A task shifting approach to primary mental health care for adults in South Africa: human resource requirements and costs for rural settings
Abstract
BACKGROUND A recent situational analysis suggests that post-apartheid South Africa has made some gains with respect to the decentralization and integration of mental health into primary health care. However, service gaps within and between provinces remain, with rural areas particularly underserved. Aim This study aims to calculate and cost a hypothetical human resource mix required to populate a framework for district adult mental health services. This framework embraces the concept of task shifting, where dedicated low cost mental health workers at the community and clinic levels supplement integrated care. METHOD The expected number and cost of human resources was based on: (a) assumptions of service provision derived from existing services in a sub-district demonstration site and a literature review of evidence-based packages of care in low- and middle-income countries; and (b) assumptions of service needs derived from other studies. RESULTS For a nominal population of 100 000, minimal service coverage estimates of 50% for schizophrenia, bipolar affective disorder, major depressive disorder and 30% for post-traumatic stress disorder and maternal depression would require that the primary health care staffing package include one post for a mental health counsellor or equivalent and 7.2 community mental health worker posts. The cost of these personnel amounts to £28 457 per 100 000 population. This cost can be offset by a reduction in the number of other specialist and non-specialist health personnel required to close service gaps at primary care level. CONCLUSION The adoption of the concept of task shifting can substantially reduce the expected number of health care providers otherwise needed to close mental health service gaps at primary health care level in South Africa at minimal cost and may serve as a model for other middle-income countries.
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Task shifting to using CHWs to deliver interventions primarily delivered by behaviorists can be seen as an important aspect of delivering more accessible, efficient, cost-effective services.
“Task shifting to using CHWs to deliver interventions primarily delivered by behaviorists can be seen as an important aspect of delivering more accessible, efficient, cost-effective services 29,30 .”
From Addressing Behavioral Health Disparities for Somali Immigrants Through Group Cognitive Behavioral Therapy Led by Community Health Workers (2017) · cites this paper as [29]
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- Authors
- Petersen, I., Lund, C., Bhana, A., Flisher, A. J., & the Mental Health and Poverty Research Programme Consortium
- Affiliations
- University of KwaZulu-Natal (ZA)
- Venue
- Health Policy and Planning
- Publisher
- Oxford University Press (OUP)
- Published
- 2011-02-15
- Volume
- 27
- Issue
- 1
- Pages
- 42-51
- ISSN
- 0268-1080 (ISSN-L)
- 1460-2237
- OpenAlex
- W2142560219
- Cited by
- 158
- References
- 42
- Citations by year
- 2026: 9 · 2025: 7 · 2024: 9 · 2023: 4 · 2022: 8 · 2021: 12 · 2020: 10 · 2019: 13 · 2018: 11 · 2017: 10 · 2016: 24 · 2015: 8 · 2014: 13 · 2013: 8 · 2012: 7
- FWCI
- 13.97
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Health Policy and Planning (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Wellcome Trust (50534, GR065377MA)
- Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
- Department for International Development
- University of Cape Town
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Health Professions › Emergency Medical Services › Global Health Workforce Issues
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- task shifting, primary care mental health, mental health professionals, human resource needs, community mental health workers, rural mental health services, mental health treatment gap, integrated mental health care, schizophrenia, bipolar disorder, major depressive disorder, post-traumatic stress disorder, maternal depression, South Africa
- MeSH terms
- Catchment Area, Health, Female, Health Workforce, Health Planning, Humans, Male, Medically Underserved Area, Mental Health Services, Personnel Staffing and Scheduling, Primary Health Care, South Africa, Models, Organizational, Delivery of Health Care, Integrated, Rural Health Services
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