Strengthening child and adolescent mental health systems in South Africa: A multi-stakeholder implementation science initiative

Simelane, Simphiwe

Strengthening child and adolescent mental health systems in South Africa: A multi-stakeholder implementation science initiative

Thesis / Dissertation

2025

Publisher

University of Cape Town

Department

Department of Psychiatry and Mental Health

Faculty

Faculty of Health Sciences

Abstract

Background: Child and adolescent mental health services and systems (CAMHSS) in low- and middle-income countries (LMICs), including South Africa, face significant challenges despite 10–20% of under-18-year-olds experiencing mental and neurodevelopmental disorders. In South Africa the mental health treatment gap remains at 90%. This thesis used multi-methods across three aims to explore CAMHSS strengthening innovations in LMICs, the state of CAMHSS in South Africa, and potential strategies for improvement. Methods: A targeted literature review identified CAMHSS strengthening innovations in LMICs from the preceding 18 months. A narrative review examined the state of CAMHSS in South Africa, synthesising findings from two regional situational analyses. A nationwide electronic survey was conducted to assess the relevance of previous regional findings at a national level and to identify system strengthening priorities. Participatory Theory of Change (ToC) workshops were held across care levels in the Western Cape to co-create a shared vision for CAMHSS strengthening. Lastly, a qualitative study evaluated the acceptability, appropriateness, and feasibility of the child mental health module from the WHO Mental Health Gap Action Programme Intervention Guide (mhGAP-IG CMH) at the primary care level in Khayelitsha, Cape Town. Results: CAMHSS innovations in LMICs were identified across WHO health system building blocks, including service provider training, school-based programmes, and digital tools. The integrative review of CAMHSS in South Africa highlighted 38 critical gaps, particularly in clinical care and human resources. Findings from the nationwide survey supported 63% of the previous regional findings, and priorities included quality services close to home, competent teams, and widespread CAMHSS engagement. ToC workshops identified six pathways to strengthen CAMHSS, with a focus on care pathways, capacity building, and political buy-in. The qualitative study on the mhGAP-IG CMH module noted potential utility but also identified many contextual barriers such as time constraints and lack of support. Conclusion: The original contributions of this thesis include a comprehensive assessment of CAMHSS in South Africa including current gaps and priorities, a co-produced roadmap for CAMHSS strengthening, and findings on the mhGAP-IG CMH module as a potential tool in primary care. Actions from the thesis could bridge the treatment gap to improve CAMHSS in the country.

Keywords

Health systems

South Africa

Reference:

Collections

PhD / Doctoral

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