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Scaling up integrated primary mental health in six low- and middle-income countries: obstacles, synergies and implications for systems reform

  • Inge Petersen (a1), André van Rensburg (a2), Fred Kigozi (a3), Maya Semrau (a4), Charlotte Hanlon (a5), Jibril Abdulmalik (a6), Lola Kola (a7), Abebaw Fekadu (a8), Oye Gureje (a9), Dristy Gurung (a10), Mark Jordans (a11), Ntokozo Mntambo (a12), James Mugisha (a13), Shital Muke (a14), Ruwayda Petrus (a15), Rahul Shidhaye (a16), Joshua Ssebunnya (a17), Bethlehem Tekola (a18), Nawaraj Upadhaya (a19), Vikram Patel (a20), Crick Lund (a21) and Graham Thornicroft (a22)...

Abstract

Background

There is a global drive to improve access to mental healthcare by scaling up integrated mental health into primary healthcare (PHC) systems in low- and middle-income countries (LMICs).

Aims

To investigate systems-level implications of efforts to scale-up integrated mental healthcare into PHC in districts in six LMICs.

Method

Semi-structured interviews were conducted with 121 managers and service providers. Transcribed interviews were analysed using framework analysis guided by the Consolidated Framework for Implementation Research and World Health Organization basic building blocks.

Results

Ensuring that interventions are synergistic with existing health system features and strengthening of the healthcare system building blocks to support integrated chronic care and task-sharing were identified as aiding integration efforts. The latter includes (a) strengthening governance to include technical support for integration efforts as well as multisectoral collaborations; (b) ring-fencing mental health budgets at district level; (c) a critical mass of mental health specialists to support task-sharing; (d) including key mental health indicators in the health information system; (e) psychotropic medication included on free essential drug lists and (f) enabling collaborative and community- oriented PHC-service delivery platforms and continuous quality improvement to aid service delivery challenges in implementation.

Conclusions

Scaling up integrated mental healthcare in PHC in LMICs is more complex than training general healthcare providers. Leveraging existing health system processes that are synergistic with chronic care services and strengthening healthcare system building blocks to provide a more enabling context for integration are important.

Declaration of interest

None.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.

Corresponding author

Correspondence: Inge Petersen, Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, South Africa. E-mail: peterseni@ukzn.ac.za

References

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Scaling up integrated primary mental health in six low- and middle-income countries: obstacles, synergies and implications for systems reform

  • Inge Petersen (a1), André van Rensburg (a2), Fred Kigozi (a3), Maya Semrau (a4), Charlotte Hanlon (a5), Jibril Abdulmalik (a6), Lola Kola (a7), Abebaw Fekadu (a8), Oye Gureje (a9), Dristy Gurung (a10), Mark Jordans (a11), Ntokozo Mntambo (a12), James Mugisha (a13), Shital Muke (a14), Ruwayda Petrus (a15), Rahul Shidhaye (a16), Joshua Ssebunnya (a17), Bethlehem Tekola (a18), Nawaraj Upadhaya (a19), Vikram Patel (a20), Crick Lund (a21) and Graham Thornicroft (a22)...
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