Implementing the World Health Report 2001 recommendations for integrating mental health into primary health care: A situation analysis of three African countries: Ghana, South Africa and Uganda

Abstract

Integrating mental health into primary health care is widely promoted for a host of reasons, chief among which is providing a more comprehensive health care service. However, only a few countries have adequate mental health resources to undertake the integration of mental health into primary health care in a uniform manner, with wide variations among countries. This paper examines the extent to which two low-income countries (Ghana and Uganda) and one middle-income country (South Africa) are managing the integration of mental health into primary health care using the recommendations of the WHO World Health Report, 2001. Primary and secondary data sources from a situational analysis of mental health services in the three countries were analysed. The findings indicate that significant challenges remain in integrating mental health care into primary health care. Poor or uneven implementation of policy, inadequate access to essential drugs and lack of mental health specialists are some of the reasons advanced. Aside from better human resource planning for mental health, integration may be advanced by the development of packages of care which adopt a task-shifting approach suited to a country's needs.

A task shifting mental health program for an impoverished rural Indian community

“…Resources for community based mental healthcare are scarce in many low and middle income countries, yet the demand is comparable to economically advanced nations (Bhana et al, 2010;Patel, 2012). The treatment gap can be addressed using 'task shifting' programs, defined as 'rational redistribution of tasks among health workforce teams, involving the appropriate transfer of specific tasks from specialists to those with abbreviated training' (WHO, 2007;Lehmann et al, 2009).…”

“…In many countries, there has also been a progressive move from custodial institutionalized specialist care to voluntary, community-based specialist care, with increasing contributions from primary health care. If adequate financial and human resources are available, community specialist care can be delivered effectively, but such resources are generally unavailable in low and middle income countries (LMIC) (Bhana et al, 2010). Furthermore, because of the acute shortage of psychiatric care professionals, task shifting is critical in LMIC for community based mental health treatment (Lehmann et al, 2009;Collins et al, 2011).…”

See my work

“…The Carter Center's Mental Health Liberia program was an early effort in the developing world [5], with an ambitious agenda comprising three pillars: mental health policy at the national level, capacity building through clinician training, and community-based education and stigma reduction. The Carter Center has worked in Liberia over many years on programs in peace and democracy.…”

Barriers and facilitators to the integration of mental health services into primary health care: a systematic review protocol

“…Integration of mental health into PHC has been done by various countries and in different forms [21][22][23][24] including training PHC workers to identify mental health problems, assessing for mental illnesses during medical standard of care, PHC providers/community health workers and health care managers working together to address mental health related illnesses, and availing psychotropic medications to PHC centers [25]. In addition, researchers have documented information about barriers and facilitators to the integration process [26][27][28].…”