Exploring the perspectives and experiences of health workers at primary health facilities in Kenya following training

Jenkins, Rachel; Othieno, Caleb; Okeyo, Stephen; Aruwa, Julyan; Wallcraft, Jan; Jenkins, Ben

doi:10.1186/1752-4458-7-6

Cited by 19 publications

(15 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The perspectives of health workers on specific aspects of assessment, diagnosis and management of mental disorders were explored in an earlier article [13] which found differences between intervention and control groups in their attitudes, understanding and practice. However, by contrast in this article, we have not found major differences between intervention and control groups in their perspectives on health system challenges to integration of mental health into primary care, but rather a concerted view of the significant problems that impede delivery of good care, and which are discussed above.…”

Section: Discussionmentioning

confidence: 99%

“…Thus the questions were designed to elicit open ended discussion about mental health care issues rather than to specifically focus on generic health system challenges, and the information thus obtained has been reported elsewhere [12,13]. It is therefore noteworthy that the generic health system issues highlighted in this paper arose spontaneously in discussions with both the intervention group and the control group, and not in response to leading questions about specific health service problems.…”

Section: Discussionmentioning

confidence: 99%

“…This paper is the third in a series reporting the results of the focus groups, the first presented the experiences and perspectives of the clients [12]; the second presented the experiences and perspectives of the health workers and their ability to understand, assess, and treat mental disorder [13]; and this third paper explores the generic health system difficulties encountered by health workers when trying to integrate mental health care into routine primary care practice.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Health system challenges to integration of mental health delivery in primary care in Kenya- perspectives of primary care health workers

Jenkins

Othieno

Okeyo

et al. 2013

BMC Health Serv Res

Self Cite

View full text Add to dashboard Cite

BackgroundHealth system weaknesses in Africa are broadly well known, constraining progress on reducing the burden of both communicable and non-communicable disease (Afr Health Monitor, Special issue, 2011, 14-24), and the key challenges in leadership, governance, health workforce, medical products, vaccines and technologies, information, finance and service delivery have been well described (Int Arch Med, 2008, 1:27). This paper uses focus group methodology to explore health worker perspectives on the challenges posed to integration of mental health into primary care by generic health system weakness.MethodsTwo ninety minute focus groups were conducted in Nyanza province, a poor agricultural region of Kenya, with 20 health workers drawn from a randomised controlled trial to evaluate the impact of a mental health training programme for primary care, 10 from the intervention group clinics where staff had received the training programme, and 10 health workers from the control group where staff had not received the training).ResultsThese focus group discussions suggested that there are a number of generic health system weaknesses in Kenya which impact on the ability of health workers to care for clients with mental health problems and to implement new skills acquired during a mental health continuing professional development training programmes. These weaknesses include the medicine supply, health management information system, district level supervision to primary care clinics, the lack of attention to mental health in the national health sector targets, and especially its absence in district level targets, which results in the exclusion of mental health from such district level supervision as exists, and the lack of awareness in the district management team about mental health. The lack of mental health coverage included in HIV training courses experienced by the health workers was also striking, as was the intensive focus during district supervision on HIV to the detriment of other health issues.ConclusionGeneric health system weaknesses in Kenya impact on efforts for horizontal integration of mental health into routine primary care practice, and greatly frustrate health worker efforts.Improvement of medicine supplies, information systems, explicit inclusion of mental health in district level targets, management and supervision to primary care are likely to greatly improve primary care health worker effectiveness, and enable training programmes to be followed by better use in the field of newly acquired skills. A major lever for horizontal integration of mental health into the health system would be the inclusion of mental health in the national health sector reform strategy at community, primary care and district levels rather than just at the higher provincial and national levels, so that supportive supervision from the district level to primary care would become routine practice rather than very scarce activity.Trial registrationTrial registration ISRCTN 53515024

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Health system challenges to integration of mental health delivery in primary care in Kenya- perspectives of primary care health workers

Jenkins

Othieno

Okeyo

et al. 2013

BMC Health Serv Res

Self Cite

View full text Add to dashboard Cite

show abstract

“…The research was conducted as part of an overall collaborative programme of work between the Kenya Ministry of Health and the UK Institute of Psychiatry, Kings College London over the last 15 years, (including collaborations with the Kenya Medical Training College (KMTC), the Kenya Medical Research Institute (KEMRI) ,the Kenya Psychiatric Association, and Great Lakes University) comprising situation appraisal [ 9 , 10 , 11 , 12 , 13 ], studies of traditional healers [ 14 ], community health workers [ 15 ], district health workers [ 16 ], policy development [ 17 ], primary care training [ 18 , 19 ] and its evaluation [ 20 , 21 , 22 , 23 ]. This repeat epidemiological survey is important to assess the sustained mental health needs in the general adult population of Kenya, in a region of Kenya which experienced serious election violence in August 2007 [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

Probable Post Traumatic Stress Disorder in Kenya and Its Associated Risk Factors: A Cross-Sectional Household Survey

Jenkins

Othieno

Omollo

et al. 2015

IJERPH

Self Cite

View full text Add to dashboard Cite

This study aimed to assess the prevalence of probable post-traumatic stress disorder (PTSD), and its associated risk factors in a general household population in Kenya. Data were drawn from a cross-sectional household survey of mental disorders and their associated risk factors. The participants received a structured epidemiological assessment of common mental disorders, and symptoms of PTSD, accompanied by additional sections on socio-demographic data, life events, social networks, social supports, disability/activities of daily living, quality of life, use of health services, and service use. The study found that 48% had experienced a severe trauma, and an overall prevalence rate of 10.6% of probable PTSD, defined as a score of six or more on the trauma screening questionnaire (TSQ). The conditional probability of PTSD was 0.26. Risk factors include being female, single, self-employed, having experienced recent life events, having a common mental disorder (CMD)and living in an institution before age 16. The study indicates that probable PTSD is prevalent in this rural area of Kenya. The findings are relevant for the training of front line health workers, their support and supervision, for health management information systems, and for mental health promotion in state boarding schools.

show abstract

“…They promote good nutrition, sanitation, hygiene and link families to essential services [ 22 , 23 ]. Previous studies by Africa Mental Health Research and Training Foundation (AMHRTF) [ 24 , 25 ], other studies in Kenya [ 26 ] and from and other LMICs [ 27 ] have suggested that they can be trained to provide mental health awareness and screen for mental disorders. CHVs link health centers and dispensaries with the surrounding communities.…”

Section: Introductionmentioning

confidence: 99%

A step-wise community engagement and capacity building model prior to implementation of mhGAP-IG in a low- and middle-income country: a case study of Makueni County, Kenya

Mutiso

Gitonga

Musau

et al. 2018

Int J Ment Health Syst

View full text Add to dashboard Cite

BackgroundThe World Health Organization developed the Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) as guidelines for innovative utilization of available resources in low- and middle-income countries (LMICs) in order to accelerate the reduction of the mental health treatment gap. The mhGAP-IG calls for each country to contextualize the guide to their social, cultural and economic context. The objective of this paper is to describe a model for a stepwise approach for implementation of mhGAP-IG in a rural Kenyan setting using existing formal and informal community resources and health systems.MethodsWe conducted an analysis of mental health services in Makueni County, one of the 47 counties in Kenya, in order to understand the existing gaps and opportunities in a low-resource setting. We conducted stakeholder analysis and engagement through interactive dialogue in order for them to appreciate the importance of mental health to their communities. Through the process of participatory Theory of Change, the stakeholders gave their input on the process between the initiation and the end of the process for community mental health development, with the aim of achieving buy-in and collective ownership of the whole process. We adapted the mhGAP-IG to the local context and trained local human resources in skills necessary for the implementation of mhGAP-IG and for monitoring and evaluating the process using instruments with good psychometric properties that have been used in LMICs.ResultsWe were able to demonstrate the feasibility of implementing the mhGAP-IG using existing and trained community human resources using a multi-stakeholder approach. We further demonstrated the feasibility to transit seamlessly from research to policy and practice uptake using our approach.ConclusionsAn inclusive model for low resource settings is feasible and has the potential to bridge the gap between research, policy and practice. A major limitation of our study is that we did not engage a health economist from the beginning in order to determine the cost-effectiveness of our proposed model, occasioned by lack of resources to hire a suitable one.

show abstract

Exploring the perspectives and experiences of health workers at primary health facilities in Kenya following training

Cited by 19 publications

References 2 publications

Health system challenges to integration of mental health delivery in primary care in Kenya- perspectives of primary care health workers

Health system challenges to integration of mental health delivery in primary care in Kenya- perspectives of primary care health workers

Probable Post Traumatic Stress Disorder in Kenya and Its Associated Risk Factors: A Cross-Sectional Household Survey

A step-wise community engagement and capacity building model prior to implementation of mhGAP-IG in a low- and middle-income country: a case study of Makueni County, Kenya

Contact Info

Product

Resources

About