Barriers to utilization of decentralized mental health services in Rwanda: Central level service users’ perspectives

Abstract

Background While Ministry of Health in Rwanda has done its best to decentralize and integrate mental health services into the national Health care system that is organized along the principles of primary health care, there is an observation that stable patients who could be followed at the decentralized level of mental health care for medication renewals, continue to seek care at the central level mental health settings. This creates a potential burden for both the health care providers (in terms of patient volume) and patients (in terms of travel expenses). No study has been done yet in Rwanda to identify barriers to utilization of decentralized mental health services. Objective This study aims at identifying barriers to utilization of decentralized mental health services in Rwanda from the central level service users’ perspectives. Methods This study was conceived as a descriptive cross-sectional study using qualitative method (semi-structured interview) for data collection. 50 participants from 2 study sites were targeted. Descriptive analysis of socio-demographic data was done in the form of frequencies using SPSS version 21. Charts were generated using Microsoft excel 2007, while the thematic analysis was used to generate meaning and structure to the data collected. Results We studied 50 patients predominantly from the city of Kigali (58%) females (56%), financially independent (54%) and with no formal level of education (18%) or a lower level of education (Primary school level 40%, uncompleted secondary school 20%). They all had health insurance. Many factors were found to act as barriers to utilization of decentralized mental health services and are classified as “patient-related” and “provider-related”. Among the patientrelated ones, barriers were found to be in the dimensions of “ability to reach the health care” and the “ability to engage in health care”, while on the provider-related side those dimensions were the “approachability” and “appropriateness”. Conclusion Barriers to the use of decentralized mental health services were identified and are similar to those in other parts of the world. Mitigation of these barriers will require engagement by different stakeholders throughout the health delivery system to optimize mental health services utilization, improve patient adherence, and support provider resilience given the significant burden of disease and limited mental health human resources.