Mixed-methods evaluation of mental healthcare integration into tuberculosis and maternal-child healthcare services of four South African districts

Abstract

BackgroundThe South African National Mental Health Policy Framework and Strategic Plan 2013–2020 was adopted to address the country’s substantial burden and inadequate treatment of mental illness. It outlines measures toward the goal of full integration of mental health services into primary care by 2020. To evaluate progress and challenges in implementation, we conducted a mixed-methods assessment of mental health service provision in tuberculosis and maternal-child healthcare services of four districts in South Africa.MethodsForty clinics (ten per district) were purposively selected to represent both urban and rural locations. District-level program managers (DPMs) for mental health, tuberculosis, and maternal-child healthcare were qualitatively interviewed about district policy and procedures for management of mental illness and challenges in integrating mental health services into primary care. Clinic nurses and mental health practitioners (MHPs) completed a quantitative questionnaire to assess their engagement with stepped care for patients with mental illness. Qualitative and quantitative data were collected concurrently and compared to triangulate progress in implementation of integrated services.ResultsA total of 59 nurses and 17 MHPs completed questionnaires, and nine DPMs were interviewed (total n = 85). DPMs indicated that nurses should screen for mental illness at every patient visit, although only 43 (73%) nurses reported conducting universal screening and 26 (44%) reported using a specific screening tool. For patients who screen positive for mental illness, DPMs described a stepped-care approach in which MHPs diagnose patients and then treat or refer them to specialized care. However, only 7 (41%) MHPs indicated that they diagnose mental illness and 14 (82%) offer any treatment for mental illness. Addressing challenges to current integration efforts, DPMs highlighted 1) insufficient funding and material resources, 2) poor coordination at the district administrative level, and 3) low mental health awareness in district administration and the general population.ConclusionsThough some progress has been made toward integration of mental health services into primary care settings, there is a substantial lack of training and clarity of roles for nurses and MHPs. To enhance implementation, increased efforts must be directed toward improving district-level administrative coordination, mental health awareness, and financial and material resources.

Nurses' and midwives' awareness of intimate partner violence‐related mental healthcare and associated factors in Tanzania

“…In addition, in this study, HCs were less likely than hospitals to have screening tools and a focal/resource person for mental health. This finding is consistent with a previous study in South Africa, where less than half of nurses reported using a specific screening tool for mental disorders (Lovero et al., 2019). These findings imply that emphasis should be placed not only on screening women for IPV‐related mental disorders (Holden et al., 2012), but also on ensuring that the appropriate screening tools are available in health facilities.…”

“…A previous study in Malawi reported that healthcare providers felt inadequately prepared to handle the psychosocial and mental health consequences of IPV (Chepuka et al., 2014). In view of our findings and those of previous research, increased efforts should be directed towards improving the IPV‐related mental healthcare provided by nurses and midwives in health facilities by addressing both individual and facility‐related factors (Lovero et al., 2019).…”

Integrating tuberculosis and noncommunicable diseases care in low- and middle-income countries (LMICs): A systematic review

“…The need for such a platform is further emphasised in the cross-sectional study by Araia and colleagues in Eritrea, which points out the shared risk factors such as BMI for the development of TB and DM whereby only 54.5% of the patients in the study were aware that they have both conditions [ 56 ]. Furthermore, free screening using mobile units was deemed effective to reach participants in rural areas where screening for diabetes was performed using handheld glucometers and screening for hypertension performed with electronic sphygmomanometers [ 57 ]. Provision of trained staff for the integrated screening and referral processes and coordination between the involved healthcare facilities was recognised as a facilitator for the success of this model [ 57 , 58 ].…”

Leveraging HIV Care Infrastructures for Integrated Chronic Disease and Pandemic Management in Sub-Saharan Africa

“…Task-shifting, or the use of non-physician cadres (nurses, community health workers) to provide care, has been one approach recommended in LMICs to address clinical workforce shortages. Several recent studies have assessed the feasibility, pilot effectiveness, and cost-effectiveness of task-shifting in delivering integrated primary care in SSA, both for PLHIV [56,[67][68][69][70][71][72][73][74] and HIV-negative patients [75][76][77][78][79][80]. This growing literature highlights a few key recommendations for implementation.…”