TY - JOUR
KW - Catchment Area (Health)
KW - Delivery of Health Care, Integrated/manpower
KW - Female
KW - Health Manpower/organization & administration
KW - Health Planning
KW - Humans
KW - Male
KW - Medically Underserved Area
KW - Mental Health Services/economics/manpower
KW - Models, Organizational
KW - Personnel Staffing and Scheduling/organization & administration
KW - Primary Health Care/economics/manpower
KW - Rural Health Services/economics
KW - South Africa
AU - I. Petersen
AU - C. Lund
AU - A. Bhana
AU - A. J. Flisher
AU - Mental Health and Poverty Research Programme Consortium
A1 - 
AB - BACKGROUND A recent situational analysis suggests that post-apartheid South Africa has made some gains with respect to the decentralization and integration of mental health into primary health care. However, service gaps within and between provinces remain, with rural areas particularly underserved. Aim This study aims to calculate and cost a hypothetical human resource mix required to populate a framework for district adult mental health services. This framework embraces the concept of task shifting, where dedicated low cost mental health workers at the community and clinic levels supplement integrated care. METHOD The expected number and cost of human resources was based on: (a) assumptions of service provision derived from existing services in a sub-district demonstration site and a literature review of evidence-based packages of care in low- and middle-income countries; and (b) assumptions of service needs derived from other studies. RESULTS For a nominal population of 100 000, minimal service coverage estimates of 50% for schizophrenia, bipolar affective disorder, major depressive disorder and 30% for post-traumatic stress disorder and maternal depression would require that the primary health care staffing package include one post for a mental health counsellor or equivalent and 7.2 community mental health worker posts. The cost of these personnel amounts to pound28 457 per 100 000 population. This cost can be offset by a reduction in the number of other specialist and non-specialist health personnel required to close service gaps at primary care level. CONCLUSION The adoption of the concept of task shifting can substantially reduce the expected number of health care providers otherwise needed to close mental health service gaps at primary health care level in South Africa at minimal cost and may serve as a model for other middle-income countries.
BT - Health policy and planning
C5 - Financing & Sustainability; Healthcare Disparities
CP - 1
CY - England
DO - 10.1093/heapol/czr012
IS - 1
JF - Health policy and planning
N2 - BACKGROUND A recent situational analysis suggests that post-apartheid South Africa has made some gains with respect to the decentralization and integration of mental health into primary health care. However, service gaps within and between provinces remain, with rural areas particularly underserved. Aim This study aims to calculate and cost a hypothetical human resource mix required to populate a framework for district adult mental health services. This framework embraces the concept of task shifting, where dedicated low cost mental health workers at the community and clinic levels supplement integrated care. METHOD The expected number and cost of human resources was based on: (a) assumptions of service provision derived from existing services in a sub-district demonstration site and a literature review of evidence-based packages of care in low- and middle-income countries; and (b) assumptions of service needs derived from other studies. RESULTS For a nominal population of 100 000, minimal service coverage estimates of 50% for schizophrenia, bipolar affective disorder, major depressive disorder and 30% for post-traumatic stress disorder and maternal depression would require that the primary health care staffing package include one post for a mental health counsellor or equivalent and 7.2 community mental health worker posts. The cost of these personnel amounts to pound28 457 per 100 000 population. This cost can be offset by a reduction in the number of other specialist and non-specialist health personnel required to close service gaps at primary care level. CONCLUSION The adoption of the concept of task shifting can substantially reduce the expected number of health care providers otherwise needed to close mental health service gaps at primary health care level in South Africa at minimal cost and may serve as a model for other middle-income countries.
PP - England
PY - 2012
SN - 1460-2237; 0268-1080
SP - 42
EP - 51
EP - 
T1 - A task shifting approach to primary mental health care for adults in South Africa: human resource requirements and costs for rural settings
T2 - Health policy and planning
TI - A task shifting approach to primary mental health care for adults in South Africa: human resource requirements and costs for rural settings
U1 - Financing & Sustainability; Healthcare Disparities
U2 - 21325270
U3 - 10.1093/heapol/czr012
VL - 27
VO - 1460-2237; 0268-1080
Y1 - 2012
ER -