Mapping services at two Nairobi County primary health facilities: identifying challenges and opportunities in integrated mental health care as a Universal Health Coverage (UHC) priority.
Mapping services at two Nairobi County primary health facilities: identifying challenges and opportunities in integrated mental health care as a Universal Health Coverage (UHC) priority.
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DOI：
10.1186/s12991-021-00359-x
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发表时间：
2021-08-17
影响因子：
3.7
通讯作者：
Saxena S
中科院分区：
文献类型：
--
作者：
Kumar M;Nyongesa V;Kagoya M;Mutamba BB;Amugune B;Krishnam NS;Wambua GN;Petersen I;Gachuno O;Saxena S
有必要扩大初级卫生保健中的精神卫生服务。目前将心理健康纳入初级保健的程度与在这一层面上促进和加强心理健康有关。我们描述了在肯尼亚的两个低收入/初级卫生设施中进行的设施测绘工作，以确定在初级卫生保健中提供一般精神卫生服务，特别是围产期青少年精神卫生服务方面的现有障碍和促进者，以及当地可用的服务资源、干部和发展伙伴。这项研究利用了定性的证据合成，通过绘制设施级服务图和关键利益相关者访谈。使用内罗毕城县人力资源健康战略记录表从两个设施收费中收集了与服务有关的数据。此外，我们还对临床医生(文凭级别的临床医生)、护士、社区卫生助理(CHAS)、预防艾滋病毒母婴传播指导母亲(PMTCTM)进行了10次关键线人访谈(KIIS)，内容涉及一般和青少年心理健康以及他们提供的心理社会服务。以世界卫生组织精神卫生系统评估工具(WHO-AIMS)作为访谈指南，所有Kii问题都被组织起来，以确定初级卫生保健服务中精神卫生一体化的程度。然后对采访记录进行系统的分析，找出共同的主题，并由前三位作者进行讨论，以消除差异。我们的研究结果表明，以身体健康为中心的医疗保健服务每天都提供，而精神健康服务仍然是垂直的，由卫生部直接或非政府合作伙伴每周通过专家服务提供。尽管卫生保健工作者意识到将精神卫生服务纳入常规护理的迫切需要，但他们对精神障碍的了解有限，并报告说，这些场所缺乏训练有素的精神卫生人员。值得注意的是，需要更多的资金和资源来提供精神健康服务，以及需要对普通保健提供者进行识别和治疗精神障碍的培训。我们的利益攸关方强调了将针对青少年，特别是围产期少女的心理健康治疗、预防和幸福促进活动结合起来的紧迫性。需要进一步完善心理健康服务的综合护理模式，并有针对性地建设保健提供者提供优质服务的能力。
There is a need to scale-up mental health service provision in primary health care. The current extent of integration of mental health in primary care is pertinent to promoting and augmenting mental health at this level. We describe a facility mapping exercise conducted in two low-income/primary health facilities in Kenya to identify existing barriers and facilitators in the delivery of mental health services in general and specifically for peripartum adolescents in primary health care as well as available service resources, cadres, and developmental partners on the ground. This study utilized a qualitative evidence synthesis through mapping facility-level services and key-stakeholder interviews. Services-related data were collected from two facility in-charges using the Nairobi City County Human Resource Health Strategy record forms. Additionally, we conducted 10 key informant interviews (KIIs) with clinical officers (Clinicians at diploma level), Nurses, Community Health Assistants (CHAs), Prevention of Mother-to-child Transmission of HIV Mentor Mothers (PMTCTMs), around both general and adolescent mental health as well as psychosocial services they offered. Using the World Health Organization Assessments Instrument for Mental Health Systems (WHO-AIMS) as a guideline for the interview, all KII questions were structured to identify the extent of mental health integration in primary health care services. Interview transcripts were then systematically analyzed for common themes and discussed by the first three authors to eliminate discrepancies. Our findings show that health care services centered around physical health were offered daily while the mental health services were still vertical, offered weekly through specialist services by the Ministry of Health directly or non-governmental partners. Despite health care workers being aware of the urgent need to integrate mental health services into routine care, they expressed limited knowledge about mental disorders and reported paucity of trained mental health personnel in these sites. Significantly, more funding and resources are needed to provide mental health services, as well as the need for training of general health care providers in the identification and treatment of mental disorders. Our stakeholders underscored the urgency of integrating mental health treatment, prevention, and well-being promotive activities targeting adolescents especially peripartum adolescent girls. There is a need for further refining of the integrated care model in mental health services and targeted capacity-building for health care providers to deliver quality services.
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影响因子：
8.1
作者：
Iemmi, Valentina
通讯作者：
Iemmi, Valentina
影响因子：
168.9
作者：
Kakuma, Ritsuko;Minas, Harry;Scheffler, Richard M.
通讯作者：
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影响因子：
34.3
作者：
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Whiteford, Harvey
影响因子：
2.8
作者：
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通讯作者：
Jenkins, Ben
影响因子：
3.6
作者：
Muga, Florence A.;Jenkins, Rachel
通讯作者：
Jenkins, Rachel