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
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.
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
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.
Hanlon, C.; Luitel, N.P.; Kathree, T.; Murhar, V.; Shrivasta, S.; Medhin, G.; Ssebunnya, J.; Fekadu, A.; Shidhaye, R.; Petersen, I.; Jordans, M.; Kigozi, F.; Thornicroft, G.; Patel, V.; Tomlinson, M.; Lund, C.; Breuer, E.; de Silva, M.; Prince, M. Challenges and Opportunities for Implementing Integrated Mental Health Care: A District Level Situation Analysis from Five Low- and Middle-Income Countries. PLoS ONE (2014) 9 (2) e88437. [DOI: 10.1371/journal.pone.0088437]
Challenges and Opportunities for Implementing Integrated Mental Health Care: A District Level Situation Analysis from Five Low- and Middle-Income Countries