Integration of mental health into primary health care in Uganda: opportunities and challenges

Abstract

Background Worldwide, a number of reforms have been undertaken with the intention of improving access to mental health services. Notable among these is the integration of mental health services into primary health care, which has been one of the most fundamental healthcare reform recommendations globally.Objectives This paper describes the opportunities for and challenges to the integration of mental health into primary health care in Uganda, as identified in a wider study, aimed at exploring the policy interventions required to address the vicious cycle of mental ill-health and poverty.Methods Semi-structured interviews and focus group discussions (FGDs) were conducted with purposefully selected mental health stakeholders from various sectors. The interviews and FGDs were audio-recorded, and transcripts coded on the basis of a pre-determined coding frame. Thematic analysis of the data was conducted using NVivo7, adopting a framework analysis approach.Results The participants identified a number of opportunities that could be exploited to strengthen the integration process. Notable among these was the political will and prioritisation of mental health at policy level. Poor appreciation of the integration process and attitudinal problems emerged as the most pressing challenges for integration of mental health into primary health care.Conclusion Irrespective of the various opportunities in place, the integration of mental health into primary health care has not yet been fully realised, as it faces a number of challenges within and outside the health sector. This calls for more concerted efforts to scale up activities for effective integration of mental health care into primary health care.