Health system governance to support scale up of mental health care in Ethiopia : a qualitative study

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dc.contributor.authorHanlon, Charlotteen_ZA
dc.contributor.authorEshetu, Tigisten_ZA
dc.contributor.authorAlemayehu, Danielen_ZA
dc.contributor.authorFekadu, Abebawen_ZA
dc.contributor.authorSemrau, Mayaen_ZA
dc.contributor.authorThornicroft, Grahamen_ZA
dc.contributor.authorKigozi, Freden_ZA
dc.contributor.authorMarais, Debra Leighen_ZA
dc.contributor.authorPetersen, Ingeen_ZA
dc.contributor.authorAlem, Atalayen_ZA
dc.date.accessioned2019-02-13T13:58:42Z
dc.date.available2019-02-13T13:58:42Z
dc.date.issued2017
dc.descriptionCITATION: Hanlon, C., et al. 2017. Health system governance to support scale up of mental health care in Ethiopia : a qualitative study. International Journal of Mental Health Systems, 11:38, doi:10.1186/s13033-017-0144-4.
dc.descriptionThe original publication is available at https://ijmhs.biomedcentral.com
dc.description.abstractBackground: Ethiopia is embarking upon a ground-breaking plan to address the high levels of unmet need for mental health care by scaling up mental health care integrated within primary care. Health system governance is expected to impact critically upon the success or otherwise of this important initiative. The objective of the study was to explore the barriers, facilitators and potential strategies to promote good health system governance in relation to scale-up of mental health care in Ethiopia. Methods: A qualitative study was conducted using in-depth interviews. Key informants were selected purposively from national and regional level policy-makers, planners and service developers (n = 7) and district health office administrators and facility heads (n = 10) from a district in southern Ethiopia where a demonstration project to integrate mental health into primary care is underway. Topic guide development and analysis of transcripts were guided by an established framework for assessing health system governance, adapted for the Ethiopian context. Results: From the perspective of respondents, particular strengths of health system governance in Ethiopia included the presence of high level government support, the existence of a National Mental Health Strategy and the focus on integration of mental health care into primary care to improve the responsiveness of the health system. However, both national and district level respondents expressed concerns about low baseline awareness about mental health care planning, the presence of stigmatising attitudes, the level of transparency about planning decisions, limited leadership for mental health, lack of co-ordination of mental health planning, unreliable supplies of medication, inadequate health management information system indicators for monitoring implementation, unsustainable models for specialist mental health professional involvement in supervision and mentoring of primary care staff, lack of community mobilisation for mental health and low levels of empowerment and knowledge undermining meaningful involvement of stakeholders in local mental health care planning. Conclusions: To support scale-up of mental health care in Ethiopia, there is a critical need to strengthen leadership and co-ordination at the national, regional, zonal and district levels, expand indicators for routine monitoring of mental healthcare, promote service user involvement and address widespread stigma and low mental health awareness.en_ZA
dc.description.urihttps://ijmhs.biomedcentral.com/articles/10.1186/s13033-017-0144-4
dc.description.versionPublisher's version
dc.format.extent16 pages
dc.identifier.citationHanlon, C., et al. 2017. Health system governance to support scale up of mental health care in Ethiopia : a qualitative study. International Journal of Mental Health Systems, 11:38, doi:10.1186/s13033-017-0144-4
dc.identifier.issn1752-4458 (online)
dc.identifier.otherdoi:10.1186/s13033-017-0144-4
dc.identifier.urihttp://hdl.handle.net/10019.1/105409
dc.language.isoen_ZAen_ZA
dc.publisherBMC (part of Springer Nature)
dc.rights.holderAuthors retain copyright
dc.subjectHealth services administration -- Ethiopiaen_ZA
dc.subjectMental health services -- Planning -- Ethiopiaen_ZA
dc.subjectMedical policy -- Ethiopiaen_ZA
dc.subjectPrimary health care -- Planning -- Ethiopiaen_ZA
dc.subjectSystems thinkingen_ZA
dc.titleHealth system governance to support scale up of mental health care in Ethiopia : a qualitative studyen_ZA
dc.typeArticleen_ZA
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