Table 3.
System level | Facilitators | Barriers |
Service user | Ability to see traditional healers alongside biomedical care.31
Community awareness raising.32 |
Cultural differences with the biomedical model.33
Different perspectives on appropriate treatment.34–36 Rural residence, distance from health facilities, thinking that problems will self-resolve, concerns about treatment costs.37 Resistance to treatment.38 |
Staff | Health worker motivation.39
Sharing research findings collaboratively.40 |
Resistance from faculty members.41
Time constraints and workload.42 43 Stigma.38 39 43 Mistrust of informal health providers, cultural misunderstandings.38 |
Service | Supervision.39 42 44
Onward referral.32 Reliable psychotropic medicine procurement.32 39 44 Trained female community health volunteers.32 |
Scarcity of specialist staff to deliver supervision.39 45
Lack of financial resources38 41 Limited referral systems.38 Staff turnover, lack of confidential space for consultation.39 |
Leadership | Strong political and organisational support.35 36 39 40 | Lack of institutional support.41 |