The challenges
Gaps in evidence and a lack of disaggregated data risks leading to ill-informed service
delivery and gaps in health policies and provisioning, entrenching social care disparities.
Particular challenges existed in two specific areas where Ghana Somubi Dwumadie’s
civil society partners identified an evidence gap: the mental health needs of women
accused of witchcraft; and the mental health needs of the Deaf community
Accused women
In Northern Ghana, older, poor and widowed women have for decades been accused
of witchcraft and blamed for incidents within a community. Accused women have been
captured, beaten and even murdered by their communities. They are banished to
isolated camps under the authority of traditional leaders who deem these camps as a
‘haven’ despite the poor conditions in which the women live. In the absence of evidence
on the quality of the camps, the government indicated that improving quality of life in
camps could ‘incentivise’ women to live there.
Deaf persons
An examination of Ghana’s mental health legislation and practices revealed that Deaf
persons have been underrepresented in national mental health policies, regulations
and research because it is assumed that wider public health services will benefit Deaf
people. The inadequate attention given to deafness in national mental health policies,
law and research has far-reaching negative consequences for Deaf people who often
have limited understanding of mental health conditions. Deaf people struggle to find
healthcare professionals they can communicate with; are not informed about health
services they can access; and have their needs and symptoms misunderstood. In
addition, communication is hampered because Sign Language for different mental
health conditions is not widely known or reinforces stigma.
The solution
Conducting research and producing strong and relevant evidence can lead to
the creation of more useful insight and recommendations for policy and practice.
Dissemination of the evidence and advocacy around recommendations has
the potential to address health and social care disparities and influence policy
change.
Evidence was needed to demonstrate the poor quality of life experienced in the camps
of women accused of witchcraft, so that the case for improvements could be made
and the camps eventually eradicated. Separately, evidence was needed to illustrate
the specific needs of the Deaf community.
The evidence generated subsequently identified the need for advocacy work as well
as the need to build skills and knowledge with health services to support the specific
needs of these communities.
What did the programme do?
Our grant funding was allocated to organisations with long-standing experience
of working with the affected communities using a rights-based approach. Since
2005, Songtaba has been empowering and supporting women, children and other
vulnerable groups in the Northern Region of Ghana, including women accused of
witchcraft. And since 1968, Ghana National Association of the Deaf (GNAD) has been
working to support Ghana’s estimated 110,000 Deaf people.
Using evidence to demonstrate the need for interventions
Songtaba was funded to undertake research into the quality of life and the levels
of depression amongst the women in the camps. The study found that 97% of the
women have low or extremely low quality of life, and more than half have depression.
This provided clear evidence that the wellbeing of women needed to be urgently
addressed.
GNAD undertook research on the unmet mental health needs of Deaf people, using
Deaf people as principal investigator and research assistants. They identified low
mental health awareness in the Deaf community, resulting in people not seeking the
help they needed.
The research done by both grantees provided evidence on the need for policy
influencing and advocacy work to address stigma and discrimination on the unmet
mental health needs of women accused of witchcraft and of Deaf people.
Both grantees also recognised the importance of disseminating findings to key
stakeholders, including policy makers at the regional and national level; publishing
findings and attending conferences; and producing policy briefs and factsheets to
support dissemination.
Advocacy and social behaviour change
In the case of accused women, advocacy and social and behaviour change
campaigns were needed at individual, community and national level. As many women
are scared to speak out, Songtaba worked with them to build their skills and selfconfidence to advocate for themselves and others in the group in terms of both access
to healthcare and advocating for their wider needs.
Engagement with communities was essential to develop respect for gender,
human rights and disability to change attitudes and behaviours and deter future
accusations. This engagement would also support reintegration into communities,
so returning women would feel and be safe in their communities. Songtaba worked
with communities to prevent allegations and to reintegrate accused women into their
communities of choice.
Advocacy was also needed to support Ghana’s parliament to pass a Bill which
would criminalise the practice of accusing people of being witches. The British High
Commissioner hosted a roundtable with the Minister for Gender, Children, and Social
Protection to highlight the need for commitment to end witchcraft accusations in
Ghana and to resettle victims into communities.
Organisations including Songtaba and Ghana Somubi Dwumadie lobbied for the
introduction of national protective legislation. We drafted a memo to the Speaker of
Parliament in support of the Criminal Offences (Amendment) Bill, 2022 (commonly
referred to as the Anti-Witchcraft Bill) and shared the memo as a template for partners
to use in their advocacy.
GNAD’s research identified a need for increasing awareness of mental health
amongst the Deaf community themselves, as well as family and healthcare workers.
They provided training for Deaf leaders from disability groups to build their skills on
mental health and raise awareness of mental health issues among Deaf people.
GNAD’s evidence also identified the need for less discriminatory Sign Language and
created new signs for mental health conditions, such as anxiety and depression, as
well as training healthcare providers on Sign Language use.
Improving access to health services
Improving conditions in camps is critical and Songtaba used its research to secure
support from social welfare and the health service to undertake medical screenings
GNAD’s research was used to engage with Pantang and Accra Psychiatric Hospitals
to enhance access to mental healthcare for Deaf people
The evidence from GNAD enabled them to advocate with the national government
for the inclusion of Deaf-friendly services, more qualified Sign Language interpreters
and health workers with knowledge in Basic Sign Language in public mental health
services
How we made a difference
Improved access to health services
Using the research, Songtaba secured support from social welfare and the health
service to undertake medical screenings and sign up women in the camps to the
National Health Insurance Scheme. Those identified with serious health needs were
referred to district hospitals for more attention. 80% of women respondents isolated in
the camps have now reported improved access to healthcare as a result of registering
onto health insurance. One woman who was identified with and treated for bipolar
disorder has subsequently reintegrated into her family.
41 psychiatric nurses have completed intensive sign language training provided by
GNAD, resulting in a positive change in staff behaviour towards Deaf people, and
more Deaf people accessing mental health services and reporting a high satisfaction
with services received.
Advocacy and social and behaviour change
Songtaba reported a reduction in the numbers of allegations after their activities.
The individual impact of empowerment and advocacy training is illustrated through
Ama Tilichir, who, 12 years ago, was accused of being a witch after her nephew
died in a car crash. She was forced to flee her community. The 77-year-old is now
President of Tigbubtaba, the Alleged Witches Network in the Northern Region, where
she supports other women facing allegations of witchcraft, and discusses their
concerns and welfare needs.
At the national level, the research was used to enable a conducive policy environment
and generate institutional support for Ghana’s Parliament to pass a Bill to protect
people accused of witchcraft, making it a crime to abuse people or send them away
from communities.
A delegation of women who have been in camps met with the Ministry of Gender,
Children and Social Protection, and talked to the District Assemblies, providing
government and health officials with an opportunity to hear from the women
themselves.
An independent evaluation of GNAD’s work found that the advocacy efforts based
on this research have led to a significant increase in the recognition of Deaf people’s
needs within disability groups
Key lessons learned
- Even when the need for intervention may seem obvious, evidence is critical
to drive understanding of the situation, prioritise funding, and allocate specific
services and support. - Solutions cannot be addressed with technical or legislative solutions alone.
Working with communities, media and government to develop understanding
and drive attitude and behaviour change is key to prevent harmful practices in
the first place
Resources produced on this topic
- Depression and Quality of Life of People Accused of Witchcraft and Living in
Alleged Witches’ Camps in Northern Ghana, February 2023 - Policy Brief: Mental Health and Quality of Life Situation of Women Accused of
Witchcraft in Northern and North East Regions in Ghana, January 2023 - Policy Brief: Addressing mental health needs of Deaf people: The need for
inclusive mental health policy, June 2023 - Mental health interventions and deaf people in Ghana: assessing the barriers
to mental healthcare to deaf people in Ghana, Journal of Biosciences and
Medicines, January 2024 - Examining the effects of mental health stigma on help seeking behaviour
among deaf people in Ghana, Open Journal of Psychiatry, July 2023 - Film on the work of Songtaba addressing the needs of women accused of
witchcraft, July 2024 - Film on the work of GNAD on their work addressing the mental health needs
of Deaf people, July 2024
