Health systems context(s) for integrating mental health into primary health care in six Emerald countries: a situation analysis
Date
2017-01-05
Journal Title
Journal ISSN
Volume Title
Publisher
International Journal of Mental Health Systems.
Abstract
Mental, 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.
Methods: A 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.
Results: Three 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.
Conclusion: Integration 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.
Description
13 p.
Keywords
Mental health, Mental health service, Primary health care, Study country, Maternal mental health
Citation
Mugisha, James...et al (2017). Health systems context(s) for integrating mental health into primary health care in six Emerald countries: a situation analysis. International Journal of Mental Health Systems. DOI 10.1186/s13033-016-0114-2