16 The results of those cases for whom self-report scores were kept show a strong effect for improvement: 85%(33 cases) were rated as improved as opposed to 15% (6 cases) that remained the same or got worse. Referral agencies used by Trainees: In addition to managing cases, the trainees also made referrals when they felt the need. As can be seen for the figure below, the major point of referral was to doctors, which is unsurprising. It was also gratifying to see that the trainees made use of most local resources, and did not show dependency upon AMANI as the major source of support. This can be interpreted as weak evidence for local sustainability. Referral routes for trainees. 40 35 30 25 20 15 10 Other AMANI Physio Soc.Welfare Doctor 0 ZRP 5 ` Conclusions: From the scientific reports available, it has been shown that, although cases of psychological disorders are common, and possibly on the increase, identification, assessment, and management have been poor. Detection of disorders due to organised violence and torture (OVT) have also not been well-understood and this led to the training programme mounted by AMANI Trust The training programme generally tried to boost the District capacity to manage both cases of psychological disorder and OVT. The overall framework was aimed to support a primary health care model, whilst the major aim was to create the capacity for a selfsustaining system in which both the District and the Province could continue training on its own. This proved difficult in the current climate of cost recovery and diminished expenditure on health. This forced a move from a District “roll-over model” to a training of trainers approach. This new approach will be completed in 2000, and the final phase is now underway. Training nurses in the assessment and management of psychological disorders: Report of AMANI Trust’s programme in Mashonaland Central Province, Zimbabwe.