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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

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

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.

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  • Sarkar, Nandini D.P. & Baingana, Florence & Criel, Bart, 2022. "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," Social Science & Medicine, Elsevier, vol. 296(C).
    • Handle: RePEc:eee:socmed:v:296:y:2022:i:c:s0277953620306833
    DOI: 10.1016/j.socscimed.2020.113464
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    References listed on IDEAS

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    1. Sarkar, Nandini D.P. & Bunders-Aelen, Joske & Criel, Bart, 2018. "The complex challenge of providing patient-centred perinatal healthcare in rural Uganda: A qualitative enquiry," Social Science & Medicine, Elsevier, vol. 205(C), pages 82-89.
    2. Kelly Clarke & Michael King & Audrey Prost, 2013. "Psychosocial Interventions for Perinatal Common Mental Disorders Delivered by Providers Who Are Not Mental Health Specialists in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis," PLOS Medicine, Public Library of Science, vol. 10(10), pages 1-17, October.
    3. Kaiser, Bonnie N. & Haroz, Emily E. & Kohrt, Brandon A. & Bolton, Paul A. & Bass, Judith K. & Hinton, Devon E., 2015. "“Thinking too much”: A systematic review of a common idiom of distress," Social Science & Medicine, Elsevier, vol. 147(C), pages 170-183.
    4. Joshua Ssebunnya & Fred Kigozi & Sheila Ndyanabangi, 2012. "Developing a National Mental Health Policy: A Case Study from Uganda," PLOS Medicine, Public Library of Science, vol. 9(10), pages 1-4, October.
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    7. Vikram Patel & Gary S Belkin & Arun Chockalingam & Janice Cooper & Shekhar Saxena & Jürgen Unützer, 2013. "Grand Challenges: Integrating Mental Health Services into Priority Health Care Platforms," PLOS Medicine, Public Library of Science, vol. 10(5), pages 1-6, May.
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    9. Mendenhall, Emily & De Silva, Mary J. & Hanlon, Charlotte & Petersen, Inge & Shidhaye, Rahul & Jordans, Mark & Luitel, Nagendra & Ssebunnya, Joshua & Fekadu, Abebaw & Patel, Vikram & Tomlinson, Mark &, 2014. "Acceptability and feasibility of using non-specialist health workers to deliver mental health care: Stakeholder perceptions from the PRIME district sites in Ethiopia, India, Nepal, South Africa, and U," Social Science & Medicine, Elsevier, vol. 118(C), pages 33-42.
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    1. Piquer-Martinez, Celia & Urionagüena, Amaia & Benrimoj, Shalom I. & Calvo, Begoña & Dineen-Griffin, Sarah & Garcia-Cardenas, Victoria & Fernandez-Llimos, Fernando & Martinez-Martinez, Fernando & Gaste, 2024. "Theories, models and frameworks for health systems integration. A scoping review," Health Policy, Elsevier, vol. 141(C).

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