From
mapping to strengthening
Dr Simphiwe RN Simelane (MBChB, BSc(Med)Hons, UCT) PhD student
Centre for Autism Research in Africa Department of Psychiatry
University of Cape Town
How big is the problem?
Mental disorders are a leading cause of morbidity in young people
No good prevalence data
Estimated that 10-20%, conservative estimate of 10%
Approximately 2 million South African children
Falling into the (treatment) gap
• Huge discrepancy between
• Proportion of population with disorder (prevalence)
• Proportion of those that receive care
• Worse LMICs
• Worse for children and adolescents
• Mental health treatment gap in SA 90%
• Only 1 in 10 who need
care receive it
What is the current situation in the Western Cape?
Service delivery
• No dedicated CAMH services at secondary level
• No specialist CAMH services in rural districts
• No psychosocial treatments at primary and secondary level
Health workforce
• No documentation of training of primary care staff
Information systems
• No disaggregated and accessible information
Access to essential medicines
• Access to at least one drug each class
Financing
• No dedicated financing for CAMH
Leadership and governance
• Outdated policy (2003), no implementation plans
• Newly appointed CAMH provincial lead
Adapted from Mokitimi et al., 2021
Where do
we begin?
Health systems approach
Service delivery Health workforce Health information systems
Access to essential medicines and
technologies
Financing Leadership/governance
Mental health systems are “wicked problems”
Health systems are complex adaptive systems Fuzzy boundaries
Requires systems thinking
Solution cannot be linear
Systems thinking • “Problems" as part of a wider, dynamic system
• Shifts focus to
• Nature of relationships among the building blocks
• Spaces between the blocks
• Synergies emerging
from interactions among the blocks
• Stakeholders seen as a the
actors driving the system
Participatory approach
• Who are the players
• Dept of Health
• Health care providers
• Researchers
• Policy makers
• Dept of Education
• Dept of Social Development
• Dept of Justice/Correctional services
• South African Police Services
• Private, Public and NPO
The often forgotten
stakeholder
Figure 2: Different roles of service users in health systems, adapted
from Frenk et al., 2010
What is the next step-
the future
funnel
What is being done in other LMIC settings
Service delivery
• Task shifting and public education
• School based programmes
• Digital support systems
Health workforce
• Validating screening tools
• Training of non-specialist providers
Access to essential medicines and technologies Financing
• Different financing models (PRIME)
• Economic strengthening (cash transfers)
Leadership/governance
Simelane and de Vries, 2021.
Messy problems, complex solutions
• Not a straightforward process
• Needs all the voices to be heard
• Combination of bottom up and top down strategies
• Tackle the problem from different angles
• Coordination and communication about work being done
• Buy in from policymakers, providers and users
Acknowledgements
Petrus J de Vries, Supervisor
Department of Psychiatry, University of Cape Town
SAMRC RCD Clinician Researcher Pogramme University of Cape Town Accelerated
Transformation Academic Programme
References
• Kieling, C. et al. Child and adolescent mental health worldwide: evidence for action. Lancet 378, 1515–1525 (2011).
• Gilson, L., for Health Policy, A., Research, S. & Organization, W. H. Health policy and systems research : a methodology reader / edited by Lucy Gilson. 18 p. (2012).
• Organization WH. Mental health atlas 2020 [Internet]. Geneva PP - Geneva: World Health Organization; Available from:
https://apps.who.int/iris/handle/10665/345946
• Simelane SRN, de Vries PJ. Child and adolescent mental health services and systems in low and middle-income countries: from mapping to strengthening. Curr Opin Psychiatry. 2021;34(6):608–16.
• Docrat S, Besada D, Cleary S, Daviaud E, Lund C. Mental health system costs, resources and constraints in South Africa: a national survey. Health Policy Plan. 2019;34(9):706–19.
• Mokitimi S, Schneider M, de Vries PJ. A situational analysis of child and adolescent mental health services and systems in the Western Cape Province of South Africa. Child Adolesc Psychiatry Ment Health.
2022;16(1):1–22.
• Frenk, J. (2010) ‘The global health system: Strengthening national health systems as the next step for global progress’, PLoS Medicine, 7(1), pp.
2008–2010. doi: 10.1371/journal.pmed.1000089.
Questions?
Academy of Science of South Africa (ASSAf)
ASSAf Research Repository http://research.assaf.org.za/
B. Academy of Science of South Africa (ASSAf) Events I. Other
2022
Priorities for child and adolescent
mental health research and services in South Africa
Academy of Science of South Africa (ASSAf)
Academy of Science of South Africa (ASSAf)
Academy of Science of South Africa (ASSAf), (2022). Priorities for child and adolescent
mental health research and services in South Africa. [Online] Available at: http://hdl.handle.net/20.500.11911/237 https://youtu.be/CoOEpxPzHJs
Downloaded from ASSAf Research Repository, Academy of Science of South Africa (ASSAf)
