Integrating mental health into primary health care in Zambia: a care provider's perspective.

BACKGROUND: Despite the 1991 reforms of the health system in Zambia, mental health is still given low priority. This is evident from the fragmented manner in which mental health services are provided in the country and the limited budget allocations, with mental health services receiving 0.4% of the total health budget. Most of the mental health services provided are curative in nature and based in tertiary health institutions. At primary health care level, there is either absence of, or fragmented health services. AIMS: The aim of this paper was to explore health providers' views about mental health integration into primary health care. METHODS: A mixed methods, structured survey was conducted of 111 health service providers in primary health care centres, drawn from one urban setting (Lusaka) and one rural setting (Mumbwa). RESULTS: There is strong support for integrating mental health into primary health care from care providers, as a way of facilitating early detection and intervention for mental health problems. Participants believed that this would contribute to the reduction of stigma and the promotion of human rights for people with mental health problems. However, health providers felt they require basic training in order to enhance their knowledge and skills in providing health care to people with mental health problems. RECOMMENDATIONS: It is recommended that health care providers should be provided with basic training in mental health in order to enhance their knowledge and skills to enable them provide mental health care to patients seeking help at primary health care level. CONCLUSION: Integrating mental health services into primary health care is critical to improving and promoting the mental health of the population in Zambia.

Human resource challenges facing Zambia's mental health care system and possible solutions: results from a combined quantitative and qualitative study.

Human resources for mental health care in low- and middle-income countries are inadequate to meet the growing public health burden of neuropsychiatric disorders. Information on actual numbers is scarce, however. The aim of this study was to analyse the key human resource constraints and challenges facing Zambia's mental health care system, and the possible solutions. This study used both qualitative and quantitative methodologies. The WHO-AIMS Version 2.2 was utilized to ascertain actual figures on human resource availability. Semi-structured interviews and focus group discussions were conducted to assess key stakeholders' perceptions regarding the human resource constraints and challenges. The results revealed an extreme scarcity of human resources dedicated to mental health in Zambia. Respondents highlighted many human resource constraints, including shortages, lack of post-graduate and in-service training, and staff mismanagement. A number of reasons for and consequences of these problems were highlighted. Dedicating more resources to mental health, increasing the output of qualified mental health care professionals, stepping up in-service training, and increasing political will from government were amongst the key solutions highlighted by the respondents. There is an urgent need to scale up human and financial resources for mental health in Zambia.