Dispositions of Health Facility In-charges Towards Decentralization and Integration of Mental Health Services into Primary Health Care: A Case of Lusaka District.

Abstract

Introduction: Worldwide, the burden of mental illnesses poses serious public health challenges, with approximately 7.4% of the global burden attributed to mental disorders. However, many primary healthcare systems in countries around the world focus mainly on physical care and neglect to provide mental health care to their populations. In Zambia, the prevalence of mental disorders is approximately 20%, with common mental disorders including acute psychotic episodes, schizophrenia, alcohol-related problems, and organic brain syndromes. These are mainly seen in Chainama, the only mental institution in the country. The institution is highly stigmatized, and previous studies have shown that the general population does not access services at this facility as intended, leading to considerations of decentralizing these services to be integrated into primary health care. This study sought to understand the dispositions of primary health facility in-charges towards decentralization and the integration of mental health services into primary health care. Methods: This study was cross-sectional and employed both quantitative and qualitative techniques. A total of 76 primary health care facility in-charges from seven subdistricts of Lusaka district provided data through a questionnaire, and 56 participated in focus group discussions. Findings: The study found that in-charges had a positive disposition (52 in-charges: 68.3 percent) despite having inadequate knowledge (56 in-charges: 73.7 percent) of the subject matter and the decentralization process. While their current practices towards mental patients were found to be acceptable, the study also found that the majority (52.6 percent) of the in-charges foresaw more barriers to the integration of mental health, citing skilled staff, infrastructure, and drugs as main barriers. Conclusion: The study concludes that integration requires more investment and sensitization for its success.