Health systems strengthening to optimise scale-up in global mental health in low- and middle-income countries: lessons from the frontlines. A re-appraisal.

I Petersen,L R Fairall,S G Gigaba,A Van Rensburg,Z B P Luvuno

doi:10.1017/s2045796020000475

I Petersen, L R Fairall + Show 3 more

Open Access

https://doi.org/10.1017/s2045796020000475

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Abstract

Against the backdrop of mounting calls for the global scaling-up of mental health services - including quality care and prevention services - there is very little guidance internationally on strategies for scaling-up such services. Drawing on lessons from scale-up attempts in six low- and middle-income countries, and using exemplars from the front-lines in South Africa, we illustrate how health reforms towards people-centred chronic disease management provide enabling policy window opportunities for embedding mental health scale-up strategies into these reforms. Rather than going down the oft-trodden road of vertical funding for scale-up of mental health services, we suggest using the policy window that stresses global policy shifts towards strengthening of comprehensive integrated primary health care systems that are responsive to multimorbid chronic conditions. This is indeed a substantial opportunity to firmly locate mental health within these horizontal health systems strengthening funding agendas. Although this approach will promote systems more enabling of scaling-up of mental health services, implications for donor funders and researchers alike is the need for increased time commitments, resources and investment in local control.

Highlights

To reduce the ever-increasing burden of mental health problems in resource-scarce contexts, the recent Lancet Commission on global mental health and sustainable development has identified the need for, inter alia, scale-up of access to quality care as well as prevention efforts
Grounded in lessons emerging from efforts that use some of these key innovations to scale-up integrated mental health care at the district level in low- and middle-income countries (LMICs), we suggest the need to locate these strategies within a broader enabling health system strengthening agenda so as to optimise institutionalisation and sustainability of scale-up efforts
How the lessons gleaned from the Emerging Mental Health Systems in Low-and Middle-Income Countries (Emerald) research consortium (Semrau et al, 2015) suggest that health systems reforms to support chronic care provide an enabling framework for integrated mental health care

Summary

Introduction

To reduce the ever-increasing burden of mental health problems in resource-scarce contexts, the recent Lancet Commission on global mental health and sustainable development has identified the need for, inter alia, scale-up of access to quality care as well as prevention efforts.

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