Health system governance to support integrated mental health care in South Africa: challenges and opportunities

Marais, Debbi; Petersen, Inge

doi:10.1186/s13033-015-0004-z

Cited by 101 publications

(136 citation statements)

References 34 publications

(60 reference statements)

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“…This may imply that there are other factors outside the health systems building blocks that should further be examined as a key contributor to health outcomes. These findings supported claims that although the health system in South Africa successfully transformed into an integrated, comprehensive national service system, many failures remain in the system burdened by the massive HIV epidemic and poor health outcomes (Chopra, Daviaud, Pattinson, Fonn, & Lawn, 2009;Coovadia, Jewkes, Barron, Sanders, & McIntyre, 2009;Kahn et al, 2007;Leon, Arana, & de Leon, 2013;D. L. Marais & Petersen, 2015;H.…”

Section: Discussionsupporting

confidence: 70%

Health systems strengthening in global and national contexts

Macarayan¹

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Despite advances in medical research, the burden of disease in most countries remains high.Further, health inequalities continue to grow and emerging infectious diseases are still wreaking havoc across countries. To respond to contemporary public health challenges, a new systems thinking paradigm has emerged that highlighted a holistic approach towards health systems, resulting to an emerging field -health policy and systems research (HPSR). HPSR seeks to understand and enhance how societies organize themselves in achieving collective health goals, and how different actors interact in the policy and implementation processes. However, research gaps remain particularly in applying this paradigm to strengthen health systems performance across countries. This thesis contributes to HPSR by: a. examining the underlying concepts of health systems strengthening; b. determining how health systems contribute to better health outcomes, particularly on reducing infant mortality rates and improving life expectancies at birth, and c. understanding mechanisms to use findings from health systems strengthening assessments to inform global and national-level health policymaking processes.In 2015, 40% of the Global Fund investments go toward health systems strengthening (HSS). The global health threats posed by recent viral epidemics such as Ebola and Zika even further increased calls to invest in and develop better health systems. These health systems investments were also in most cases subjected to performance-based funding, but contrary to other monitoring and evaluation methods used for other health programs, health systems monitoring and evaluation demand a new analytical frame due to its complexity, along with the very different country capacities, uneven data sources and data availability and quality, including the varied contexts that drive priority areas for health systems. As such, monitoring these initiatives remain to be highly contentious despite its importance to inform health resource allocation. In particular, studies often highlighted different conceptual and methodological challenges associated with health systems assessments worldwide.To address these issues, I first introduced a new HSS framework based on existing monitoring and evaluation frameworks collected from my field experience, systematic reviews, and thematic analyses of existing HSS documents and database. Based on the developed HSS framework, existing HSS indicators were also examined to guide further analysis. Further, I quantitatively assessed health systems performance using a new composite indicator based on previous efforts for a global health systems performance index. To do this index, I used data collected from the Demographic Health Surveys, the World Bank Indicators, and the World Health Organisation ii (WHO) Global Health Surveys. In particular, I used fixed-effects and random-effects regression analyses to determine how each health system characteristic affects health outcomes, particularly infant mortality rates and life expectan...

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Section: Discussionsupporting

confidence: 70%

Health systems strengthening in global and national contexts

Macarayan¹

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“…In South Africa, at the district level, mental health is specifically mentioned in the program for “Integration of mental health into PHC” and district guidelines have been developed [22]. In Nepal, the National Health Policy (1991) devolves mental health delivery to regional hospitals where specialized mental health services are provided.…”

Section: Resultsmentioning

confidence: 99%

Health systems context(s) for integrating mental health into primary health care in six Emerald countries: a situation analysis

Mugisha

Abdulmalik

Hanlon

et al. 2017

Int J Ment Health Syst

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BackgroundMental, neurological and substance use disorders contribute to a significant proportion of the world’s disease burden, including in low and middle income countries (LMICs). In this study, we focused on the health systems required to support integration of mental health into primary health care (PHC) in Ethiopia, India, Nepal, Nigeria, South Africa and Uganda.MethodsA checklist guided by the World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS) was developed and was used for data collection in each of the six countries participating in the Emerging mental health systems in low and middle-income countries (Emerald) research consortium. The documents reviewed were from the following domains: mental health legislation, health policies/plans and relevant country health programs. Data were analyzed using thematic content analysis.ResultsThree of the study countries (Ethiopia, Nepal, Nigeria, and Uganda) were working towards developing mental health legislation. South Africa and India were ahead of other countries, having enacted recent Mental Health Care Act in 2004 and 2016, respectively. Among all the 6 study countries, only Nepal, Nigeria and South Africa had a standalone mental health policy. However, other countries had related health policies where mental health was mentioned. The lack of fully fledged policies is likely to limit opportunities for resource mobilization for the mental health sector and efforts to integrate mental health into PHC. Most countries were found to be allocating inadequate budgets from the health budget for mental health, with South Africa (5%) and Nepal (0.17%) were the countries with the highest and lowest proportions of health budgets spent on mental health, respectively. Other vital resources that support integration such as human resources and health facilities for mental health services were found to be in adequate in all the study countries. Monitoring and evaluation systems to support the integration of mental health into PHC in all the study countries were also inadequate.ConclusionIntegration of mental health into PHC will require addressing the resource limitations that have been identified in this study. There is a need for up to date mental health legislation and policies to engender commitment in allocating resources to mental health services.Electronic supplementary materialThe online version of this article (doi:10.1186/s13033-016-0114-2) contains supplementary material, which is available to authorized users.

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“…[11] Furthermore, past studies have shown SA to be 'data rich but information poor' , [15] since data systems do not always provide nationally representative, good-quality information in a timely manner. [15] Capacity building to improve data collection, and making use of new digital technology, must be considered to improve implementation.…”

Section: Information and Researchmentioning

confidence: 99%

“…[13] Although political will is essential, it is necessary to involve all stakeholders when attempting any reform. [11] Vision, collaboration and oversight of the NHI will require co-operation and input from multiple levels, getting community members, service users, health workers and politicians together from the start, to share their views about the system and to commit to working together to solve problems. [13] As Bishai et al [13] explain, 'People who own the problem can anticipate the most likely social obstacles to its resolution, and their participation is essential. '…”

Section: In Practicementioning

confidence: 99%