Short reportThe acceptability and feasibility of task-sharing for mental healthcare in low and middle income countries: A systematic review
Introduction
According to the most recent WHO report, neuropsychiatric conditions contribute to approximately 14% of the global burden of disease (World Health Organisation, 2008). Furthermore there remains a substantial treatment gap, (Kohn, Saxena, Levav, & Saraceno, 2004) despite the existence of a wide range of treatments with proven effectiveness in low and middle income countries (LMIC) (Patel et al., 2007).
A major barrier to scaling up services is a shortage of human resources, for which task-sharing has been proposed as a strategy (Kakuma et al., 2011). Task-sharing is the process by which tasks are delegated to less specialised workers in order to use human resources more efficiently and increase capacity and health care coverage within a constrained budget. For mental health, non-specialist health and other workers have been trained to contribute to the detection, diagnosis, treatment, and prevention of various mental disorders (Kakuma et al., 2011). Preliminary results from a Cochrane review of the effectiveness of task-sharing interventions for mental health in LMIC have shown that individuals with no mental health background can deliver psychological treatments effectively with relatively little training and continued supervision (Van Ginneken et al., 2011, 2013).
To date no review has been conducted to assess the acceptability and feasibility of task-sharing mental health care. Feasibility may be challenged by factors such as time-constraints and number of workers available whilst the approach may not be acceptable to service users, carers and health care providers since mental health care is often complex and sensitive. This review summarises current findings and highlights barriers which tasking-sharing will need to overcome if it is to be scaled up as a strategy to reduce the treatment gap for mental disorders.
Section snippets
Methods
A full description of the methods is available in Supplementary File 1. In brief, five electronic databases were searched combining the concepts non-specialist workforce AND mental disorders AND LMIC and relevant organisations and experts were contacted. Titles and abstracts were screened and the full text copies of all potentially relevant studies examined to determine whether they met the pre-specified inclusion criteria. Both English language peer-reviewed and grey literature was included
Characteristics of included studies
A total of seventeen articles describing twenty-one studies met the eligibility criteria and were included in the review. Supplementary File 2 presents the flow chart for included studies and Supplementary File 3 provides full details of all included studies including a summary of their findings and quality assessment. Fifteen studies were published in peer-reviewed journals, while six were grey literature. Nearly all studies were conducted in either Africa or South Asia. The task-sharing
Discussion
This review aimed to explore the acceptability and feasibility of task-sharing interventions in LMIC through the experiences and perceptions of those involved. As a number of different factors affect the acceptability and feasibility of an intervention, it was not possible to distinguish whether some interventions were more acceptable or feasible than others. However synthesis of the available data allowed a number of broader conclusions regarding the characteristics of acceptable and feasible
Conclusion
Task-sharing has become a widely adopted strategy to scale-up mental health care in LMIC following a number of large trials demonstrating its effectiveness. However to date little emphasis has been placed on evaluating the acceptability and feasibility of these interventions. This review illustrates the complexity of both acceptability and feasibility and the importance of exploring them in depth. It concludes that task-sharing is not an outright solution for shortages of mental health
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