六个翡翠国家将精神卫生纳入初级卫生保健的卫生系统背景：情况分析
Health systems context(s) for integrating mental health into primary health care in six Emerald countries: a situation analysis.
作者信息
Mugisha James, Abdulmalik Jibril, Hanlon Charlotte, Petersen Inge, Lund Crick, Upadhaya Nawaraj, Ahuja Shalini, Shidhaye Rahul, Mntambo Ntokozo, Alem Atalay, Gureje Oye, Kigozi Fred
机构信息
Kyambogo University, Kampala, Uganda ; Butabika Hospital Emerald Project, Kampala, Uganda ; Stellenbosch University, Stellenbosch, South Africa.
Department of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Neuroscience, University of Ibadan, Ibadan, Nigeria.
出版信息
Int J Ment Health Syst. 2017 Jan 5;11:7. doi: 10.1186/s13033-016-0114-2. eCollection 2017.
BACKGROUND
Mental, neurological and substance use disorders contribute to a significant proportion of the world's disease burden, including in low and middle income countries (LMICs). In this study, we focused on the health systems required to support integration of mental health into primary health care (PHC) in Ethiopia, India, Nepal, Nigeria, South Africa and Uganda.
METHODS
A checklist guided by the World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS) was developed and was used for data collection in each of the six countries participating in the Emerging mental health systems in low and middle-income countries (Emerald) research consortium. The documents reviewed were from the following domains: mental health legislation, health policies/plans and relevant country health programs. Data were analyzed using thematic content analysis.
RESULTS
Three of the study countries (Ethiopia, Nepal, Nigeria, and Uganda) were working towards developing mental health legislation. South Africa and India were ahead of other countries, having enacted recent Mental Health Care Act in 2004 and 2016, respectively. Among all the 6 study countries, only Nepal, Nigeria and South Africa had a standalone mental health policy. However, other countries had related health policies where mental health was mentioned. The lack of fully fledged policies is likely to limit opportunities for resource mobilization for the mental health sector and efforts to integrate mental health into PHC. Most countries were found to be allocating inadequate budgets from the health budget for mental health, with South Africa (5%) and Nepal (0.17%) were the countries with the highest and lowest proportions of health budgets spent on mental health, respectively. Other vital resources that support integration such as human resources and health facilities for mental health services were found to be in adequate in all the study countries. Monitoring and evaluation systems to support the integration of mental health into PHC in all the study countries were also inadequate.
CONCLUSION
Integration of mental health into PHC will require addressing the resource limitations that have been identified in this study. There is a need for up to date mental health legislation and policies to engender commitment in allocating resources to mental health services.
背景
精神、神经和物质使用障碍在全球疾病负担中占相当大的比例，在低收入和中等收入国家（LMICs）亦是如此。在本研究中，我们聚焦于埃塞俄比亚、印度、尼泊尔、尼日利亚、南非和乌干达将精神卫生纳入初级卫生保健（PHC）所需的卫生系统。
方法
制定了一份以世界卫生组织精神卫生系统评估工具（WHO - AIMS）为指导的清单，并用于参与低收入和中等收入国家新兴精神卫生系统（Emerald）研究联盟的六个国家中的每一个国家的数据收集。所审查的文件来自以下领域：精神卫生立法、卫生政策/计划及相关国家卫生项目。采用主题内容分析法对数据进行分析。
结果
研究中的三个国家（埃塞俄比亚、尼泊尔、尼日利亚和乌干达）正在努力制定精神卫生立法。南非和印度领先于其他国家，分别于2004年和2016年颁布了近期的《精神卫生保健法》。在所有6个研究国家中，只有尼泊尔、尼日利亚和南非有独立的精神卫生政策。然而，其他国家有提及精神卫生的相关卫生政策。缺乏完善的政策可能会限制精神卫生部门资源调动的机会以及将精神卫生纳入初级卫生保健的努力。大多数国家用于精神卫生的卫生预算分配不足，南非（5%）和尼泊尔（0.17%）分别是精神卫生支出占卫生预算比例最高和最低的国家。在所有研究国家中，发现支持整合的其他重要资源，如精神卫生服务的人力资源和卫生设施也不足。所有研究国家中支持将精神卫生纳入初级卫生保健的监测和评价系统也不完善。
结论
将精神卫生纳入初级卫生保健需要解决本研究中确定的资源限制问题。需要最新的精神卫生立法和政策，以促使在向精神卫生服务分配资源方面做出承诺。
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