputs and patient outcomes. Outcomes: The PPP has treated 2868 patients and trained 1000 indigenous mental health professionals at five annual African Psycho-trauma Workshops. It has locally validated the Self-reported Questionnaire-20 and the Harvard Trauma Questionnaire to measure depression and PTSD respectively. It has developed a contextually-sensitive function tool for trauma victims with mental disorders. Serial measurements with these at baseline and at three-month intervals in patients following psychotherapy and/or pharmacotherapy demonstrated 80% reduction in symptom loads of depression and PTSD with a concomitant improvement in function. Conclusion: A committed PPP can deliver effective, culturally sensitive, sustainable MHC in northern Uganda.