Ambikile Joel Seme, Iseselo Masunga K
Department of Clinical Nursing, Muhimbili University of Health & Allied Sciences (MUHAS), P.O. Box 65004, Dar es Salaam, Tanzania.
BMC Psychiatry. 2017 Mar 23;17(1):109. doi: 10.1186/s12888-017-1271-9.
Low and middle income countries face many challenges in meeting mental health needs in their regions. Treatment of patients with mental disorders is inadequate in most of these countries and majority of individuals with severe mental disorders remain untreated. The bad news is that mental health problems in these countries are on the rise due to socioeconomic challenges being faced. Regardless of guidelines and directives provided by WHO for organizing mental health services, these countries continue to face many challenges in the effort to cater for mental health needs. Such challenges include lack of human resource for mental health especially at primary health care level, inadequate training of human resource for mental health, misplacement of human resource for mental health, lack of drugs, wrong priorities, problematic insurance coverage for mental disorders, and stigma. This study aimed at exploring mental health care and delivery system at Temeke district hospital, and how services were organized to meet the increasing mental health needs of its population.
A qualitative study was conducted at Temeke hospital in Dar es Salaam, involving 7 in-depth interviews with mental health care providers, 7 in-depth interviews with mentally ill patients, and 2 focus group discussions with caregivers. A convenient sampling procedure was used to select participants for the study. All interviews were audio-recorded in Kiswahili and transcribed. A qualitative Content Analysis was used to analyze data after translation with the aid of Nvivo 10 software.
Three main themes were identified. These were resource challenges, environmental/system challenges, and satisfaction with mental health services. Temeke health facility faced resource and environmental/system challenges, and there were mixed feelings on satisfaction with services. Funding and priority issues were found to mainly affect delivery of appropriate services to clients.
Health facilities that provide mental health services in the community need to be well equipped with necessary resources to meet the vast needs of people they serve. Having a political will, improving the health systems governance for mental health, and priority setting, are necessary to address the challenges experienced in the delivery of mental health services.
低收入和中等收入国家在满足其地区的心理健康需求方面面临诸多挑战。在这些国家中的大多数，精神障碍患者的治疗并不充分，大多数严重精神障碍患者仍未得到治疗。坏消息是，由于面临社会经济挑战，这些国家的心理健康问题正在增加。尽管世界卫生组织提供了关于组织心理健康服务的指导方针和指令，但这些国家在满足心理健康需求的努力中仍继续面临许多挑战。这些挑战包括心理健康人力资源短缺，尤其是在初级卫生保健层面；心理健康人力资源培训不足；心理健康人力资源配置不当；药物短缺；优先事项错误；精神障碍保险覆盖存在问题以及污名化。本研究旨在探索坦梅克区医院的心理健康护理和服务提供系统，以及服务是如何组织以满足其人口日益增长的心理健康需求的。
在达累斯萨拉姆的坦梅克医院进行了一项定性研究，包括对7名心理健康护理提供者进行深入访谈、对7名精神病患者进行深入访谈以及与护理人员进行2次焦点小组讨论。采用便利抽样程序选择研究参与者。所有访谈均用斯瓦希里语进行录音并转录。在借助Nvivo 10软件翻译后，使用定性内容分析法对数据进行分析。
确定了三个主要主题。分别是资源挑战、环境/系统挑战以及对心理健康服务的满意度。坦梅克卫生设施面临资源和环境/系统挑战，对服务满意度的感受不一。发现资金和优先事项问题主要影响向客户提供适当服务。
在社区提供心理健康服务的卫生设施需要配备充足的必要资源，以满足其所服务人群的广泛需求。要有政治意愿，改善心理健康的卫生系统治理并确定优先事项，对于应对心理健康服务提供中遇到的挑战是必要的。
