Collaboration Between Traditional Practitioners and Primary Health Care Staff in South Africa: Developing a Workable Partnership for Community Mental Health Services

Abstract Background The Programme for Improving Mental Health Care (PRIME) sought to implement mental health care plans (MHCP) for four priority mental disorders (depression, alcohol use disorder, psychosis and epilepsy) into routine primary care in five low- and middle-income country districts. The impact of the MHCPs on disability was evaluated through establishment of priority disorder treatment cohorts. This paper describes the methodology of these PRIME cohorts. Methods One cohort for each disorder was recruited across some or all five districts: Sodo (Ethiopia), Sehore (India), Chitwan (Nepal), Dr. Kenneth Kaunda (South Africa) and Kamuli (Uganda), comprising 17 treatment cohorts in total (N = 2182). Participants were adults residing in the districts who were eligible to receive mental health treatment according to primary health care staff, trained by PRIME facilitators as per the district MHCP. Patients who screened positive for depression or AUD and who were not given a diagnosis by their clinicians (N = 709) were also recruited into comparison cohorts in Ethiopia, India, Nepal and South Africa. Caregivers of patients with epilepsy or psychosis were also recruited (N = 953), together with or on behalf of the person with a mental disorder, depending on the district. The target sample size was 200 (depression and AUD), or 150 (psychosis and epilepsy) patients initiating treatment in each recruiting district. Data collection activities were conducted by PRIME research teams. Participants completed follow-up assessments after 3 months (AUD and depression) or 6 months (psychosis and epilepsy), and after 12 months. Primary outcomes were impaired functioning, using the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS), and symptom severity, assessed using the Patient Health Questionnaire (depression), the Alcohol Use Disorder Identification Test (AUD), and number of seizures (epilepsy). Discussion Cohort recruitment was a function of the clinical detection rate by primary health care staff, and did not meet all planned targets. The cross-country methodology reflected the pragmatic nature of the PRIME cohorts: while the heterogeneity in methods of recruitment was a consequence of differences in health systems and MHCPs, the use of the WHODAS as primary outcome measure will allow for comparison of functioning recovery across sites and disorders.

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Mental health in primary care

Psychiatric Bulletin ◽

10.1192/pb.13.1.20 ◽

1989 ◽

Vol 13 (1) ◽

pp. 20-24 ◽

Cited By ~ 1

Author(s):

O. O. Famuyiwa

Keyword(s):

Mental Health ◽

Health Care ◽

Primary Health Care ◽

Community Mental Health ◽

Rural Areas ◽

Third World ◽

Community Mental Health Services ◽

Primary Health Care System ◽

Primary Health ◽

The Third World

The expression primary health care (PHC) gives the impression of an ensemble of control of communicable diseases, infant care, avoidance of insanitary personal habits and curbing environmental pollution. These indeed constitute the main elements of the scheme but are not exclusive to it. An integral but often ignored aspect is the community dimension of mental health whose importance is underscored by the fact that a significant majority of people in the third world live in rural areas with minimal or no access to formal psychiatric facilities. In this paper, I shall review the conceptual framework and practicality of primary health care with special reference to community mental health, highlight some notable limitations to policy execution and finally propose an organisational model structure for the community mental health services within the primary health care system.

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Practitioners’ experience of the integration of mental health into primary health care in the West Rand District, South Africa

Journal of Mental Health ◽

10.1080/09638237.2017.1340604 ◽

2017 ◽

Vol 27 (2) ◽

pp. 135-141 ◽

Cited By ~ 2

Author(s):

Ora Gerber

Keyword(s):

Mental Health ◽

South Africa ◽

Health Care ◽

Primary Health Care ◽

The West ◽

Primary Health

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A Well Woman Clinic in Bangalore: one strategy to attempt to decrease the transmission of HIV infection

International Journal of STD & AIDS ◽

10.1258/0956462981922520 ◽

1998 ◽

Vol 9 (7) ◽

pp. 418-423 ◽

Cited By ~ 3

Author(s):

C M Baksi ◽

I Harper ◽

Margaret Raj

Keyword(s):

Health Care ◽

Primary Health Care ◽

Hiv Infection ◽

Sex Workers ◽

Pilot Project ◽

Care Staff ◽

Vulnerable Groups ◽

Health Care Staff ◽

Governmental Organization ◽

Primary Health

Samraksha, a non governmental organization NGO in Bangalore, South India, was established in 1993 to take steps to control the spread of HIV infection. As a result of their interactions the Samraksha team recognized the urgent need for management of sexually transmitted diseases STDs as a crucial component of their work. Samraksha approached Action Health, a UK based charity, for assistance. This paper outlines the needs assessment and the process of setting up a Well Woman Clinic for commercial sex workers CSWs and other vulnerable groups in Bangalore. The pilot project has been running for over a year and has gained credibility both with vulnerable women and with professionals. Furthermore it has officially become a government resource centre for the training of doctors and health care staff in the management of STDs, and provides formal training sessions for the staff at each of the primary health care centres in Bangalore. Thus STD management is being integrated with the current primary health care provision for women throughout Bangalore. Factors influencing the successful development of such a service are considered.

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