Table 3.
Cross-Cutting themes for feasibility of task-sharing mental health services.
| Ethiopia | India | Nepal | South Africa | Uganda | |
|---|---|---|---|---|---|
| Logistical opportunities | |||||
| Improve access by reducing transportation to health care facility (e.g., cost, distance) | X | X | X | X | X |
| Overcome human resources barriers, such as shortage of specialist human resources (psychiatrists, psychologists, clinical psychologists, and counselors) | X | X | X | X | |
| Mental health care is not included in role or job chart of doctors | X | X | |||
| Logistical challenges | |||||
| Deficit of medicine for psychiatric disorders | X | X | X | X | |
| Multiple Projects Competing for Staff | X | X | X | X | |
| Lack of required equipment to diagnose mental illnesses | X | X | X | ||
| Poor quality of services (e.g., doctors or medicines unavailable) | X | X | X | ||
| No space for private consultation | X | X | |||
| Inadequate in-patient care facility at district level or below | X | ||||
| Need to match health worker and patient by gender | X | X | |||
| Unattended health posts | X | X | |||
| Availability of task-sharing workforce with mental health training | |||||
| Shortage of CHWs | X | X | X | X | |
| Shortage of PHC workers | X | X | X | X | |
| Shortage of specialists | X | X | X | X | |
| Need clearer division of labor across levels of mental health care workforce | X | X | |||
| Policy that contributes to staff turnover | X | ||||
| Personnel not located in places where medications and instruments are used | X | ||||
| Competency to provide mental health care | |||||
| CHWs' lack of competency | X | X | X | X | |
| Staff nurses' lack of competency | X | X | X | X | |
| Medical officers' lack of competency | X | X | |||
| Specialists' and gynecologists' lack of competency | X | X | |||
| Workload | |||||
| Insufficient staff/too much workload | X | X | X | X | X |
| Too much work for CHWs | X | X | X | X | X |
| Too much work for PHC workers | X | X | X | X | |
| Too much work for supervisors | X | ||||
| New cadre of health worker (nurse-level) should be trained to provide mental health services | X | ||||
| Government should hire specialists to focus on mental health care only | X | ||||
| Training | |||||
| More training needed | X | X | X | X | X |
| All levels of health professionals should receive training (rather than training one person who trains the rest) | X | X | X | X | |
| Trainers should have practical experience (e.g., nurses, psychologists, or social workers—not necessarily physicians) | X | X | X | X | |
| Training should be hands-on | X | X | X | ||
| Distance learning should be part of training, using multi-media component | X | X | |||
| Training evaluation should include pre- and post-test to measure learning | X | X | |||
| Refresher training every 3–4 months | X | X | |||
| Medical officer or other training personnel needed at the district level | X | ||||
| Training should not be focused on physicians because they change posts frequently | X | ||||
| Supervision | |||||
| Need more “supportive supervision” | X | X | X | X | |
| Supervisors must be adequately trained and qualified to provide supervision | X | X | X | ||
| Supervisors need to be accountable for providing supervision | X | ||||
| Supervision should be more frequent | X | ||||
| Need more “peer supervision” | X | ||||
| Lack of provision of necessary psychoeducation by doctors and nurses | X | ||||
| Compensation | |||||
| Need to compensate task-shifted workforce for training | X | X | X | X | X |
| Need to compensate CHWs for delivery of services | X | X | X | X | X |
| Need to compensate supervisors for supervision | X | X | X | ||