Health system constraints in integrating mental health services into primary healthcare in rural Uganda: perspectives of primary care providers

Wakida, Edith K.; Okello, Elialilia S.; Rukundo, Godfrey Zari; Akena, Dickens; Alele, Paul E.; Talib, Zohray; Obua, Celestino

doi:10.1186/s13033-019-0272-0

Cited by 31 publications

(37 citation statements)

References 39 publications

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“…A-1-1-Insufficient resources: results of the analysis showed that lack of sufficient resources was the most frequent barrier regarding the provision of MH services. Findings indicated that scarcity of resources for MH services in LMICs can be classified into four main categories including restricted financial resources (12,15,33,35,39), shortage of adequate MH professionals (33)(34)(35)(38)(39)(40), insufficiency of medications (42), and limited healthcare facilities (13,33,42,43).…”

Section: A-1-resource and Administrative Barriersmentioning

confidence: 99%

“…A-1-3-Centralized and non-integrated services: this review showed that one of the main barriers to equitable provision of MH services in many LMICs is that these services are usually not integrated into Primary Health Care (PHC) and a major proportion of service facilities are located in the centers of provinces (10,12,13,20,31,38,40).…”

Section: A-1-resource and Administrative Barriersmentioning

confidence: 99%

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Key Barriers to the Provision and Utilization of Mental Health Services in Low-and Middle-Income Countries: A Scope Study

Sarikhani

Bastani

Rafiee

et al. 2020

Community Ment Health J

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Background: Mental Health(MH) is among the main determinants of community well-being and a remarkable portion of global burden of diseases is pertaining to mental disorders. Despite this fact, little attention has been given to the provision of adequate and appropriate MH services and improving equitable access to these services in some parts of the world especially in low-and middleincome countries(LMICs). This review was aimed to identify key barriers to the provision and utilization of MH services in LMICs. Methods: We carried out a systematic and comprehensive search on 7 important online databases for English-language literature on key barriers to the provision and utilization of MH services in LMICs from Jan 2000 to Nov 2019. Arksey and O'Malley instructor was used in 5 steps to implement scope study. The extracted materials were tabulated and synthesized using a qualitative content analysis approach. Results: Three main themes were developed regarding the barriers to the provision of MH services in LMICs including resource and administrative barriers, information and knowledge obstacles, as well as policy and legislation barriers. Also four main themes emerged about barriers to the utilization of MH services including attitudinal, structural, knowledge, and treatment-related barriers. Conclusion: Equitable access to MH services in LMICs is under influence of many barriers in both provision and utilization sides. In order to alleviate these problems, health systems in LMICs could adopt some strategies including integration of MH policy into general health policy, improvement of public MH knowledge regarding the MH and its related issues, developing anti-stigma programs, reallocation of health resources toward high-priority MH needs, developing community-based insurance, as well as integration of MH services into all levels of health-care systems. Further studies are also required for determining relative importance of the barriers and their related solutions based on the national context of each country.

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Section: A-1-resource and Administrative Barriersmentioning

confidence: 99%

Section: A-1-resource and Administrative Barriersmentioning

confidence: 99%

Key Barriers to the Provision and Utilization of Mental Health Services in Low-and Middle-Income Countries: A Scope Study

Sarikhani

Bastani

Rafiee

et al. 2020

Community Ment Health J

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“…Many countries achieved health related goals with this approach. Low and middle income countries like Zambia, Uganda and Bangladesh integrated their mental health services with community health approach and shown massive improvement in mental health and service use (18,23,24). Preventive, promotive and rehabilitative mental health service were integrated in the Ethiopian HEP in 2015 (25,26).…”

Section: Discussionmentioning

confidence: 99%

Barriers and Facilitators to Implementing Mental Health Services into the Ethiopian Health Extension Program: A Qualitative Study

Yitbarek

Birhanu

Terefe

et al. 2020

Preprint

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Background: Mental health problem is the major health problem globally and nationally in Ethiopia. To address this problem the Ministry of health of Ethiopia integrated mental health services in to the community health service. However, the preliminary reports showed the service has not been implemented yet. Therefore, the aim of this study was to explore the barriers and facilitators of mental health service implementation in to the Ethiopian health extension program.Methods: A qualitative case study was conducted in the Ethiopian primary health care system from 12 August to 25 September 2019. We have conducted about ten purposively selected key informant interviews from the Ministry of Health and community level workers (i.e. health extension workers). All interviews were recorded using voice recorder and transcribed verbatim and translated for analysis. The data then analyzed manually in relevant themes. Results: Mental health problem currently is a major health issue in Ethiopia. However, the service is not ready to respond for the existing health service need. The recently designed integration of mental health services in to health extension program was not implemented so far. The basic identified barriers were, low political commitment, shortage of resources, non-functional referral system, lack of interest from private health service organizations, attitudinal problems from both the society and service providers, the lack of reporting system for mental health problems. On the contrary, there are also facilitators for the service like well-designed primary health care system, trained health extension workers, changing political commitment and attitude of the community.Conclusion: Although mental health problems are widely spread and increasing in alarming rate, in Ethiopia, the existing health system is not capable enough to respond. This problem is complex and intertwined. A series of activities to solve the major barriers are expected especially from the health system leaders to implement follow up and evaluate mental health services at the health extension programs.

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“…The SURE Framework analysis 33 (online supplemental appendix 6) will be used to analyse data and for improving comparability and trustworthiness of the study. The SURE framework can be applied to any healthcare research 41 and the research team agreed on this framework analysis because of its domains that are linked to factors affecting health service delivery. 41 The data synthesis approach that we will use is the same approach that was used in other studies.…”

Section: Data Synthesismentioning

confidence: 99%

Barriers and facilitators of rendering HIV services by community health workers in sub-Saharan Africa: a meta-synthesis protocol

et al. 2020

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IntroductionIn sub-Saharan Africa (SSA), Human Immunodeficiency Virus (HIV) is the leading cause of morbidity and mortality. Community healthcare workers (CHWs) worldwide have been reported to be effective in strengthening the HIV programme by providing services such as adherence support, HIV education and safe sex education as part of their roles. The main aim of this meta-synthesis is to synthesise qualitative evidence on studies that have been conducted in SSA countries to understand the barriers to and facilitators of providing HIV services by CHWs across all settingsMethods and analysisThis meta-synthesis will be guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses. An initial search was conducted on 15 November 2019 for studies published between 2009 and 2019 using the population exposure outcome nomenclature. We searched the EBSCOHost- (ERIC; Health Source-Nursing/Academic Edition), Google Scholar and PubMed databases for the relevant studies. The Ritchie and Spencer framework will be used for data synthesis and the Supporting the Use of Research Evidence Framework analysis will be used to analyse data. We will conduct critical appraisal on selected studies using the Qualitative Assessment and Review Instrument to limit risk of bias.Ethics and disseminationThis review does not involve any human participants and therefore ethical approval will not be required. We will publish the protocol as well as the findings in any relevant journal and various media namely conferences; symposia, local and international health stakeholders.PROSPERO registration numberCRD42020160012.ConclusionEvidence from this review will provide synthesised evidence to the utilisation of CHWs in HIV services in SSA.

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Health system constraints in integrating mental health services into primary healthcare in rural Uganda: perspectives of primary care providers

Cited by 31 publications

References 39 publications

Key Barriers to the Provision and Utilization of Mental Health Services in Low-and Middle-Income Countries: A Scope Study

Key Barriers to the Provision and Utilization of Mental Health Services in Low-and Middle-Income Countries: A Scope Study

Barriers and Facilitators to Implementing Mental Health Services into the Ethiopian Health Extension Program: A Qualitative Study

Barriers and facilitators of rendering HIV services by community health workers in sub-Saharan Africa: a meta-synthesis protocol

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