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A framework to facilitate the implementation of mental health service task-shifting from medical practitioners to registered nurses in primary care settings in the Khomams region, Namibia
Thesis (PhD)--Stellenbosch University, 2025.
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Stellenbosch : Stellenbosch University
2025
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| author | Ashipala, Daniel Opotamutale |
| author2 | Mayers, Pat |
| author_browse | Ashipala, Daniel Opotamutale Mayers, Pat |
| author_facet | Mayers, Pat Ashipala, Daniel Opotamutale |
| author_sort | Ashipala, Daniel Opotamutale |
| collection | Thesis |
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Thesis (PhD)--Stellenbosch University, 2025. |
| format | Thesis |
| id | oai:scholar.sun.ac.za:10019.1/132048 |
| institution | Stellenbosch University (South Africa) |
| last_indexed | 2026-06-10T12:43:36.943Z |
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| publishDate | 2025 |
| publishDateRange | 2025 |
| publishDateSort | 2025 |
| publisher | Stellenbosch : Stellenbosch University |
| publisherStr | Stellenbosch : Stellenbosch University |
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| spelling | oai:scholar.sun.ac.za:10019.1/132048 A framework to facilitate the implementation of mental health service task-shifting from medical practitioners to registered nurses in primary care settings in the Khomams region, Namibia Ashipala, Daniel Opotamutale Mayers, Pat van der Merwe, Anita Young, Cornelle Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing and Midwifery. Mental health services -- Namibia Primary health care -- Mental health services -- Namibia Mental health facilities -- Employees UCTD Thesis (PhD)--Stellenbosch University, 2025. Ashipala, D. O. 2025. A Framework to facilitate the implementation of mental health service task-shifting from medical practitioners to registered nurses in primary care settings in the Khomams region, Namibia. Unpublished doctoral dissertation. Stellenbosch: Stellenbosch Univeristy [online]. Available: https://scholar.sun.ac.za/items/691f351b-eb51-420a-a396-02b3b781042e ENGLISH SUMMARY: Introduction: The shortage of health workers in Namibia is a significant barrier to accessing mental health treatment. The absence of mental health care in primary health services has important implications for the Namibian population. Mental health conditions are among the leading causes of disability and morbidity in Namibia, yet only a small percentage of the population receives adequate care. To address these shortages and enhance healthcare access, adopting evidence-based task-sharing or task-shifting strategies, where nonspecialists provide healthcare, has been effectively implemented globally and has shown success in managing HIV. However, there is limited knowledge and implementation of such strategies in the context of Namibia, leaving a knowledge gap that needs to be addressed. Aim: The study aimed to develop a framework in collaboration with stakeholders, that is, registered nurses and medical practitioners to implement mental healthcare task shifting from medical practitioners to registered nurses in primary healthcare (PHC) settings in the Khomas Region, Namibia. The objectives were to: • Conduct a qualitative scoping review in order to identify the strengths, weaknesses, opportunities, and threats (SWOT) relating to a mental healthcare task shifting approach from medical practitioners to registered nurses in PHC settings in Africa and low- and middle-income countries. • Explore the barriers and facilitators to a mental healthcare task shifting approach as perceived by registered nurses and medical practitioners working in PHC settings. • Conduct a survey of the existing scope of practice for registered nurses working in PHC facilities, as well as their training needs, job descriptions, access to and use of relevant policies, supervision, and support. • Develop a framework in collaboration with stakeholders in order to assess, adjust and finalise the framework for relevance, clarity, simplicity, generality, and feasibility. Design: The study employed a multi-phased mixed method, explorative, sequential design that incorporated a qualitative, explorative, descriptive, and contextual design and a quantitative cross-sectional descriptive survey through a four-phased approach. The study was based on the philosophy of pragmatism. Population and setting: The study was conducted in the public health care sector in Windhoek, Khomas Region, and focused on registered nurses and medical practitioners involved in PHC. To achieve the research objectives, the study comprised four phases. Phase 1 was a qualitative scoping review that identified global best practices and challenges related to task shifting in mental health care, with a focus on low- and middle-income countries (LMICs) and African settings, providing foundational insights into its implementation. Phase 2 involved qualitative interviews with 16 participants (10 registered nurses and six doctors) to explore their perceptions of barriers and facilitators to implementing task shifting in PHC. In Phase 3 a survey of 64 registered nurses from local clinics in the Khomas Region was conducted to assess their scope of practice, training needs, job descriptions, access to policies, and support received, yielding important statistical insights into their readiness for task shifting. Phase 4 focused on framework development, engaging key stakeholders in an expert review and consultative workshop to evaluate the task shifting framework for clarity, relevance, feasibility, and applicability in Khomas Region PHC settings, ensuring it was practical and aligned with local contexts. Findings: The qualitative scoping review resulted in the identification of 2250 articles from five databases, of which 27 articles were extracted for analysis. A thematic analysis revealed the themes of the construct of task shifting, an implementation framework for a task shifting approach, and the need for a task shifting professional scope in mental health services. Qualitative study: The themes that emerged from the analysis of the interviews were the role of systemic factors in task shifting of mental health services; availability of resources and implications thereof for the adoption of task shifting; competence of registered nurses in mental health services; conceptualisation of task shifting; and pointers for success in implementing task shifting. Quantitative study: Survey participants generally disagreed with the feasibility of task shifting but agreed that they were willing to be involved in the implementation and agreed on the need for training. Framework development: The framework derived from the qualitative scoping review and the qualitative and quantitative findings emphasised the need for training, support, funding, and the expansion of nurses’ scope of practice to facilitate task shifting of mental health services. This framework has potential value for practice by guiding targeted interventions and policies to address mental health workforce shortages. The framework can provide a basis for evaluating the impact of task shifting on mental health outcomes and exploring various funding models, thereby strengthening the evidence base for effective mental health interventions. AFRIKAANSE OPSOMMING: Inleiding: Die tekort aan gesondheidswerkers in Namibie is 'n beduidende struikelblok vir toegang tot geestesgesondheidsbehandeling. Die afwesigheid van geestesgesondheidsorg in primere gesondheidsdienste het belangrike implikasies vir die Namibiese bevolking. Geestesgesondheidstoestande is veral een van die hoofoorsake van gestremdheid en morbiditeit in Namibie, maar slegs 'n klein persentasie van die bevolking ontvang voldoende sorg. Om hierdie tekorte aan te spreek en toegang tot gesondheidsorg te verbeter, is die aanvaarding van bewysgebaseerde taakdeling of taakverskuiwingstrategiee, waar niespesialiste gesondheidsorg verskaf, wereldwyd effektief geimplementeer en het sukses getoon in die bestuur van MIV. Daar is egter beperkte kennis en implementering van sulke strategiee in die konteks van Namibie, wat 'n kennisgaping laat wat aangespreek moet word. Doel: Die studie het ten doel gehad om 'n raamwerk in samewerking met belanghebbendes te ontwikkel, dit wil se geregistreerde verpleegkundiges en mediese praktisyns implementeer geestesgesondheidsorgtaakverskuiwing van mediese praktisyns na geregistreerde verpleegkundiges in primere gesondheidsorginstellings (PHC) in die Khomas-streek, Namibie. Die doelwitte was: • Doen 'n omvangsoorsig om die sterkpunte, swakpunte, geleenthede en bedreigings (SWOT) te identifiseer wat verband hou met 'n geestesgesondheidsorgtaakverskuiwingsbenadering van mediese praktisyns na geregistreerde verpleegkundiges in PHC-omgewings in Afrika en lae- en middelinkomstelande. • Verken die hindernisse en fasiliteerders vir 'n geestesgesondheidsorgtaakverskuiwingsbenadering soos waargeneem deur geregistreerde verpleegkundiges en mediese praktisyns wat in PHC-omgewings werk. • Doen 'n opname van die bestaande omvang van praktyk vir geregistreerde verpleegkundiges wat in PHC-fasiliteite werk, sowel as hul opleidingsbehoeftes, posbeskrywings, toegang tot en gebruik van relevante beleide, toesig en ondersteuning. • Ontwikkel 'n raamwerk in samewerking met belanghebbendes om die raamwerk vir relevansie, duidelikheid, eenvoud, algemeenheid en uitvoerbaarheid te assesseer, aan te pas en te finaliseer. Ontwerp: Die studie het 'n gemengde metode, verkennende, opeenvolgende ontwerp gebruik wat beide 'n kwalitatiewe, verkennende, beskrywende en kontekstuele ontwerp en 'n kwantitatiewe deursnee-beskrywende opname deur 'n vierfase-benadering ingesluit het. Die studie was gebaseer op die filosofie van pragmatisme. Bevolking en omgewing: Die studie is in die openbare gesondheidsorgsektor in Windhoek, Khomas-streek, uitgevoer en het gefokus op geregistreerde verpleegkundiges en dokters wat by PHC betrokke was. Om die navorsingsdoelwitte te bereik, het die studie uit vier fases bestaan. Fase 1 was 'n omvangsoorsig wat wereldwye beste praktyke en uitdagings geidentifiseer het wat verband hou met taakverskuiwing in geestesgesondheidsorg, met 'n fokus op lae- en middelinkomstelande (LMIL's) en Afrika-omgewings, wat grondliggende insigte in die implementering daarvan verskaf het. Fase 2 het kwalitatiewe onderhoude met 16 deelnemers (10 geregistreerde verpleegkundiges en ses dokters) behels om hul persepsies van hindernisse en fasiliteerders vir die implementering van taakverskuiwing in PHC te ondersoek. In Fase 3 is 'n opname van 64 geregistreerde verpleegkundiges van plaaslike klinieke in die Khomas-streek gedoen om hul omvang van praktyk, opleidingsbehoeftes, posbeskrywings, toegang tot beleide en ondersteuning ontvang te bepaal, wat belangrike statistiese insigte in hul gereedheid vir taakverskuiwing opgelewer het. Fase 4 het gefokus op raamwerkontwikkeling, en sleutelbelanghebbendes betrek by 'n kundige oorsig en raadgewende werkswinkel om die taakverskuiwingsraamwerk vir duidelikheid, relevansie, uitvoerbaarheid en toepaslikheid in Khomas-streek PHC-instellings te evalueer, om te verseker dat dit prakties en in lyn is met plaaslike kontekste. Bevindinge: Die omvangsoorsig het gelei tot die identifisering van 2250 artikels uit vyf databasisse, waarvan 27 artikels vir ontleding onttrek is. 'n Tematiese ontleding het die temas van die konstruk van taakliteverskuiwing, 'n implementeringsraamwerk vir 'n taakverskuiwingsbenadering en die behoefte aan 'n taakverskuiwende professionele omvang in geestesgesondheidsdienste aan die lig gebring. Kwalitatiewe studie: Die temas wat uit die ontleding van die onderhoude na vore gekom het, was die rol van sistemiese faktore in taakverskuiwing van geestesgesondheidsdienste; beskikbaarheid van hulpbronne en implikasies daarvan vir die aanvaarding van taakverskuiwing; bevoegdheid van geregistreerde verpleegkundiges in geestesgesondheidsdienste; konseptualisering van taakverskuiwing; en wenke vir sukses in die implementering van taakverskuiwing. Kwantitatiewe studie: Deelnemers aan die opname het oor die algemeen nie saamgestem met die haalbaarheid van taakverskuiwing nie, maar het saamgestem dat hulle bereid was om by die implementering betrokke te wees en het saamgestem oor die behoefte aan opleiding. Raamwerkontwikkeling: Die raamwerk afgelei van die omvangsoorsig en die kwalitatiewe en kwantitatiewe bevindings beklemtoon die behoefte aan opleiding, ondersteuning, befondsing en die uitbreiding van verpleegkundiges se praktykomvang om taakverskuiwing van geestesgesondheidsdienste te fasiliteer. Hierdie raamwerk het potensiele waarde vir die praktyk deur geteikende intervensies en beleide te rig om tekorte aan geestesgesondheidswerkers aan te spreek. Die raamwerk kan 'n basis bied vir die evaluering van die impak van taakverskuiwing op geestesgesondheidsuitkomste en die ondersoek van verskeie befondsingsmodelle, en sodoende die bewysbasis vir effektiewe geestesgesondheidsintervensies versterk. Doctoral 2025-05-21T06:50:17Z 2025-05-21T06:50:17Z 2025-03 Thesis https://scholar.sun.ac.za/handle/10019.1/132048 Stellenbosch University xxiv, 404 pages : illustrations, maps, includes annexures application/pdf Stellenbosch : Stellenbosch University |
| spellingShingle | Mental health services -- Namibia Primary health care -- Mental health services -- Namibia Mental health facilities -- Employees UCTD Ashipala, Daniel Opotamutale A framework to facilitate the implementation of mental health service task-shifting from medical practitioners to registered nurses in primary care settings in the Khomams region, Namibia |
| title | A framework to facilitate the implementation of mental health service task-shifting from medical practitioners to registered nurses in primary care settings in the Khomams region, Namibia |
| title_full | A framework to facilitate the implementation of mental health service task-shifting from medical practitioners to registered nurses in primary care settings in the Khomams region, Namibia |
| title_fullStr | A framework to facilitate the implementation of mental health service task-shifting from medical practitioners to registered nurses in primary care settings in the Khomams region, Namibia |
| title_full_unstemmed | A framework to facilitate the implementation of mental health service task-shifting from medical practitioners to registered nurses in primary care settings in the Khomams region, Namibia |
| title_short | A framework to facilitate the implementation of mental health service task-shifting from medical practitioners to registered nurses in primary care settings in the Khomams region, Namibia |
| title_sort | framework to facilitate the implementation of mental health service task shifting from medical practitioners to registered nurses in primary care settings in the khomams region namibia |
| topic | Mental health services -- Namibia Primary health care -- Mental health services -- Namibia Mental health facilities -- Employees UCTD |
| url | https://scholar.sun.ac.za/handle/10019.1/132048 |
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