Policies, delivery models, and lessons learned from integrating mental health and substance abuse services into primary health care in Ethiopia

Abstract

In Ethiopia, noncommunicable diseases (NCDs) represent 18.3% of premature mortality, consume 23% of the household expenditures, and cost 1.8% of the gross domestic product. Risk factors such as alcohol, khat, and cannabis use are on the rise and are correlated with a substantial portion of NCDs. Associated NCDs include depression, anxiety, hypertension, coronary heart disease, and myocardial infarction.The multi-faceted nature of mental health and substance abuse disorders require multi-dimensional interventions. The article draws upon participant observation and literature review to examine the Accepted Article policies, delivery models, and lessons learned from the Federal Ministry of Health (FMOH) experience in integrating Mental Health and Substance Abuse (MH/SA) services into primary care in Ethiopia. In 2019, FMOH developed national strategies for both NCDs and mental health to reach its population of over 114,000. Ethiopia integrated MH/SA services at all levels within the government sector, with an emphasis on primary care. FMOH launched the Ethiopian Primary Health Care Clinical Guidelines, which includes the delivery of NCD services, to standardize the care given at the primary health care level. To date, the guidelines have been implemented by over 800 health centers and is expected to improve the quality of service and health outcomes. Existing primary care programs were expanded to include prevention, early detection, treatment, and rehabilitation for MH/SA. This included training and leveraging an array of health professionals, including traditional healers and those from faith-based institutions and community-based organizations. A total of 244 health centers completed training in the Mental Health Gap Action Programme (mhGAP). In 2020, 5,000 urban Health Extension Workers (HEWs) participated in refresher training, which includes mental health and NCDs. A similar curriculum for rural health workers is in development.Ethiopia's experience has many lessons learned about stakeholder buy-in, roles, training, logistics, and sustainability that are transferable to other countries. Lessons include that "buy-in" by leaders of public health care facilities requires consistent and persistent nurturing. Ensure the gradual and calibrated integration of MH/SA services so that the task-sharing will not be viewed as "task dumping." Supervision and mentorship of the newly trained is important for the delivery of quality care and acquisition of skills.

The Role of Faith-Based Organizations in Improving Vaccination Confidence & Addressing Vaccination Disparities to Help Improve Vaccine Uptake: A Systematic Review

“…A total of 37 articles were included in the analysis ( Figure 1 ) [ 6 , 7 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ]. Results were categorized as “public health interventions”, where interventions were related to addressing public health needs across various topics including mental health and physical activity, then “vaccination interventions” which are those focused specifically on supporting vaccine uptake.…”

“…Sheikhi et al [ 7 ] concluded FBOs provide avenues for partnership with stakeholders and collaboration with healthcare providers, especially mental health professionals. Tadesse Gebremedhin et al [ 44 ] found that committed leadership by policymakers and “buy-in” from crucial stakeholders allows for the involvement of community members at different levels. In a systematic review, DeHaven et al [ 45 ] provided recommendations for FBOs to increase their effectiveness by encouraging partnerships between FBOs and health professionals to evaluate public health interventions, disseminate findings, and focus on fostering relationships with racially and ethnically diverse populations.…”

Barriers and enablers to improving integrated primary healthcare for non-communicable diseases and mental health conditions in Ethiopia: a mixed methods study

“…Community based health insurance had been recently initiated at the time of this study. The intention to integrate care for people with MHCs and NCDs into primary health care services has been articulated in national level strategies from the Ministry of Health (7).…”

“…Reliance on vertical programmes or centralised models of specialist care has resulted in high treatment gaps for both NCDs (4) and MHCs (5) and a fragmented and inadequate response to co-morbidity or multi-morbidity (6). In response, it has been recommended to integrate care for people with NCDs and MHCs into service packages delivered within PHC (7,8).…”

Data quality and associated factors of routine health information system among health centers of West Gojjam Zone, northwest Ethiopia, 2021

“…Since 2008, Ethiopia's RHIS has gathered and provided fundamental monitorable indicators that may be utilized to improve healthcare delivery, and the RHIS has been proven to be an invaluable tool for tracking and revising policy implementation and resource allocation (8). For health decisionmaking, the requirement for organized, accessible, timely, and reliable data is becoming a major problem.…”