Integration of perinatal mental health care into district health services in Uganda: Why is it not happening? The Four Domain Integrated Health (4DIH) explanatory framework

Nandini D.P. Sarkar*, Florence Baingana, Bart Criel

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

The Sustainable Development Goals recognise mental health and well-being as a target area, however, mobilizing funding and prioritisation of the same remains a challenge. Perinatal mental health care has the potential for incorporation and integration across the overall maternal health agenda, and can be especially relevant for low- and middle-income countries in their overall health systems strengthening strategies. This study aimed at qualitatively situating the extent to which integration of perinatal mental health care into maternal health care was considered desirable, possible and opportune within the existing policy and service-delivery environment in Uganda. A total of 81 in-depth interviews and nine focus group discussions (N = 64) were conducted with a variety of national, district, health system and community-level stakeholders. Data were analysed thematically using theory- and data-driven codebooks in NVivo 11. Analysis of the desirability, possibility and opportunity for integrating perinatal mental health care within the Ugandan district health system, highlights that concerned stakeholders perceive this as a worthwhile endeavour that would benefit the communities as well as the health system as a whole. Based on these current realities and ideal scenarios, a tentative explanatory framework that brings together various perspectives – that is, the perceived nature of the health problem, local and national health system issues, alternative systems of care and support, and international global perspectives – was constructed. The framework needs further validation but already hints at the need for global, national and local forces to concurrently rally behind the inclusion and integration of perinatal mental health care, especially at the primary care level in low- and middle-income contexts. If the global health community is poised to achieve high quality, women-centered care and people-centered health systems across the lifespan, then the sustainable integration of mental health care into general health care, is a commitment that can no longer be delayed.

Original languageEnglish
Article number113464
Pages (from-to)1-9
Number of pages9
JournalSocial Science and Medicine
Volume296
Early online date20 Oct 2020
DOIs
Publication statusPublished - Mar 2022

Bibliographical note

Funding Information:
We would like to acknowledge Makerere University School of Public Health for all the contacts within the university and beyond. We would also like to acknowledge the Iganga-Mayuge Health and Demographic Surveillance Site for their assistance in district level engagements, as well as our research assistants (Betty Kyobe, Sarah Namasuko, and Rogers Mandu) in data collection. Special thanks go to all the participants of this research. Lastly, we would like to forward a note of appreciation and remembrance towards the late Dr. Sheila Ndyanabangi, a true champion for inclusion and integration of mental health care into the Ugandan health system.

Publisher Copyright:
© 2020 Elsevier Ltd

Funding

We would like to acknowledge Makerere University School of Public Health for all the contacts within the university and beyond. We would also like to acknowledge the Iganga-Mayuge Health and Demographic Surveillance Site for their assistance in district level engagements, as well as our research assistants (Betty Kyobe, Sarah Namasuko, and Rogers Mandu) in data collection. Special thanks go to all the participants of this research. Lastly, we would like to forward a note of appreciation and remembrance towards the late Dr. Sheila Ndyanabangi, a true champion for inclusion and integration of mental health care into the Ugandan health system.

Keywords

  • Explanatory framework
  • Integration
  • Maternal health
  • Mental health
  • Perinatal
  • Qualitative research
  • Uganda

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