PRIME calls for the inclusion of mental health in South Africa’s primary health care (PHC) re-engineering and National Health Insurance (NHI)
Public health professionals at the 2012 joint PHASA/RuDASA (Public Health Association of South Africa/Rural Doctors Association of South Africa) Conference in Bloemfontein (5-7 September 2012) were reminded of the importance of integrating mental health into the re-engineering of South Africa’s primary healthcare system.
PHASA/RuDASA delegates were told that 1 in 6 South African’s reported depression, anxiety or substance abuse disorders in the past year. There is also a high level of comorbidity between mental disorders and other public health priorities such as HIV, TB, cardiovascular disease and diabetes. A/Prof Crick Lund (PRIME CEO, UCT) and Prof Inge Petersen (PRIME-SA PI, UKZN) presented compelling data for including mental health in South Africa’s primary health care re-engineering, but also highlighted how this could happen within the existing District Health System model.
Both Professors Lund and Petersen highlighted the need for the adoption of a task sharing model to increase access to mental health care in South Africa, given the shortage of mental health specialists. This entails diversification of the roles of mental health specialists to include training and support of PHC doctors and nurses to identify and manage mental disorders. In addition, lay counsellors and community health workers could also potentially be harnessed to further this endeavour. They further emphasised the role that school health teams could perform through counselling and mental health promotion.
Presenting PRIME’s development of a District Mental Health Care plan in one pilot site of the re-engineered PHC system and NHI in South Africa, Prof Petersen outlined the process it entailed, starting with a rigorous situational analysis, followed by participatory stakeholder workshops to develop the mental health care plans for specific priority mental disorders: depression comorbid with HIV, maternal depression, psychosis and alcohol use disorders, as well as a final integrated plan. In more detail, Erica Breuer (PRIME Project Manager) presented a poster on the participatory workshops (known as ‘Theory of Change’ workshops), and how these workshops can facilitate inclusive inter-sectoral development of a mental health care plan for the PRIME districts.
Finally, Prof Petersen shared the lessons learnt from developing the district mental health plan, highlighting the importance of the participatory process to create awareness of the importance of integrating mental health into PHC, as well as ownership of the plan; and explained the next phase of PRIME, which was to implement and evaluate the plan in South Africa; whilst Prof Lund highlighted PRIME’s policy recommendations to include mental health in primary health care re-engineering and the planned National Health Insurance, and to improve the monitoring of its delivery and outcomes.