Health system governance to support integrated mental health care in South Africa: challenges and opportunities
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BACKGROUND: While South Africa has a new policy framework supporting the integration of mental health care into primary health care, this is not sufficient to ensure transformation of the health care system towards integrated primary mental health care. Health systems strengthening is needed, incorporating, inter alia, capacity building and resource inputs, as well as good governance for ensuring that the relevant policy imperatives are implemented. OBJECTIVES: To identify systemic factors within institutional and policy contexts that are likely to facilitate or impede the implementation of integrated mental health care in South Africa. METHODS: Semi-structured qualitative interviews were conducted with 17 key stakeholders in the Department of Health and Department of Social Development at national level, at provincial level in the North West Province, and at district level in the Dr Kenneth Kaunda district. Participants were purposively identified based on their positions and job responsibilities. Interview questions were guided by a hybrid of Siddiqi et al.'s governance framework principles and Mikkelsen-Lopez et al.'s health system governance approach. Data were analysed using framework analysis in NVivo. RESULTS: Facilitative factors included the recent mental health care policy framework and national action plan that embraces integrated care using a task sharing model and provides policy imperatives for the establishment of district mental health teams to facilitate the development and implementation of district mental health care plans; the roll out of the integrated chronic disease service delivery platform that can be leveraged to increase access and resources as well as decrease stigma; and the presence of NGOs that can assist with service delivery. Challenges included the low prioritisation and stigmatisation of mental illness; weak managerial and planning capacity to develop and implement mental health care plans at provincial and district level; poor pre-service training of generalists in mental health care; weak orientation to integrated care; high staff turnover; weak intersectoral coordination; infrastructural constraints; and no dedicated mental health budget. CONCLUSION: This study identifies strategies to support and improve integrated mental health care in primary health care services.
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Poor coordination across levels of government (local, provincial, national) is a barrier related to strategic direction of policy development and implementation.
“Poor coordination across levels of government (local, provincial, national) 77”
From Integrated care for people with long-term mental and physical health conditions in low-income and middle-income countries (2019) · cites this paper as [77]
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- Authors
- Marais, D. L., & Petersen, I.
- Affiliations
- University of KwaZulu-Natal (ZA)
- Corresponding author
- Petersen, Inge
- Venue
- International Journal of Mental Health Systems
- Published
- 2015-03-11
- Volume
- 9
- Issue
- 1
- Pages
- 14-14
- ISSN
- 1752-4458 (ISSN-L)
- PMC
- PMC4372271
- OpenAlex
- W2141032510
- Cited by
- 132
- References
- 51
- Citations by year
- 2026: 10 · 2025: 12 · 2024: 13 · 2023: 14 · 2022: 7 · 2021: 14 · 2020: 10 · 2019: 15 · 2018: 10 · 2017: 13 · 2016: 7 · 2015: 3
- FWCI
- 18.04
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- International Journal of Mental Health Systems (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- European Commission (2007–2013, FP7 2007-2013, 305968, FP7/2007)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Keywords
- integrated mental health care, primary care, health system governance, health system strengthening, mental health policy, task sharing, mental health stigma, intersectoral coordination, employee turnover, mental health funding, South Africa
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