Barriesr to the Utilisation of Mental Health Services in Zambia
Date
2016
Authors
Munakampe, Margarate
Journal Title
Journal ISSN
Volume Title
Publisher
University of Zambia
Abstract
Globally, mental health is recognised as an important component of health. However, it is one of
the most neglected areas in the health sector. Poor mental health has been linked to low socioeconomic
status. With many Zambians living in poverty, susceptibility to these conditions is high.
While Lusaka has better mental health services than any other province, under-utilisation has been
reported. The situation can only be much worse in other provinces and rural areas with limited
access to services at primary level. The aim of this study was to explore the barriers to the
utilisation of mental health services in Zambia at policy, facility and individual level.
A concurrent triangulation study was done in 2015; comprising a household survey of 270
participants from Chilenje Township in Lusaka and a qualitative case study of 12 participants
including health workers, patients’ family members and policy makers. The case study was
conducted in 2 secondary health facilities, a tertiary mental health facility and the Ministry of
Health. Data was collected using questionnaires and interview guides. Proportions and logistic
regression were used to analyse survey data while thematic analysis was used to analyse qualitative
data.
Inadequate financing to mental health services was observed as the main barrier to utilisation of
services across the different levels investigated. Late detection of mental health conditions was
attributed to little knowledge and low awareness about conditions, sometimes leading to relapse.
Those knowledgeable about mental health conditions were over 3 times more likely to utilise
services than those who were not (OR 3.1 95% CI, p=0.006). Knowledge could have led to
utilisation or vice versa. Stigma from the community and health care providers and visits to
traditional healers were also reported. There was a strong association between utilisation of services
and stigma from health care personnel (OR 13.6 95% CI p< 0.001). A weak referral system was
reported as well as lack of services at primary level. This was attributed to few health workers
trained in managing mental health conditions despite undergoing basic training. The existing
referral system and low levels of awareness in the community were also linked to overcrowding in
secondary facilities.
Overall, mental health services are hindered by inadequate financing, stigma and low prioritisation
at facility level. As such, there is lack of services at primary level creating a pattern of utilisation
that begins at secondary level. There is need to improve financing for mental health as well as
strengthen efforts to educate the community about mental health and mental health conditions.
Also, the stipulated referral system needs to be reinforced so as to strengthen service provision at
primary level. Most health care providers have basic knowledge that allows them to do so.
Key words: mental health services, barriers, health service utilisation, utilization, Zambia,
community stigma, health care provider stigma
Description
M Public Health
Keywords
Mental health services--Utilization--Zambia