Hanlon Charlotte, Eshetu Tigist, Alemayehu Daniel, Fekadu Abebaw, Semrau Maya, Thornicroft Graham, Kigozi Fred, Marais Debra Leigh, Petersen Inge, Alem Atalay
Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Int J Ment Health Syst. 2017 Jun 8;11:38. doi: 10.1186/s13033-017-0144-4. eCollection 2017.
Ethiopia is embarking upon a ground-breaking plan to address the high levels of unmet need for mental health care by scaling up mental health care integrated within primary care. Health system governance is expected to impact critically upon the success or otherwise of this important initiative. The objective of the study was to explore the barriers, facilitators and potential strategies to promote good health system governance in relation to scale-up of mental health care in Ethiopia.
A qualitative study was conducted using in-depth interviews. Key informants were selected purposively from national and regional level policy-makers, planners and service developers (n = 7) and district health office administrators and facility heads (n = 10) from a district in southern Ethiopia where a demonstration project to integrate mental health into primary care is underway. Topic guide development and analysis of transcripts were guided by an established framework for assessing health system governance, adapted for the Ethiopian context.
From the perspective of respondents, particular strengths of health system governance in Ethiopia included the presence of high level government support, the existence of a National Mental Health Strategy and the focus on integration of mental health care into primary care to improve the responsiveness of the health system. However, both national and district level respondents expressed concerns about low baseline awareness about mental health care planning, the presence of stigmatising attitudes, the level of transparency about planning decisions, limited leadership for mental health, lack of co-ordination of mental health planning, unreliable supplies of medication, inadequate health management information system indicators for monitoring implementation, unsustainable models for specialist mental health professional involvement in supervision and mentoring of primary care staff, lack of community mobilisation for mental health and low levels of empowerment and knowledge undermining meaningful involvement of stakeholders in local mental health care planning.
To support scale-up of mental health care in Ethiopia, there is a critical need to strengthen leadership and co-ordination at the national, regional, zonal and district levels, expand indicators for routine monitoring of mental healthcare, promote service user involvement and address widespread stigma and low mental health awareness.
埃塞俄比亚正在开展一项开创性计划，通过扩大初级保健中整合的精神卫生保健来解决精神卫生保健需求未得到满足的高水平问题。卫生系统治理预计将对这一重要举措的成败产生关键影响。该研究的目的是探讨在埃塞俄比亚扩大精神卫生保健方面促进良好卫生系统治理的障碍、促进因素和潜在策略。
采用深入访谈进行定性研究。从国家和地区层面的政策制定者、规划者和服务开发者（n = 7）以及埃塞俄比亚南部一个正在开展将精神卫生纳入初级保健示范项目的地区的区卫生办公室管理人员和机构负责人（n = 10）中，有目的地选取关键信息提供者。主题指南的制定和转录本分析以一个既定的评估卫生系统治理框架为指导，并根据埃塞俄比亚的情况进行了调整。
从受访者的角度来看，埃塞俄比亚卫生系统治理的特别优势包括政府高层的支持、国家精神卫生战略的存在以及将精神卫生保健纳入初级保健以提高卫生系统反应能力的重点。然而，国家和地区层面的受访者都对精神卫生保健规划的基线认识较低、存在污名化态度、规划决策的透明度水平、精神卫生领导力有限、精神卫生规划缺乏协调、药品供应不可靠、监测实施的卫生管理信息系统指标不足、精神卫生专业人员参与基层医疗人员监督和指导的模式不可持续、缺乏精神卫生社区动员以及利益相关者在地方精神卫生保健规划中有意义参与的赋权和知识水平较低表示担忧。
为支持埃塞俄比亚扩大精神卫生保健，迫切需要加强国家、地区、分区和区级的领导力与协调，扩大精神卫生保健常规监测指标，促进服务使用者参与，并解决普遍存在的污名化和精神卫生意识低下问题。
