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Cited by 44Mental Health Treatment and AccessPsychiatric care and mental health servicesMigration, Health and Trauma

Equitable access to mental healthcare integrated in primary care for people with severe mental disorders in rural Ethiopia: a community-based cross-sectional study

Open access
Hailemariam, Maji, Fekadu, Abebaw, Medhin, Girmay, Prince, Martin, Hanlon, Charlotte·2019·International Journal of Mental Health Systems
DOI 10.1186/s13033-019-0332-5PMC PMC6935213
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Abstract

Background: Integration of mental healthcare into non-specialist settings is advocated to expand access to care for people with severe mental disorders (SMD) in low-income countries. However, the impact upon equitable access for disenfranchised members of society has not been investigated. The purpose of this study was to (1) estimate contact coverage for SMD of a new service in primary healthcare (PHC) in a rural Ethiopian district, and (2) investigate equity of access for rural residents, women, people with physical impairments and people of low socio-economic status. Methods: Community key informants were trained to identify and refer people with probable SMD in Sodo district, south-central Ethiopia, using vignettes of typical presentations. Records of those referred to the new PHC-based service were linked to healthcare records to identify people who engaged with care and non-engagers over a 6 month period. Standardised interviews by psychiatric nurses were used to confirm the diagnosis in those attending PHC. Non-engagers were visited in their homes and administered the Psychosis Symptom Questionnaire. Socio-economic status, discrimination, disability, substance use, social support and distance to the nearest health facility were measured. Results: Contact coverage for the new service was estimated to be 81.3% (300 engaged out of 369 probable cases of SMD identified). Reimbursement for transport and time may have elevated coverage estimates. In the fully adjusted multivariable model, rural residents had 3.81 increased odds (95% CI 1.22, 11.89) of not accessing care, in part due to geographical distance from the health facility (odds ratio 3.37 (1.12, 10.12)) for people living more than 180 min away. There was no association with lower socioeconomic status, female gender or physical impairment. Higher levels of functional impairment were associated with increased odds of engagement. Amongst non-engagers, the most frequently endorsed barriers were thinking the problem would get better by itself and concerns about the cost of treatment. Conclusion: Integrating mental healthcare into primary care can achieve high levels of coverage in a rural African setting, which is equitable with respect to gender and socio-economic status. Service outreach into the community may be needed to achieve better contact coverage for rural residents.

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  • The provider adoption rate in MeHPriC (69.1%) compares favourably with PRIME sites in South Africa (23-50% adoption) but is lower than Ethiopia (81.7%).

    “The provider adoption rate in MeHPriC (69.1%) compares favourably with experiences from similar programs: higher than reported in some PRIME sites in South Africa (23–50% adoption depending on sites) [34] but lower than Ethiopia (81.7%) [35].”

    From Co-creating systems change for mental health: a theory of change approach from the MeHPriC initiative in Lagos, Nigeria (2025) · cites this paper as [35]

    The citation [35] is attached to the Ethiopia comparison. The Results (Contact coverage for SMD; page unavailable) report 81.3% contact coverage among people with probable severe mental disorders, not 81.7% provider adoption. The source therefore reports a different rate for a different measure. (LLM, conf=0.88)

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Research works printed but not linked: 3

  1. [3]WHO Mental Health Gap Action Programme Scaling up care for mental, neurological, and substance use disorders 2008 Geneva WHO 26290926
  2. [25]Nosikov A, Gudex C. Development of a common instrument for mental health. In: EUROHIS: developing common instruments for health surveys. Vol. 57. 2003. p. 35.
  3. [30]Corp S. Statistics/data analysis 4905. College Station: Edition LDS; 1984–2009.

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Authors
Hailemariam, M., Fekadu, A., Medhin, G., Prince, M., & Hanlon, C.
Affiliations
  • Addis Ababa University (ET)
  • King's College London (GB)
Corresponding author
Hanlon, Charlotte
ORCID
Venue
International Journal of Mental Health Systems
Publisher
Springer Science and Business Media LLC
Published
2019-12
Volume
13
Issue
1
Pages
78-78
ISSN
1752-4458 (ISSN-L)
DOI
10.1186/s13033-019-0332-5
PMC
PMC6935213
OpenAlex
W2997770809
Cited by
44
References
43
Citations by year
2026: 3 · 2025: 11 · 2024: 11 · 2023: 11 · 2022: 4 · 2021: 4
FWCI
2.51
Type
journal article
Language
en
Open access
Licence
Locations
  • International Journal of Mental Health Systems (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Research Portal (King's College London) (submittedVersion, cc-by)
  • Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by)
Funders
Department for International Development, UK Government (201446)
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
  • Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
Keywords
severe mental illness, primary care, access to mental health care, equitable access, rural health, barriers to care, distance to health facility, functional disability, women, socioeconomic status

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