Centre for Rural Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
Directorate for Mental Health Substance Abuse, KwaZulu-Natal Department of Health, Pietermaritzburg, KwaZulu-Natal, South Africa.
BMJ Glob Health. 2024 Oct 22;9(10):e015165. doi: 10.1136/bmjgh-2024-015165.
Despite progress in the development and evaluation of evidence-based primary mental health interventions in low-income and middle-income countries, implementation and scale-up efforts have had mixed results. Considerable gaps remain in the effective translation of research knowledge into routine health system practices, largely due to real-world contextual constraints on implementation and scale-up efforts. The Southern African Research Consortium for Mental Health Integration (S-MhINT) programme used implementation research to strengthen the implementation of an evidence-based integrated collaborative depression care model for primary healthcare (PHC) services in South Africa. To facilitate the scale-up of this model from a testing site to the whole province of KwaZulu-Natal, a capacity building programme was embedded within the Alliance for Health Policy and Systems Research (AHPSR) learning health systems (LHS) approach. The paper discusses efforts to scale up and embed case finding and referral elements of the S-MhINT package within routine PHC. Data from semistructured interviews, a focus group discussion, proceedings from participatory workshops and outputs from the application of continuous quality improvement (CQI) cycles were thematically analysed using the AHPSR LHS framework. Learning particularly occurred through information sharing at routine participatory workshops, which also offered mutual deliberation following periods of applying CQI tools to emergent problems. Individual-level, single-loop learning seemed to be particularly observable elements of the AHPSR LHS framework. Ultimately, our experience suggests that successful scale-up requires strong and sustained relationships between researchers, policy-makers and implementers, investments into learning platforms and organisational participation across all levels to ensure ownership and acceptance of learning processes.
尽管在制定和评估中低收入国家基本精神卫生干预措施方面取得了进展，但实施和扩大规模的努力成果喜忧参半。由于实施和扩大规模努力受到现实环境的限制，将研究知识有效转化为常规卫生系统实践方面仍存在很大差距。南部非洲精神卫生一体化研究联盟（S-MhINT）项目利用实施研究，加强了在南非基层医疗保健服务中实施基于证据的综合协作性抑郁症护理模式。为了促进该模式从测试点扩展到夸祖鲁-纳塔尔省全省范围，在联盟卫生政策和系统研究（AHPSR）学习卫生系统（LHS）方法中嵌入了一项能力建设方案。本文讨论了在常规基层医疗保健中扩大和嵌入 S-MhINT 一揽子计划中的病例发现和转介要素的努力。采用半结构化访谈、焦点小组讨论、参与式研讨会的会议记录以及持续质量改进（CQI）循环应用的产出，使用 AHPSR LHS 框架进行主题分析。学习主要通过常规参与式研讨会中的信息共享来实现，这也为在应用 CQI 工具解决突发问题后提供了共同审议的机会。个人层面的单循环学习似乎是 AHPSR LHS 框架的特别明显的要素。最终，我们的经验表明，成功的扩展需要研究人员、政策制定者和执行者之间建立强大而持久的关系，对学习平台进行投资，以及各级组织的参与，以确保学习过程的所有权和接受度。
