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District mental healthcare plans for five low- and middle-income countries: commonalities, variations and evidence
Charlotte Hanlon1, Abebaw Fekadu1, Mark Jordans1
1Charlotte Hanlon, MRCPsych, PhD, College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia and Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Abebaw Fekadu, MD, PhD, MRCPsych, College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia; Mark Jordans, PhD, HealthNet TPO, Research and Development Department, Amsterdam, The Netherlands and Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Fred Kigozi, MBChB, MMed, Butabika National Referral and Teaching Mental Hospital, Makerere University, Kampala, Uganda; Inge Petersen, PhD, School of Applied Human Sciences, Howard College, University of KwaZulu-Natal, Durban, South Africa; Rahul Shidhaye, MD, MHS, Public Health Foundation of India, New Delhi, India and CAPHRI School for Public Health and Primary Care, Maastricht University, The Netherlands; Simone Honikman, MBChB, MPhil, Perinatal Mental Health Project, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; Crick Lund, BA, BSocSci, MA, MSocSci, PhD, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa, and Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Martin Prince, MD, MSc, MRCPsych, Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Shoba Raja, BA, MA, BasicNeeds, Banasawadi, Bangalore, India; Graham Thornicroft, FRCPsych, PhD, Health Services and
Background:
Little is known about the service and system interventions required for successful integration of mental healthcare into primary care across diverse low- and middle-income countries (LMIC).
Aims:
To examine the commonalities, variations and evidence gaps in district-level mental healthcare plans (MHCPs) developed in Ethiopia, India, Nepal, Uganda and South Africa for the PRogramme for Improving Mental health carE (PRIME).
Method:
A comparative analysis of MHCP components and human resource requirements.
Results:
A core set of MHCP goals was seen across all countries. The MHCPs components to achieve those goals varied, with most similarity in countries within the same resource bracket (low income v. middle income). Human resources for advanced psychosocial interventions were only available in the existing health service in the best-resourced PRIME country.
Conclusions:
Application of a standardised methodological approach to MHCP across five LMIC allowed identification of core and site-specific interventions needed for implementation.
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