Training needs and perspectives of community health workers in relation to integrating child mental health care into primary health care in a rural setting in sub-Saharan Africa: a mixed methods study.
BACKGROUND
Community health workers can help to address the substantial unmet need for child mental health care in low and middle income countries. However, little is known about their training needs for this potential role. The aim of this study was to examine training needs and perspectives of community health extension workers (HEWs) in relation to providing child mental health care in rural Ethiopia.


METHODS
The study was conducted in the Southern Nations, Nationalities and Peoples' Region of Ethiopia. A mixed methods approach was used. A total of 104 HEWs who had received training in child mental health using the Health Education and Training (HEAT) curriculum were interviewed using a structured survey. In-depth interviews were then conducted with 11 HEWs purposively selected on the basis of the administrative zone they had come from. A framework approach was used for qualitative data analysis.


RESULTS
Most of the HEWs (88.5%; n = 93/104) reported that they were interested in the training provided and all respondents considered child mental health to be important. The perceived benefits of training included improved knowledge (n = 52), case identification (n = 14) and service provision (n = 22). While most of the participants had their training four months prior to the interview, over a third of them (35.6%; n = 37) had already organized mental health awareness-raising meetings. Participants in the qualitative interviews considered the problem of child mental disorders to be widespread and to cause a large burden to the family and the affected children. They reported that improving their competence and knowledge was important to address the problem and to tackle stigma and discrimination. Participants also listed some barriers for service provision, including lack of competence, stigma and institutional constraints. Opportunities mentioned included staff commitment, high levels of interest and a positive attitude towards providing the service.


CONCLUSIONS
Although the HEAT training on child mental health was brief, it appears to have had some impact in improving knowledge and care provision. If the key barriers to service provision are addressed and supported by policy guidance, community health workers may contribute substantially in addressing the treatment gap for children with mental health needs.
Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, PO 9086, Addis Ababa, Ethiopia.|Department of Health Education and Behavioural Sciences, College of Public Health and Medical Science, Jimma University, Jimma, Ethiopia.
Dejene
D
Tilahun
Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, PO 9086, Addis Ababa, Ethiopia.|Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, King's College London, London, UK.
Charlotte
0000-0002-7937-3226
C
Hanlon
Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, PO 9086, Addis Ababa, Ethiopia.
Mesfin
M
Araya
Department of Life, Health and Chemical Sciences, The Open University, Milton Keynes, UK.
Basiro
B
Davey
Department of Life, Health and Chemical Sciences, The Open University, Milton Keynes, UK.|Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Rosa A
RA
Hoekstra
Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, PO 9086, Addis Ababa, Ethiopia.|Centre for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.|Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Centre for Affective Disorders, King's College London, London, UK.
Abebaw
A
Fekadu
Africa; Community health workers; Developing countries; Developmental disabilities; Ethiopia; Primary health care