\u201cWe do not know how to screen and provide treatment\u201d: a qualitative study of barriers and enablers of implementing perinatal depression health services in Ethiopia

Abel Fekadu Dadi,Emma R Miller,Telake Azale,Lillian Mwanri

doi:10.1186/s13033-021-00466-y

Abel Fekadu Dadi, Emma R Miller + Show 2 more

Open Access

https://doi.org/10.1186/s13033-021-00466-y

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Abstract

BackgroundQualitative studies evaluating maternal mental health services are lacking in Ethiopia, and the available evidence targets severe mental illnesses in the general population. We conducted a qualitative study to explore barriers to, enablers of, or opportunities for perinatal depression health services implementations in Ethiopia.MethodsWe conducted a total of 13 face to face interviews with mental and maternal health service administrators from different levels of the Ethiopian healthcare system. We interviewed in Amharic (a local language), transcribed and translated into English, and imported into NVivo. We analysed the translated interviews inductively using thematic framework analysis.ResultsThe study identified: (i) health administrators’ low literacy about perinatal depression as individual level barriers; (ii) community low awareness, health-seeking behaviours and cultural norms about perinatal depression as socio-cultural level barriers; (iii) lack of government capacity, readiness, and priority of screening and managing perinatal depression as organisational level barriers; and (iv) lack of mental health policy, strategies, and healthcare systems as structural level barriers of perinatal mental health implementation in Ethiopia. The introduction of the new Mental Health Gap Action Programme (mhGap), health professionals’ commitment, and simplicity of screening programs were identified enablers of, or opportunities for, perinatal mental health service implementation.ConclusionsThis qualitative inquiry identified important barriers and potential opportunities that could be used to address perinatal depression in Ethiopia. Building the capacity of policy makers and planners, strengthening the mental healthcare system and governance should be a priority issue for an effective integration of maternal mental health care with the routine maternal health services in Ethiopia.

Highlights

Qualitative studies evaluating maternal mental health services are lacking in Ethiopia, and the available evidence targets severe mental illnesses in the general population
The following barriers were identified in the current study: (i) At the individual level, health administrators have little knowledge about perinatal depression risk factors, symptoms, optimal time for screening, treatment options, and the potential consequences of depression. (ii) At the socio-cultural level, there is low awareness about perinatal depression in the community, reduced health-seeking behaviours and prohibitive cultural norms; (iii) Organisational level barriers include lack of government capacity, readiness, and priority to screen and manage perinatal depression; (iv) Structural level barriers include lack of perinatal mental health policies and strategies, and transparency in the healthcare system
Good mental health literacy is important for improving health, healthcare systems, and health policy [58, 59] and this should be a priority issue for health professionals working at administrative level

Summary

Introduction

Qualitative studies evaluating maternal mental health services are lacking in Ethiopia, and the available evidence targets severe mental illnesses in the general population. We conducted a qualitative study to explore barriers to, enablers of, or opportunities for perinatal depression health services implementations in Ethiopia. Depression is one of the most common complications of the perinatal period, both in high [1] and low-income countries [2]. Barriers to poor treatment are multifactorial and could be associated with personal behaviour [21, 22], the severity of the disorder [20], social norms [23], and the lack of effective mental health care systems [24]. Situational analysis in five low- and middle-income countries showed a limited capacity of the health systems regarding feasible detection and treatment strategies [27]

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