South Africa’s PHC Mental Health Human Resources: A Situation Analysis And Call For Innovative Task-shifting

Objectives
The findings of a mental health (MH) audit comprising of 160 (98%) of South Africa's (SA) public rural primary healthcare
(PRPHC) facilities are presented.
Setting
These data provide the first national estimates of the human resources and services available to address the MH needs
of over 17 million rural South Africans, reliant on PRPHC facilities. With personnel regarded as the most valuable
resource for service delivery within a MH system, this reviews aim was to inform policy on bridging the mental illness
treatment gap that is as high as 85% in low-and middle income countries, and even higher in its rural areas.
Methodology
The review was based on the analysis of both primary and secondary data. Primary data was collected by subjecting the
clinical heads of PRPHC facilities to an interview schedule while secondary data comprised of a desk review.
Results
Results indicate that MH nurses (MHNs), clinical psychologists, MH medical doctors (MHMDs) and psychiatrists are
practicing in PRPHC areas at rates of 0.68, 0.47, 0.37 and 0.03 per 100 000 population respectively; 96% of facilities do
not have psychiatrists employed while 81% have no MHMDs, 64% do not have clinical psychologists and 61% have no
MHNs; 69% do not receive specialist MH outreach services while 78% do not have MH multidisciplinary teams.
Conclusion
Opportunities to address the severe MH workforce shortages in PRPHC areas are discussed in terms of the evidence
based approaches of task-shifting and transdisciplinarity.
References
World Health Organization. Task shifting: rational redistribution of tasks among health workforce teams: global
recommendations and guidelines. World Health Organization 2008:1-82.
Patel V, Maj M, Flisher AJ, et al. Reducing the treatment gap for mental disorders: a WPA survey. World Psychiatry:
Official Journal Of The World Psychiatric Association (WPA). 2010;9(3):169-176.