Closing the gap: decentralising mental health care to primary care centres in one rural district of Rwanda

• Published in: Public health action 2017-09, Vol.7 (3), p.231-236
• Main Authors: Nyirandagijimana, B., Edwards, J. K., Venables, E., Ali, E., Rusangwa, C., Mukasakindi, H., Borg, R., Fabien, M., Tharcisse, M., Nshimyiryo, A., Park, P. H., Raviola, G. J., Smith, S. L.
• Format: Article
• Language: English
• Subjects: Mental Disorders; Mentorship; Operational Research; Original; Task-Sharing
• ISSN: 2220-8372; 2220-8372
• DOI: 10.5588/pha.16.0130

Setting: Programmes that integrate mental health care into primary care settings could reduce the global burden of mental disorders by increasing treatment availability in resource-limited settings, including Rwanda.Objective: We describe patient demographics, service use and retention of patients in care at health centres (HC) participating in an innovative primary care integration programme, compared to patients using existing district hospital-based specialised out-patient care.Design: This was a retrospective cohort study using routinely collected data from six health centres and one district hospital from October 2014 to March 2015.Results: Of 709 patients, 607 were cared for at HCs; HCs accounted for 88% of the total visits for mental disorders. Patients with psychosis used HC services more frequently, while patients with affective disorders were seen more frequently at the district hospital. Of the 68% of patients who returned to care within 90 days of their first visit, 76% had a third visit within a further 90 days. There were no significant differences in follow-up rates between clinical settings.Conclusion: This study suggests that a programme of mentorship for primary care nurses can facilitate the decentralisation of out-patient mental health care from specialised district hospital mental health services to HCs in rural Rwanda.