Care delivery in the context of district mental healthcare plans (DMHP) in Ghana: experiences of primary healthcare workers and service users.

BackgroundThe integration of mental healthcare into primary healthcare services is an effective way to addressing the substantial treatment gap for mental health conditions in low- and middle-income (LMIC) countries. In Ghana, District Mental Healthcare Plans (DMHPs) were developed and implemented in three districts over a 2-year period. This study aimed to explore the perceptions and experiences of mental health service users and primary healthcare workers regarding the implementation of the DMHPs. MethodsThe study employed a qualitative design involving in-depth interviews with 32 service users and 28 primary healthcare providers in the three demonstration districts. Participants were purposively sampled. Interview data were analysed using reflexive thematic analysis combining inductive and deductive approaches. ResultsThree main themes were identified: 1) Factors supporting DMHP implementation, including capacity building, collaboration, awareness creation, and acceptability; 2) Challenges impacting DMHP implementation, such as inadequate resources and medication shortages; and 3) Impacts of the DMHPs, including improved access to care, reduced relapse, enhanced daily functioning, and reduced stigma. Some district-level variations were noted in the intensity of challenges and impacts. ConclusionThe DMHPs showed promise in improving mental healthcare in primary care settings in Ghana. However, addressing resource constraints and medication shortages, and sustaining capacity building and awareness creation efforts, will be crucial for successful scale-up. The perspectives of service users and healthcare providers offer valuable insights for policy makers and practitioners aiming to enhance integrated mental healthcare. Strengths and limitations of this study{Rightarrow} This study is the first in Ghana to explore in-depth the experiences of healthcare workers and service users in implementation of DMHPs. {Rightarrow}Using qualitative design provide more nuanced understanding of factors supporting implementation of DMHP which would have been more difficult to do using quantitative methods. {Rightarrow}The study reported from a relatively small sample size from only 3 districts from 261 districts in Ghana. While this sample size provided valuable insights, it may not cover the wide and diverse experiences of healthcare workers and service users involved in the DMHPs.