Health System Governance for the Integration of Mental Health Services into Primary Health Care in the Sub-Saharan Africa and South Asia Region: A Systematic Review

Abstract

Governance has been highlighted as an important building block underpinning the process of mental health integration into primary healthcare. This qualitative systematic review aims to identify the governance issues faced by countries in the Sub-Saharan Africa and South Asia Region in the implementation of integrated primary mental healthcare. PRISMA guideline was used to conduct a systematic search of relevant studies from 4 online databases that were filtered according to inclusion and exclusion criteria. Using the Critical Appraisal Skills Program (CASP) Qualitative Checklist, a quality appraisal of the selected articles was performed. By drawing upon institutional theory, data was extracted based on a pre-constructed matrix. The CERQual approach synthesized evidence and rank confidence level as low, moderate or high for 5 key findings. From 567 references identified, a total of 8 studies were included. Respondents were policymakers or implementers involved in integrated primary mental healthcare from the national, state, and district level. Overall, the main governance issues identified were a lack of leadership and mental health prioritization; inadequate financing and human resource capacity; and negative mental health perceptions/attitudes. The implication of the findings is that such issues must be addressed for long-term health system performance. This can also improve policymaking for better integration of primary mental health services into the health systems of countries in the Sub-Saharan and South Asia region.

Nurturing an organizational context that supports team-based primary mental health care: A grounded theory study

“…Clinical governance facilitates the adherence of clinical principals, organizational priorities, and standards. Yet there is a paucity of research examining clinical governance as it pertains to the integration of mental health in primary care [ 45 ]. Findings from this study suggests that clinical governance is an integral organizational structure that can facilitate the uptake of mental health as a priority in interprofessional primary care teams.…”

“…Since the onset of the COVID-19 pandemic, there has been a spike in mental health care demands, which along with the health human resources crisis, highlights the immediate need to attract and retain mental health professionals in primary care [ 47 , 80 ]. A systematic review conducted by Rahim et al found that a shortage of trained health professionals—and difficulties with recruitment and retention—significantly affected the extent to which mental health was integrated into primary care [ 45 ]. Rural and urban primary care teams are facing various challenges in the human resources crisis.…”

“…As efforts to strengthen the Patient-Centred Medical Home model continue [ 6 , 7 , 11 ] gaining a better understanding of features within an organizational context that support mental health care is needed [ 40 – 43 ]. To date, less attention has been given to the organizational structures needed to support the integration of mental health in primary care than the technical and clinical aspects of mental health care [ 44 , 45 ]. This study was part of a larger qualitative study investigating the financial and non-financial incentives that influence the quality of mental health care in Family Health Teams [ 46 ]–one example of a Patient-Centred Medical Home located in Ontario, Canada.…”

Acceptability and Feasibility of Maternal Mental Health Assessment When Managing Small, Nutritionally At-Risk Infants Aged < 6 Months: A Key Informant Interview Study

“…Once again, situation-specific governance and advocacy could determine the right balance between the potential for benefit and potential for harm in different settings. Solid governance is vital for strong MMH care systems in a country or region, and our study is not unique in highlighting that policy makers and programme specialists need to be more aware of mental health issues and improved governance needs to be set up to facilitate effective and safe services [39]. There are numerous, well-documented ways forward, including task-shifting, which could help strengthen services in the short and medium terms [40].…”

A Systematic Literature Review of Empirical Evidence on Students with Mathematics Learning Disabilities

“…The researcher summarized the selected articles to answer the research question of this study. To ease the process of summarizing the articles, data extraction was conducted in Microsoft Excel and tabulated into Summary Matrix (Appendix A), which includes the name of author, year of publication, document type, research design, keywords, type of mathematics learning disabilities and educational intervention (Rahim et al, 2021). Subsequently, Table 5 were constructed to make the researchers to have a quick review on the two important data which is the type of mathematics learning disability and the educational intervention that were discussed among the articles.…”