I want to develop this discourse by introducing myself as a product of a very rich medical pedigree, especially in the area of community medicine.
I am a medical graduate of the College of Medicine of University of Ilorin which, at the time, was a relatively young but boisterous institution, with strong emphasis and customisation of her curriculum in the direction of community-based services.
We were not only trained for the curative aspects of medicine, we had adequate exposure to community medical services from the first year in the medical school. We went to nearby rural settlements in Kwara State in groups and spent a minimum of four to six weeks interacting with the rural population and proffering modest interventions for their health problems after a thorough community diagnosis.
I can recollect how we entered the community through the traditional ruler who gave a history of the community and its peculiar health problems in the presence of other chiefs and religious leaders, based on his own understanding. We were made to follow the World Health Organisation’s theme for that particular year, identified a local problem in consonance to that theme and proposed an intervention with a well written report which was presented between the groups.
Each time I interact with medical graduates of that great school, I feel a peculiar passion for community service, whether in public or private practice; specialist or general practice, foreign or local practice. It is a form of indoctrination that has wired us in the direction of community service which, above all, is the goal of a well rounded professional education.
Community diagnosis was a core component of the Community-Based Education and Services curriculum, particularly designed to provide training component that exposes students to interventional methods that depend on working directly with populations and on understanding in the context of their communities.
Community diagnosis, in this context, is used to determine and describe the health status of the population reflected in the health indicators in a community over a specific time period. As a result of carrying out the community diagnosis, students acquire knowledge, skills and attitude necessary for working in different rural and peri-urban communities, learn from real-life situations, apply their epidemiology, biostatics and other health sciences’ knowledge, gain necessary skills for their future work as physicians, as well as learning more comprehensive approach to the main health problems encountered in that area.
Community diagnosis, therefore, is the foundation for improving and promoting the health of community members. The role of community assessment is to identify factors that affect the health of a population and determine the availability of resources within the community to adequately address these factors. The process is a means of examining aggregate and social statistics, in addition to the knowledge of the local situation, in order to determine the health needs of the community.
The ultimate goal, therefore, of the process of community diagnosis is to analyse the health status of the community, evaluate the health resources, services and system of care within the community, assess attitudes toward community health services and issues, identify priorities, establish goals, and determine courses of action to improve the health status of the community as a whole.
For basic health problems, the community is diagnosed, using health indicators mainly, which are variables used for the assessment of community health. They are essentially mortality indicators, morbidity indicators, disability rates, utilisation rates, indicators of social and mental health, environmental indicators (usually physical), health policy indicators, socio-economic indicators and many others.
These are very relevant, even in planning a mental health intervention, but definitely not enough. Mental well-being is not only a clinical product but a socio-cultural commodity. While we cannot blame the international agencies and donors for their insistence on these indicators, our researchers and policy craftsmen may need to adequately supplement these indicators with a robust socio-cultural definition and analysis, especially in planning an effective mental health intervention programme.
Rather than depending too much on our own orthodox definition of indicators of mental health, there is a need to interact and interrogate the socio-cultural characteristics of the people in order to understand the software that produces the indicators, which may be invariably useful in driving effective programmes of intervention.
There are prevailing cultural practices that may serve as embellishments of mental illness, just like some of the practices may be responsible for the development and maintenance of mental distress.
The list of psychoactive drugs in the kitty of the NDLEA does not exhaustively cover all the psychoactive substances that our local people take with grave mental health consequences. In conclusion, community participation, although fashionable in international health circles, the absence of a robust, local, complimentary socio-cultural perspective may render those interventions as mere rhetoric.