van Rensburg André Janse, Fourie Pieter
Health and Demographic Research Unit, Department of Sociology, Ghent University, Korte Meer 5, 9000 Ghent, Belgium ; Department of Political Science, Stellenbosch University, Corner Merriman and Ryneveld Street, Stellenbosch, 7602 South Africa ; Centre for Health Systems Research & Development, University of the Free State, Nelson Mandela Road, Bloemfontein, 9300 South Africa.
Department of Political Science, Stellenbosch University, Corner Merriman and Ryneveld Street, Stellenbosch, 7602 South Africa.
Int J Ment Health Syst. 2016 Jul 22;10:49. doi: 10.1186/s13033-016-0081-7. eCollection 2016.
Mental illness is a well-known challenge to global development, particularly in low-to-middle income countries. A key health systems response to mental illness is different models of integrated health care, especially popular in the South African Development Community (SADC) region. This complex construct is often not well-defined in health policy, hampering implementation efforts. A key development in this vein has been the Rainbow Model of integrated care, a comprehensive framework and taxonomy of integrated care based on the integrative functions of primary care. The purpose of this study was to explore the nature and strategic forms of integrated mental health care in selected SADC countries, specifically how integrated care is outlined in state-driven policies.
Health policies from five SADC countries were analysed using the Rainbow Model as framework. Electronic copies of policy documents were transferred into NVivo 10, which aided in the framework analysis on the different types of integrated mental health care promoted in the countries assessed.
Several Rainbow Model components were emphasised. Clinical integration strategies (coordination of person-focused care) such as centrality of client needs, case management and continuity were central considerations, while others such as patient education and client satisfaction were largely lacking. Professional integration (inter-professional partnerships) was mentioned in terms of agreements on interdisciplinary collaboration and performance management, while organisational integration (inter-organisational relationships) emerged under the guise of inter-organisational governance, population needs and interest management. Among others, available resources, population management and stakeholder management fed into system integration strategies (horizontally and vertically integrated systems), while functional integration strategies (financial, management and information system functions) included human resource, information and resource management. Normative integration (a common frame of reference) included collective attitude, sense of urgency, and linking cultures, though aspects such as conflict management, quality features of the informal collaboration, and trust were largely lacking.
Most countries stressed the importance of integrating mental health on primary healthcare level, though an absence of supporting strategies could prove to bar implementation. Inter-service collaboration emerged as a significant goal, though a lack of (especially) normative integration dimensions could prove to be a key omission. Despite the usefulness of the Rainbow Model, it failed to adequately frame regional governance aspects of integration, as the SADC Secretariat could play an important role in coordinating and supporting the development and strengthening of better mental health systems.
精神疾病是全球发展面临的一个众所周知的挑战，在低收入和中等收入国家尤为如此。卫生系统应对精神疾病的一个关键举措是采用不同模式的综合医疗保健，这在南部非洲发展共同体（SADC）地区尤为普遍。这种复杂的架构在卫生政策中往往没有明确界定，阻碍了实施工作。在这方面的一个关键发展是综合护理的彩虹模式，这是一个基于初级保健综合功能的综合护理全面框架和分类法。本研究的目的是探讨选定的南部非洲发展共同体国家综合精神卫生保健的性质和战略形式，特别是国家驱动政策中如何概述综合护理。
以彩虹模式为框架，对南部非洲发展共同体五个国家的卫生政策进行了分析。政策文件的电子副本被转入NVivo 10，这有助于对所评估国家中推广的不同类型的综合精神卫生保健进行框架分析。
强调了彩虹模式的几个组成部分。临床整合策略（以患者为中心的护理协调），如客户需求的核心地位、病例管理和连续性，是核心考虑因素，而患者教育和客户满意度等其他因素则基本缺失。专业整合（跨专业伙伴关系）在跨学科合作和绩效管理协议方面被提及，而组织整合（组织间关系）则以组织间治理、人口需求和利益管理的形式出现。其中，可用资源、人口管理和利益相关者管理纳入了系统整合策略（横向和纵向整合系统），而功能整合策略（财务、管理和信息系统功能）包括人力资源、信息和资源管理。规范整合（共同的参考框架）包括集体态度、紧迫感和文化联系，尽管冲突管理、非正式合作的质量特征和信任等方面基本缺失。
大多数国家强调在初级卫生保健层面整合精神卫生的重要性，但缺乏支持性策略可能会阻碍实施。服务间合作是一个重要目标，但缺乏（尤其是）规范整合层面可能是一个关键疏漏。尽管彩虹模式很有用，但它未能充分构建整合的区域治理方面，因为南部非洲发展共同体秘书处可以在协调和支持更好的精神卫生系统的发展和加强方面发挥重要作用。
