Health managers’ views on the status of national and decentralized health systems for child and adolescent mental health in Uganda: a qualitative study

Abstract

BackgroundRobust health systems are required for the promotion of child and adolescent mental health (CAMH). In low and middle income countries such as Uganda neuropsychiatric illness in childhood and adolescence represent 15–30 % of all loss in disability-adjusted life years. In spite of this burden, service systems in these countries are weak. The objective of our assessment was to explore strengths and weaknesses of CAMH systems at national and district level in Uganda from a management perspective.MethodsSeven key informant interviews were conducted during July to October 2014 in Kampala and Mbale district, Eastern Uganda representing the national and district level, respectively. The key informants selected were all public officials responsible for supervision of CAMH services at the two levels. The interview guide included the following CAMH domains based on the WHO Assessment Instrument for Mental Health Systems (WHO-AIMS): policy and legislation, financing, service delivery, health workforce, medicines and health information management. Inductive thematic analysis was applied in which the text in data transcripts was reduced to thematic codes. Patterns were then identified in the relations among the codes.ResultsEleven themes emerged from the six domains of enquiry in the WHO-AIMS. A CAMH policy has been drafted to complement the national mental health policy, however district managers did not know about it. All managers at the district level cited inadequate national mental health policies. The existing laws were considered sufficient for the promotion of CAMH, however CAMH financing and services were noted by all as inadequate. CAMH services were noted to be absent at lower health centers and lacked integration with other health sector services. Insufficient CAMH workforce was widely reported, and was noted to affect medicines availability. Lastly, unlike national level managers, lower level managers considered the health management information system as being insufficient for service planning.ConclusionManagers at national and district level agree that most components of the CAMH system in Uganda are weak; but perceptions about CAMH policy and health information systems were divergent.

Child and adolescent mental health services in Uganda

“…CAMHS is also not yet integrated into primary health care, which could improve access to these services. This kind of collaboration should be sought after, but the training of primary health care professionals has yet to fully begin [ 18 – 22 ] (Table 1 ). This could give CAMHS increased continuity and accessibility, as described in the WHO frameworks [ 27 ].…”

Elucidating adolescent aspirational models for the design of public mental health interventions: a mixed-method study in rural Nepal

“…This is a problem globally. Although neuropsychiatric illnesses represent a large percentage of disability adjusted life years in LMICs, mental health services in national health systems in these countries are extremely weak [ 59 ]. People with mental health problems have the lowest rates of treatment for their health conditions, and integration into primary health care has been advocated as a potential solution [ 60 ].…”

Does mhGAP training of primary health care providers improve the identification of child- and adolescent mental, neurological or substance use disorders? Results from a randomized controlled trial in Uganda

“…Pathways to mental health care typically include traditional healers (Abbo, 2011; Akol et al . 2015), and psychiatric referral facilities where they exist (Kisa et al . 2016).…”

“…Whereas the burden of CAMH disorders in Uganda has not been accurately estimated, mental health professionals agree that mental ill-health is an increasing problem, exacerbated by poor access to mental health services (Akol et al . 2015). Currently, mental health services are provided in a centralized framework at national and regional hospitals, contrary to WHO recommendations for mental health care in low-income countries to be provided at PHC clinics and in communities (World Health Organization, 2001, 2008 a ; Kigozi et al .…”

“…2010; Akol et al . 2015). Health system research aimed at increasing the availability of and access to mental health care for children and adolescents in settings like Uganda is an important public health priority (Patel et al .…”