Health system challenges to integration of mental health delivery in primary care in Kenya-perspectives of primary care health workers
Health system challenges to integration of mental health delivery in primary care in Kenya-perspectives of primary care health workers
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DOI：
10.1186/1472-6963-13-368
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发表时间：
2013-09-30
影响因子：
2.8
通讯作者：
Jenkins, Ben
中科院分区：
文献类型：
--
作者：
Jenkins, Rachel;Othieno, Caleb;Jenkins, Ben
背景：众所周知，非洲卫生系统的弱点限制了在减轻传染病和非传染性疾病负担方面的进展(AFR Health Monitor，特刊，2011年14-24日)，在领导力、治理、卫生人力、医疗产品、疫苗和技术、信息、资金和服务提供方面的关键挑战已得到很好的描述(Int Arch Med，2008，1：27)。方法：在肯尼亚贫困农业区尼安扎省进行了两个90分钟的焦点小组，从随机对照试验中抽取20名卫生工作者来评估初级保健心理健康培训计划的影响，10名来自接受培训计划的干预组诊所，结果：这些焦点小组讨论表明，肯尼亚的一般卫生系统存在一些弱点，影响卫生工作者照顾有心理健康问题的客户和实施在心理健康持续职业发展培训计划中获得的新技能的能力。这些弱点包括药品供应、卫生管理信息系统、对初级保健诊所的区级监督、国家卫生部门目标对精神卫生缺乏重视，特别是在区级目标中缺乏对精神卫生的关注，这导致精神卫生被排除在现有的区级监督之外，以及地区管理团队缺乏对精神卫生的认识。卫生工作者所经历的艾滋病毒培训课程中精神卫生覆盖面的缺乏也是令人震惊的，因为在对艾滋病毒的地区监督期间，对艾滋病毒的密集关注损害了其他健康问题。结论：肯尼亚普通卫生系统的弱点影响了将精神卫生横向纳入常规初级保健实践的努力，并极大地挫败了卫生工作者的努力。改进药品供应、信息系统、明确将精神卫生纳入地区一级目标、对初级保健的管理和监督可能会极大地提高初级保健卫生工作者的效率，并使培训计划之后能够更好地在新获得的技能领域使用。将精神卫生横向纳入卫生系统的一个主要杠杆将是在社区、初级保健和区一级将精神卫生纳入国家卫生部门改革战略，而不仅仅是在较高的省和国家一级，以便从区一级到初级保健的支持性监督将成为常规做法，而不是非常稀缺的活动。
Background: Health system weaknesses in Africa are broadly well known, constraining progress on reducing the burden of both communicable and non-communicable disease (Afr Health Monitor, Special issue, 2011, 14-24), and the key challenges in leadership, governance, health workforce, medical products, vaccines and technologies, information, finance and service delivery have been well described (Int Arch Med, 2008, 1: 27). This paper uses focus group methodology to explore health worker perspectives on the challenges posed to integration of mental health into primary care by generic health system weakness.Methods: Two ninety minute focus groups were conducted in Nyanza province, a poor agricultural region of Kenya, with 20 health workers drawn from a randomised controlled trial to evaluate the impact of a mental health training programme for primary care, 10 from the intervention group clinics where staff had received the training programme, and 10 health workers from the control group where staff had not received the training).Results: These focus group discussions suggested that there are a number of generic health system weaknesses in Kenya which impact on the ability of health workers to care for clients with mental health problems and to implement new skills acquired during a mental health continuing professional development training programmes. These weaknesses include the medicine supply, health management information system, district level supervision to primary care clinics, the lack of attention to mental health in the national health sector targets, and especially its absence in district level targets, which results in the exclusion of mental health from such district level supervision as exists, and the lack of awareness in the district management team about mental health. The lack of mental health coverage included in HIV training courses experienced by the health workers was also striking, as was the intensive focus during district supervision on HIV to the detriment of other health issues.Conclusion: Generic health system weaknesses in Kenya impact on efforts for horizontal integration of mental health into routine primary care practice, and greatly frustrate health worker efforts.Improvement of medicine supplies, information systems, explicit inclusion of mental health in district level targets, management and supervision to primary care are likely to greatly improve primary care health worker effectiveness, and enable training programmes to be followed by better use in the field of newly acquired skills. A major lever for horizontal integration of mental health into the health system would be the inclusion of mental health in the national health sector reform strategy at community, primary care and district levels rather than just at the higher provincial and national levels, so that supportive supervision from the district level to primary care would become routine practice rather than very scarce activity.