Table 2.

Cross-cutting themes for acceptability of task-sharing mental health care.

	Ethiopia	India	Nepal	South Africa	Uganda
Benefits
Increase access	X	X	X	X	X
Identify local leaders to work as CHWs (e.g., traditional and faith healers)	X	X	X	X	X
Save time	X	X	X		X
Save money	X	X	X		X
Reduce disparities			X	X	X
Decrease stigma			X	X
Prevent progression of disease		X	X
Improve medication adherence				X	X
Systemic Challenges
Lack of infrastructure	X	X	X	X	X
Workload	X	X	X	X	X
Health workers will take on new roles but not get recognition for it			X	X	X
Confidentiality (space)			X	X
CHWs reluctance to take on mental health care – risk of disappointing the community, extra burden, stigma	X				X
Clear division of labor necessary at each level of health care workforce			X		X
Support group intervention needs to be carried out by someone who understands illness and experience of users		X		X
Preference for CHWs to provide counseling as nurses appear too busy				X	X
Health workers want to take on more roles than outlined in mental health plan			X
Legal protection for workforce who have taken on new roles (e.g., health assistants who prescribe medication)			X
Social challenges
Belief CHWs should be only involved in identification, counseling, monitoring of conditions, and referral	X	X	X	X	X
Lack of trust in government health services	X	X		X	X
Belief that CHWs may be unsafe due to aggressive or violent behavior of mentally ill patients	X	X	X		X
Belief physician is required to diagnose or treat mental illness	X		X		X
Belief health care workers will preference physical illness over mental illness			X	X	X
Lack of respect for CHWs who task-share mental health services			X		X
Belief that medical professionals lack empathy while dealing with mentally ill patients		X		X	X
Educational challenges
Community lacks of knowledge around availability of effective biomedical care	X	X			X
CHWs will be unable to recognize people with mental illness who need treatment	X		X		X