CLINICAL HANDBOOK OF SCHIZOPHRENIA

53. Schizophrenia in Developing Countries 553outreach were found to be balanced by reduction in costs of informal care sector visitsand family caregiving time, and the model was found to be an effective tool for improvingthe quality and quantity of care for schizophrenia in rural communities. This modelhas since been expanded and is currently implemented in several parts of the world. Outreachworkers have also assisted in creating customized manuals for care based on prevalentsociocultural beliefs, as well as availability of resources.It is also important to note the role played by nongovernmental organizations(NGOs) in developing nations. NGOs perform a variety of functions in multiple settings,ranging from performing outreach functions similar to those performed by governmentworkers to provision of medications at subsidized rates—a function that is likely to increasein significance and impact in light of recent economic developments (see the followingsection). Given the lack of available resources in several parts of the developingworld, and overburdening of resources where available, the role of NGOs is likely to takeon importance.The outreach model does have impediments and limitations. In several parts of theworld outreach remains a voluntary activity, and this leads to poor continuity of care andobservation of patients with schizophrenia. Furthermore, lack of sufficient training, education,and expertise is a problem derived from poor availability of economic and intellectualresources. Accessing updates on health care and health information is a problemcommonly faced by both outreach workers and more specialized care providers. There isalso an absence of centralized coordination of NGOs worldwide, leading frequently tosituations in which multiple NGOs work simultaneously on similar projects in the sameregion without knowledge of each other’s activities, leading to duplicity of effort. Innovativeinitiatives to facilitate better communication, such as information communicationtechnology (ICT), which aims to uses telecommunication, as well as Internet-based systemsto facilitate better long-distance coordination and distance learning/training, need tobe implemented and studied systematically.Also of note is that in most parts of the world, the relationship between practitionersof allopathic medicine and more traditional, faith-based healers tends to be one of distrustand hostility. The need for better integration of traditional and modern health careservices was recognized even in the Alma-Ata Declaration of 1978. In most parts of thedeveloping world the traditional healer:patient ratio is far superior to the doctor:patientratio. As much as 80% of the population of developing countries has been estimated toutilize traditional care. Given this, it is important for all of medicine, but especially psychiatry,to foster better communication with this care community. This may also serve asa means to improve communication between psychiatry and the population it aims toserve.Finally, it is important to note that many of the problems faced by psychiatry in tacklingthe issue of schizophrenia in the developing world are similar to those faced by medicineat large in tackling chronic illness such as diabetes mellitus or hypertension. Muchmay be gained and learned in terms of strategies and ideas by attempting to adapt modelsused in different parts of the world for dealing with chronic medical illness.CURRENT SOCIAL AND ECONOMIC ISSUESThe social structure is changing in the developing countries. Industrial globalization, culturalmix and extensive migration, changing social norms, and economy-driven social attitudeshave altered the differences between the developing and the developed world.Economy-driven research and progressive restrictions on research have now distorted the