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Citation Information

Type Report
Title Maternal Mental Health in the Context of Community-based Home Visiting in a Re-engineered Primary Health Care System: A Case Study of the Philani Mentor Mothers Programme
Author(s)
Publication (Day/Month/Year) 2014
URL http://opendocs.ids.ac.uk/opendocs/bitstream/handle/123456789/3777/ER67 Maternal Mental Health in​the Context of Community Based Home Visiting in a Re-engineered Primary Health Care System A Case​Study of the Philani Mentor Mothers Programme.pdf
Abstract
This document constitutes a briefing summary of the case study of a maternal mental health
intervention in South Africa, the Philani Mentor Mothers Programme. The case study has
been compiled by Professor Mark Tomlinson at Stellenbosch University as a contribution to
the Empowerment of Women and Girls theme of the Accountable Grant at the Institute of
Development Studies. In particular, it relates to the sub-theme that focuses on the health of
women and girls in rapidly urbanising settings in South Africa and Kenya. The case study in
this sub-theme discusses the particular health conditions that have been identified to affect
women and girls in low-income urban settings, with a focus on identifying key ‘good practice’
and cutting edge interventions.
Community health workers (CHWs) are increasingly being identified as a potential vehicle for
strengthening community-based care, especially for maternal, newborn and child health. It is
estimated that globally there are currently more than 40 million CHWs (Lewin et al. 2010),
and there have been recent calls for one million CHWs in sub-Saharan Africa by 2015 (Singh
and Sachs 2013). Most research evaluating the impact of CHW programmes has been
limited to small and short-term interventions in heavily resourced research settings
(Haines et al. 2007). Larger scale CHW programmes have been hindered by barriers to
effective scale-up. Among other things, large-scale programmes are frequently undermined
by high attrition and low activity levels of CHWs, which are less likely in smaller scale
initiatives where supervision is often more intense and consistent (Walt et al. 1989).
In global health, the extent to which the gap can be bridged between small-scale efficacy
studies and effective interventions at scale will depend on a number of factors:
? Holistic programmes that target the broader health concerns of women, families and
children such as mental health interventions, particularly in light of the fact that mental
and behavioural disorders account for 22.7 per cent of all years lived with disability
(Vos et al. 2012);
? While the use of CHWs has achieved many successes (Baqui et al. 2008; Rahman
2008), the system has also been characterised by a lack of consistent supervision
and linkages to the health system (Walley et al. 2008; Haines et al. 2007).
? An enabling policy environment that facilitates the successful completion of tasks
across the maternal and child health continuum of care.
In this paper Professor Tomlinson argues that unless we begin to examine the ‘how’ rather
than the ‘what’ of interventions or, as McCoy and colleagues (2010) describe, moving from
knowledge of what works to systems that deliver, we will not be able to improve holistic
population health in low-middle income countries (LMIC). This summary describes the
context of global health, mental health in South Africa, and a case study of a generalist
health intervention (with a maternal mental health component) by a South African
non-governmental organisation (NGO), Philani, within the current fluid South African health
system. It analyses what the Philani experience has to offer in terms of lessons to surmount
the significant obstacles to holistic and equitable health care delivery that exist in South
Africa and elsewhere. This document constitutes a briefing summary of the case study of a maternal mental health
intervention in South Africa, the Philani Mentor Mothers Programme. The case study has
been compiled by Professor Mark Tomlinson at Stellenbosch University as a contribution to
the Empowerment of Women and Girls theme of the Accountable Grant at the Institute of
Development Studies. In particular, it relates to the sub-theme that focuses on the health of
women and girls in rapidly urbanising settings in South Africa and Kenya. The case study in
this sub-theme discusses the particular health conditions that have been identified to affect
women and girls in low-income urban settings, with a focus on identifying key ‘good practice’
and cutting edge interventions.
Community health workers (CHWs) are increasingly being identified as a potential vehicle for
strengthening community-based care, especially for maternal, newborn and child health. It is
estimated that globally there are currently more than 40 million CHWs (Lewin et al. 2010),
and there have been recent calls for one million CHWs in sub-Saharan Africa by 2015 (Singh
and Sachs 2013). Most research evaluating the impact of CHW programmes has been
limited to small and short-term interventions in heavily resourced research settings
(Haines et al. 2007). Larger scale CHW programmes have been hindered by barriers to
effective scale-up. Among other things, large-scale programmes are frequently undermined
by high attrition and low activity levels of CHWs, which are less likely in smaller scale
initiatives where supervision is often more intense and consistent (Walt et al. 1989).
In global health, the extent to which the gap can be bridged between small-scale efficacy
studies and effective interventions at scale will depend on a number of factors:
? Holistic programmes that target the broader health concerns of women, families and
children such as mental health interventions, particularly in light of the fact that mental
and behavioural disorders account for 22.7 per cent of all years lived with disability
(Vos et al. 2012);
? While the use of CHWs has achieved many successes (Baqui et al. 2008; Rahman
2008), the system has also been characterised by a lack of consistent supervision
and linkages to the health system (Walley et al. 2008; Haines et al. 2007).
? An enabling policy environment that facilitates the successful completion of tasks
across the maternal and child health continuum of care.
In this paper Professor Tomlinson argues that unless we begin to examine the ‘how’ rather
than the ‘what’ of interventions or, as McCoy and colleagues (2010) describe, moving from
knowledge of what works to systems that deliver, we will not be able to improve holistic
population health in low-middle income countries (LMIC). This summary describes the
context of global health, mental health in South Africa, and a case study of a generalist
health intervention (with a maternal mental health component) by a South African
non-governmental organisation (NGO), Philani, within the current fluid South African health
system. It analyses what the Philani experience has to offer in terms of lessons to surmount
the significant obstacles to holistic and equitable health care delivery that exist in South
Africa and elsewhere.

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