Developing a regional mental health plan for Dar es Salaam, Tanzania: Results from a situational analysis, qualitative inquiry, and stakeholder engagement process

Mental health services in sub-Saharan Africa, including Tanzania, are little studied and hence challenges and opportunities are not well known, leading to difficulties in improving access to, and quality of, services to those in need. 1. To conduct a situational analysis of mental health services in Dar es Salaam region, 2. To consult with key stakeholders on mental health services delivery and planning, and 3. To develop a regional mental health services plan. This was a mixed-methods study, using the PRIME situational analysis tool which provided a quantitative overview of mental health service needs, resources and activities. We conducted individual in-depth interviews (IDI, n=5) with regional mental health service managers, and focus group discussions (FGD, n=7) with 29 mental healthcare workers at primary healthcare facilities. We led a workshop with regional mental health service managers to discuss findings and to develop a regional mental healthcare services plan. The situational analysis identified a large burden of mental health care needs, but also a variety of health care services and providers in the region. The IDIs and FGDs found inadequate health facilities and staff providing mental health services, ineffective implementation of mental health policy regarding user fee exemptions and cost sharing, stigma in the community, and low community awareness. The financial burden on patients, and inappropriate referrals, were lower if patients were covered by health insurance, but health insurance had limitations regarding medication provision. The regional mental health plan proposed to strengthen mental health services, by integrating them into primary health care facilities, training health providers and other workers on mental health issues, strengthening referral systems, and increasing government and social insurance funding. Despite barriers hindering mental health service provision in Dar es Salaam, there are positive factors which could potentially make mental health delivery more effective and sustainable. Financial and human resource constraints will limit such developments. Implementation of the regional plan will require ongoing engagement with stakeholders, but it has the potential to increase access to and quality of mental health care in the region. • The Dar es Salaam regional mental health care system in Tanzania has a complex variety of resources as well as significant barriers to access and quality. • This study combines diverse evidence from scientific publications, reports, and stakeholders’ subjective perspectives to inform the development of a feasible, locally relevant mental health plan. • A strong regional mental health plan can potentially be achieved by engagement with and collaboration among stakeholders. • Training a wider range of health staff on mental health issues may increase access to mental health services for those in need.