TY - JOUR
KW - Community Health Workers
KW - Community Mental Health Services/economics/organization & administration
KW - Cross-Sectional Studies
KW - Developing Countries
KW - Ethiopia
KW - Health Services Accessibility
KW - HIV Infections/therapy
KW - Humans
KW - India
KW - Nepal
KW - Poverty
KW - Primary Health Care/organization & administration
KW - Program Evaluation
KW - Public Health
KW - South Africa
KW - Tuberculosis/therapy
KW - Uganda
AU - C. Hanlon
AU - N. P. Luitel
AU - T. Kathree
AU - V. Murhar
AU - S. Shrivasta
AU - G. Medhin
AU - J. Ssebunnya
AU - A. Fekadu
AU - R. Shidhaye
AU - I. Petersen
AU - M. Jordans
AU - F. Kigozi
AU - G. Thornicroft
AU - V. Patel
AU - M. Tomlinson
AU - C. Lund
AU - E. Breuer
AU - M. De Silva
AU - M. Prince
A1 - 
AB - BACKGROUND: Little is known about how to tailor implementation of mental health services in low- and middle-income countries (LMICs) to the diverse settings encountered within and between countries. In this paper we compare the baseline context, challenges and opportunities in districts in five LMICs (Ethiopia, India, Nepal, South Africa and Uganda) participating in the PRogramme for Improving Mental health carE (PRIME). The purpose was to inform development and implementation of a comprehensive district plan to integrate mental health into primary care. METHODS: A situation analysis tool was developed for the study, drawing on existing tools and expert consensus. Cross-sectional information obtained was largely in the public domain in all five districts. RESULTS: The PRIME study districts face substantial contextual and health system challenges many of which are common across sites. Reliable information on existing treatment coverage for mental disorders was unavailable. Particularly in the low-income countries, many health service organisational requirements for mental health care were absent, including specialist mental health professionals to support the service and reliable supplies of medication. Across all sites, community mental health literacy was low and there were no models of multi-sectoral working or collaborations with traditional or religious healers. Nonetheless health system opportunities were apparent. In each district there was potential to apply existing models of care for tuberculosis and HIV or non-communicable disorders, which have established mechanisms for detection of drop-out from care, outreach and adherence support. The extensive networks of community-based health workers and volunteers in most districts provide further opportunities to expand mental health care. CONCLUSIONS: The low level of baseline health system preparedness across sites underlines that interventions at the levels of health care organisation, health facility and community will all be essential for sustainable delivery of quality mental health care integrated into primary care.
BT - PloS one
C5 - General Literature
CP - 2
CY - United States
DO - 10.1371/journal.pone.0088437
IS - 2
JF - PloS one
N2 - BACKGROUND: Little is known about how to tailor implementation of mental health services in low- and middle-income countries (LMICs) to the diverse settings encountered within and between countries. In this paper we compare the baseline context, challenges and opportunities in districts in five LMICs (Ethiopia, India, Nepal, South Africa and Uganda) participating in the PRogramme for Improving Mental health carE (PRIME). The purpose was to inform development and implementation of a comprehensive district plan to integrate mental health into primary care. METHODS: A situation analysis tool was developed for the study, drawing on existing tools and expert consensus. Cross-sectional information obtained was largely in the public domain in all five districts. RESULTS: The PRIME study districts face substantial contextual and health system challenges many of which are common across sites. Reliable information on existing treatment coverage for mental disorders was unavailable. Particularly in the low-income countries, many health service organisational requirements for mental health care were absent, including specialist mental health professionals to support the service and reliable supplies of medication. Across all sites, community mental health literacy was low and there were no models of multi-sectoral working or collaborations with traditional or religious healers. Nonetheless health system opportunities were apparent. In each district there was potential to apply existing models of care for tuberculosis and HIV or non-communicable disorders, which have established mechanisms for detection of drop-out from care, outreach and adherence support. The extensive networks of community-based health workers and volunteers in most districts provide further opportunities to expand mental health care. CONCLUSIONS: The low level of baseline health system preparedness across sites underlines that interventions at the levels of health care organisation, health facility and community will all be essential for sustainable delivery of quality mental health care integrated into primary care.
PP - United States
PY - 2014
SN - 1932-6203; 1932-6203
T1 - Challenges and opportunities for implementing integrated mental health care: a district level situation analysis from five low- and middle-income countries
T2 - PloS one
TI - Challenges and opportunities for implementing integrated mental health care: a district level situation analysis from five low- and middle-income countries
U1 - General Literature
U2 - 24558389
U3 - 10.1371/journal.pone.0088437
VL - 9
VO - 1932-6203; 1932-6203
Y1 - 2014
ER -