A situation analysis of psychiatrists in South Africa’s rural primary healthcare settings

Abstract

BackgroundSouth Africa (SA) has been facing serious challenges in providing human resources for the delivery of essential mental health (MH) services. The majority of its prescribing MH specialists, psychiatrists, practise in private, urban and peri-urban areas. The findings of a situation analysis audit of psychiatrist human resources in the public rural primary healthcare (PRPHC) sector are presented in this paper.MethodThis audit was based on both primary and secondary data. The primary data were obtained from key informant interviews with the clinical heads of 160 PRPHC facilities, while the secondary data comprised a literature review.ResultsThe results indicate that psychiatrists are severely underrepresented, employed at a rate of 0.03 per 100 000 population in SA’s PRPHC settings.ConclusionsBecause of a lack of MH nurses and medical officers dedicated to MH in PRPHC facilities, recommendations are made that the current task shifting strategy be revisited to include more cadres of MH professionals with specialised psychopharmacological training, as non-medical prescribers at PRPHC level. It is advised that visiting psychiatrists and family physicians be involved in the construction of training and supervision programmes for non-medical prescribers at the primary healthcare level.

Pharmacotherapeutic interventions for bipolar disorder type II: addressing multiple symptoms and approaches with a particular emphasis on strategies in lower and middle-income countries

“…• Currently, the majority of psychiatrists in South Africa work in the private sector (approximately 60%) causing problems in the public sector [222]. The situation is even more challenging among public primary health-care centers in rural settings where currently there are only 0.03 psychiatrists per 100 000 population [223].…”

South Africa’s rural mental health human resource crisis: a situation analysis and call for innovative task-shifting

“…This situation analysis, a summary of three MH human resource audits [20][21][22], attempts to assist policy makers in filling the knowledge gap by providing a national evaluation of the MH workforce and services available to the approximately 17 million South Africans reliant on PRPHC health facilities. We discuss and explore the evidenced-based strategies of task-shifting and transdisciplinarity to support human resources for Mh, with the aim of informing policy development in rural areas.…”

“…The primary data for this situation analysis, collected between 2014 and 2016, were collected by three audits of the Mh resources and services of Mh professionals (mental health nurses [20], medical prescribers [21] and clinical psychologists [22]) in PRPHC health facilities. The aim of these audits and the subsequent synthesis of the data was to fill the secondary data analysis gaps with the goal of providing a comprehensive integrated view of the current PRPHC MH workforce situation.…”

“…The audits [20][21][22] were initiated by obtaining ethics approval (BE 416/13) from the University of KwaZulu-Natal (UKZN) Biomedical Research Ethics Committee (BREC). For each province a specific request to conduct research at their public institutions was completed, and gatekeeper permission was obtained.…”

“…After obtaining informed consent, the medical managers/ /CEOs that agreed to participate in the audits were interviewed telephonically using a structured questionnaire developed by reviewing the WHO's audit tools [27] for situation analyses, as well as the Doh's strategic planning for Mh resources [28]. The audits were constructed to obtain information about the human resources and services of a) Mental Health Nurses [20], b) clinical psychologists [22], and c) medical prescribers [21] (psychiatrists and medical officers dedicated to MHC). Where participants requested a written version of the questionnaire, an electronic version was sent to them via e-mail.…”