Table 3 Frequency with which participants agreed with health system factors likely to facilitate/impede integration (N = 413)
Facilitators by building blocks | n (%) | Â | Barriers by building blocks | n (%) |
|---|---|---|---|---|
Governance | ||||
Health managers’ commitment to integration | 301(72.9) |  | Lack of mental health priority | 113(27.4) |
Task sharing among stakeholders | 218(52.8) | Â | Complex programs to implement | 290(70.2) |
Presence of a mental health service coverage plan | 98(23.7) | Â | Lack of mental health referent | 96(23.2) |
Accessible integration guidelines | 112(27.1) | Â | Top-down Approach to Integration Program Design | 103(24.9) |
| Â | Â | Â | Lack of clear national guidelines for integration | 107(25.9) |
Human resources | ||||
Sufficient number of nonspecialist providers | 299(72.4) | Â | Lack of specialists to mentor PCPs | 246(59.6) |
Availability of specialists to coach PCPs | 221(53.5) | Â | Low retention rate of trained of health professionals | 306(74.1) |
Presence of multidisciplinary teams | 73(17.7) | Â | Fear of misdiagnosis | 54(13.1) |
| Â | Â | Â | Sporadic visits by specialists to mentor PCPs | 62(15.0) |
Medicines and technologies | ||||
Sustainable Drug Supply | 202(48.9) | Â | Lack of psychotropic medicines | 211(51.1) |
Simple treatment regimen | 197(47.7) | Â | Complex treatment regimens | 31(7.5) |
Dedicated mental health workstation | 154(37.3) | Â | Lack of mental health equipment | 64(15.5) |
| Â | Â | Â | Lack of Diagnostic and Treatment Guidelines | 99(24.0) |
| Â | Â | Â | Absence of a means of transport | 94(22.8) |
Service delivery | ||||
Primary care services prepared for integration | 49(11.9) | Â | Weakness of public health facilities | 269(65.1) |
Positive attitudes toward the provision of mental health care | 42(10.2) | Â | Beliefs linked to the efficacy of traditional medicine | 280(67.8) |
| Â | Â | Â | Inability to diagnose and treat | 65(15.7) |
| Â | Â | Â | Exclusion of other caregivers from the care process | 55(13.3) |
Financing | ||||
Existence of financial support from development partners | 218(52.8) | Â | Lack of funding for integration | 232(56.2) |
Expectations of free mental health care | 308(74.6) | Â | Belief that an out-of-pocket payment will be applied | 275(66.6) |
Financial incentives for healthcare providers | 294(71.2) | Â | Cost of recruiting new mental health specialists | 109(26.4) |
| Â | Â | Â | Low financial motivation of specialists | 86(20.8) |
Information | ||||
Existence of mental health indicators in the NHIS | 209(50.6) | Â | Lack of reporting tools | 277(67.1) |
Health services connected to DHIS2 | 71(17.2) | Â | Lack of a mental health connection to DHIS2 | 199(48.2) |
Clearly defined list of indicators | 49(11.9) | Â | Â | Â |
Infrastructure | ||||
Extension of existing healthcare facilities | 331(80.1) | Â | Narrowness Health Centers and District Hospitals | 266(64.4) |
Building new psychiatric hospitals | 198(47.9) | Â | Private ownership of many health facilities | 230(55.7) |
| Â | Â | Â | No dedicated mental health consultation room | 201(48.7) |