Facilitators and barriers of integrating traditional medicine and mental health services in the Accra metropolis, Ghana
- Batuuroh Isla Paschal Soori(Author),
- Ioannis Pappas(Supervisor),
- Krishna Regmi(Supervisor)
Student Thesis:
Student thesis
Doctoral thesis
About the thesis
Background
The African Union and the World Health Organization have championed the integration of traditional medicine and mainstream medicine in African health systems as a way of addressing the increasing health demands in Africa with mixed results. Nonetheless, there are gaps in the literature regarding the factors that influence the integration of traditional medicine and mainstream medicine in inpatient mental health services in Ghana. These gaps include the use of the unified conceptual framework for integrated care, based theoretically on the need for all integration activities of care to be coordinated and collaborated across the whole health system to achieve integration. The choice of Ghana in this research was because Ghana has arguably made some considerable progress in integrating traditional medicine and mainstream medicine in her health system. Notwithstanding this, integration discussions are often lopsided in the various publications, in favour of traditional medicine use in the physical health sector and to a lesser degree in community mental health services to the neglect of inpatient mental health services. This is in the context that out of the estimated population of 31 million people in Ghana, it was estimated that 3.1 million people have some sort of mental disorder, and some may require in inpatient mental health services in Ghana.
Aim of the study
Therefore, the aim of this study was to produce a framework of knowledge for
understanding the factors that influence the integration of traditional medicine and mainstream medicine in inpatient mental health services in Ghana.
Methods
The whole study was made up of three phases: Phase 1, was made of two parts, which involved conducting and the presentation of the findings of a narrative review of the literature (Phase 1A), and the other part entailed conducting and the presentation of the findings of a systematic review (Phase 1B). While, Phase 2 involved the conducting and presentation of the findings from a case study in the Accra Psychiatric Hospital. Finally, Phase 3, employed the unified conceptual framework for integrated care and the and hermeneutic phenomenology methodology, to discuss the combined findings from phases one and two.
The narrative review was conducted on the facilitators and barriers to the integration of traditional medicine into mental health services in Africa. Hence, 22 records were included for the narrative review because they met the eligibility criteria. While the systematic review was conducted to identify, synthesise and critically appraise evidence on the facilitators and barriers of traditional medicine and mainstream medicine integration in mental health services in West Africa. Thus 14 studies out of 6,413 studies were included for the systematic review because they met the eligibility criteria. The case study in Phase 2, which was a qualitative study, explored the facilitators and barriers to the integration of traditional medicine and mainstream medicine in the inpatient Accra Psychiatric Hospital through the lived experiences of: service users, healthcare professionals and policymakers/administrators, with data gathered through face-to-face semi-structured interviews. The fieldwork for this primary study was conducted from July to September 2023, where data were collected from 36 research participants who were interviewed, and the data included in this case study.
Findings
The key findings of the study, from Phase 3 were pooled using thematic analysis and synthesis, as a result several factors could arguably work as facilitators and barriers to the integration of traditional medicine and mainstream medicine in inpatient mental health services in Ghana. These facilitators or barriers included, attending to, or providing policies and their implementation; the different philosophies or conceptualisation of mental health, education and training, treatment safety; inter-and intra-professional and inter-and intra-organisational collaboration and working. Also, other factors that influenced integration, included, the issue of acceptance of traditional medicine, and service user and prescriber preferences. Also noted, were the absence of the use of conceptual frameworks for integration, and the absence of a fixed meaning of traditional medicine , and also the lack of a standard meaning for the integration of traditional medicine and mainstream medicine in mental health services. However, the prime finding of the study was that, the presence or absence of policy on integration was instrumental in determining how all the other factors (findings) from the study worked as facilitators and barriers. This was because policy can affect positively or negatively the expressions of these other factors, and how they impact integration at all levels of the health system. Some findings were common in both phases one and two, and others were not. This was partly a testament to the fact that integration to some degree can be location or setting specific - and due to a variety of circumstances. Though policy was a key player influencing the integration of traditional medicine and mainstream medicine, it has to be seen in the context of the likely challenges that confront the introduction of policy.
Conclusion
The factors that influence the integration of traditional medicine and mainstream medicine in the inpatient Accra Psychiatric Hospital were diverse. However, the presence or absence of policy on integration impacted all other factors of integration. The study thus, noted that there was no integration of traditional medicine and mainstream medicine in the inpatient Accra Psychiatric Hospital.
Notwithstanding this, no complete generalisable conclusions could be made from this study, however, this research produced a framework of knowledge for understanding traditional medicine and mainstream medicine integration in inpatient mental health services in Ghana, as such, has vital implications for policy, organisations and practice.
The African Union and the World Health Organization have championed the integration of traditional medicine and mainstream medicine in African health systems as a way of addressing the increasing health demands in Africa with mixed results. Nonetheless, there are gaps in the literature regarding the factors that influence the integration of traditional medicine and mainstream medicine in inpatient mental health services in Ghana. These gaps include the use of the unified conceptual framework for integrated care, based theoretically on the need for all integration activities of care to be coordinated and collaborated across the whole health system to achieve integration. The choice of Ghana in this research was because Ghana has arguably made some considerable progress in integrating traditional medicine and mainstream medicine in her health system. Notwithstanding this, integration discussions are often lopsided in the various publications, in favour of traditional medicine use in the physical health sector and to a lesser degree in community mental health services to the neglect of inpatient mental health services. This is in the context that out of the estimated population of 31 million people in Ghana, it was estimated that 3.1 million people have some sort of mental disorder, and some may require in inpatient mental health services in Ghana.
Aim of the study
Therefore, the aim of this study was to produce a framework of knowledge for
understanding the factors that influence the integration of traditional medicine and mainstream medicine in inpatient mental health services in Ghana.
Methods
The whole study was made up of three phases: Phase 1, was made of two parts, which involved conducting and the presentation of the findings of a narrative review of the literature (Phase 1A), and the other part entailed conducting and the presentation of the findings of a systematic review (Phase 1B). While, Phase 2 involved the conducting and presentation of the findings from a case study in the Accra Psychiatric Hospital. Finally, Phase 3, employed the unified conceptual framework for integrated care and the and hermeneutic phenomenology methodology, to discuss the combined findings from phases one and two.
The narrative review was conducted on the facilitators and barriers to the integration of traditional medicine into mental health services in Africa. Hence, 22 records were included for the narrative review because they met the eligibility criteria. While the systematic review was conducted to identify, synthesise and critically appraise evidence on the facilitators and barriers of traditional medicine and mainstream medicine integration in mental health services in West Africa. Thus 14 studies out of 6,413 studies were included for the systematic review because they met the eligibility criteria. The case study in Phase 2, which was a qualitative study, explored the facilitators and barriers to the integration of traditional medicine and mainstream medicine in the inpatient Accra Psychiatric Hospital through the lived experiences of: service users, healthcare professionals and policymakers/administrators, with data gathered through face-to-face semi-structured interviews. The fieldwork for this primary study was conducted from July to September 2023, where data were collected from 36 research participants who were interviewed, and the data included in this case study.
Findings
The key findings of the study, from Phase 3 were pooled using thematic analysis and synthesis, as a result several factors could arguably work as facilitators and barriers to the integration of traditional medicine and mainstream medicine in inpatient mental health services in Ghana. These facilitators or barriers included, attending to, or providing policies and their implementation; the different philosophies or conceptualisation of mental health, education and training, treatment safety; inter-and intra-professional and inter-and intra-organisational collaboration and working. Also, other factors that influenced integration, included, the issue of acceptance of traditional medicine, and service user and prescriber preferences. Also noted, were the absence of the use of conceptual frameworks for integration, and the absence of a fixed meaning of traditional medicine , and also the lack of a standard meaning for the integration of traditional medicine and mainstream medicine in mental health services. However, the prime finding of the study was that, the presence or absence of policy on integration was instrumental in determining how all the other factors (findings) from the study worked as facilitators and barriers. This was because policy can affect positively or negatively the expressions of these other factors, and how they impact integration at all levels of the health system. Some findings were common in both phases one and two, and others were not. This was partly a testament to the fact that integration to some degree can be location or setting specific - and due to a variety of circumstances. Though policy was a key player influencing the integration of traditional medicine and mainstream medicine, it has to be seen in the context of the likely challenges that confront the introduction of policy.
Conclusion
The factors that influence the integration of traditional medicine and mainstream medicine in the inpatient Accra Psychiatric Hospital were diverse. However, the presence or absence of policy on integration impacted all other factors of integration. The study thus, noted that there was no integration of traditional medicine and mainstream medicine in the inpatient Accra Psychiatric Hospital.
Notwithstanding this, no complete generalisable conclusions could be made from this study, however, this research produced a framework of knowledge for understanding traditional medicine and mainstream medicine integration in inpatient mental health services in Ghana, as such, has vital implications for policy, organisations and practice.