INTEGRATED IN NAME, FRAGMENTED IN PRACTICE: UNVEILING FACILITY-LEVEL DISPARITIES AND HEALTH SYSTEM INVESTMENT DEFICITS IN MENTAL HEALTH PRIMARY CARE INTEGRATION IN GHANA
Author(s)
Ebenezer O. Nkansah, MPhil.
Public Health and Health Services Management, Klintaps University College of Health and Allied Sciences, Accra, Ghana.
Public Health and Health Services Management, Klintaps University College of Health and Allied Sciences, Accra, Ghana.
OBJECTIVES: Ghana's Mental Health Act (2012) and National Mental Health Policy (2019-2030) mandate integration of mental health services (MHS) into primary health care (PHC). Yet despite a decade of reform, no empirical assessment has measured actual integration levels across PHC facility types in the Greater Accra Region (GAR). This study quantifies MHS integration across facility types, identifies structural and investment deficits driving integration failures, and generates actionable evidence for health system reform.
METHODS: An analytical cross-sectional study was conducted across 123 government-owned PHC facilities: hospitals (n=18), polyclinics (n=27), health centres (n=38), and CHPS compounds (n=40). Facility heads completed a structured questionnaire adapted from WHO and Mental Health Authority guidelines, assessing five domains: financing and infrastructure, service delivery, workforce capacity, community engagement, and data systems, scored 0-100%. One-way ANOVA with Tukey's HSD post-hoc tests examined facility-type differences (α=0.05).
RESULTS: Integration scores revealed that facility-type gradient (3,119) =24.73, p<0.001, η²=0.38). Hospitals achieved the highest mean score (68.0%), followed by polyclinics (65.0%) and health centres (62.0%). CHPS compounds serving Ghana's most vulnerable communities scored markedly lower (35.0%), with significant pairwise differences versus all other types (p=0.001). Data systems were the strongest domain (71.2%); workforce capacity was the weakest (28.8%). Critical deficits included near-absent mental health budgets (2.5-11.1%), minimal mhGAP training at CHPS (7.5% vs. 27.8% at hospitals), and unreliable psychotropic medicine supply (50.0% vs. 77.8%). Over three-quarters of CHPS compounds demonstrated low integration (<41.2%).
CONCLUSIONS: Ghana's integration agenda is strong on policy but fractured at the point of delivery. The stark CHPS-hospital disparity exposes systemic underinvestment in frontline community care. Achieving universal mental health coverage urgently requires targeted financing, workforce development, and supply chain strengthening at the community level. These findings provide the first facility-tier evidence base to guide Ghana's reform agenda and offer a replicable framework for mental health-PHC integration assessment across low- and middle-income countries.
METHODS: An analytical cross-sectional study was conducted across 123 government-owned PHC facilities: hospitals (n=18), polyclinics (n=27), health centres (n=38), and CHPS compounds (n=40). Facility heads completed a structured questionnaire adapted from WHO and Mental Health Authority guidelines, assessing five domains: financing and infrastructure, service delivery, workforce capacity, community engagement, and data systems, scored 0-100%. One-way ANOVA with Tukey's HSD post-hoc tests examined facility-type differences (α=0.05).
RESULTS: Integration scores revealed that facility-type gradient (3,119) =24.73, p<0.001, η²=0.38). Hospitals achieved the highest mean score (68.0%), followed by polyclinics (65.0%) and health centres (62.0%). CHPS compounds serving Ghana's most vulnerable communities scored markedly lower (35.0%), with significant pairwise differences versus all other types (p=0.001). Data systems were the strongest domain (71.2%); workforce capacity was the weakest (28.8%). Critical deficits included near-absent mental health budgets (2.5-11.1%), minimal mhGAP training at CHPS (7.5% vs. 27.8% at hospitals), and unreliable psychotropic medicine supply (50.0% vs. 77.8%). Over three-quarters of CHPS compounds demonstrated low integration (<41.2%).
CONCLUSIONS: Ghana's integration agenda is strong on policy but fractured at the point of delivery. The stark CHPS-hospital disparity exposes systemic underinvestment in frontline community care. Achieving universal mental health coverage urgently requires targeted financing, workforce development, and supply chain strengthening at the community level. These findings provide the first facility-tier evidence base to guide Ghana's reform agenda and offer a replicable framework for mental health-PHC integration assessment across low- and middle-income countries.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HSD80
Topic
Health Policy & Regulatory, Health Service Delivery & Process of Care, Organizational Practices
Disease
Mental Health (including addiction), No Additional Disease & Conditions/Specialized Treatment Areas