Policies, delivery models, and lessons learned from integrating mental health and substance abuse services into primary health care in Ethiopia.

In Ethiopia, noncommunicable diseases (NCDs) represent 18.3% of premature mortality, consume 23% of the household expenditures, and cost 1.8% of the gross domestic product. Risk factors such as alcohol, khat, and cannabis use are on the rise and are correlated with a substantial portion of NCDs. Associated NCDs include depression, anxiety, hypertension, coronary heart disease, and myocardial infarction. The multi-faceted nature of mental health and substance abuse disorders require multi-dimensional interventions. The article draws upon participant observation and literature review to examine the policies, delivery models, and lessons learned from the Federal Ministry of Health (FMOH) experience in integrating Mental Health and Substance Abuse (MH/SA) services into primary care in Ethiopia. In 2019, FMOH developed national strategies for both NCDs and mental health to reach its population. Ethiopia integrated MH/SA services at all levels within the government sector, with an emphasis on primary health care. FMOH launched the Ethiopian Primary Health Care Clinical Guidelines, which includes the delivery of NCD services, to standardize the care given at the primary health care level. To date, the guidelines have been implemented by over 800 health centers and are expected to improve the quality of service and health outcomes. Existing primary care programs were expanded to include prevention, early detection, treatment, and rehabilitation for MH/SA. This included training and leveraging an array of health professionals, including traditional healers and those from faith-based institutions and community-based organizations. A total of 244 health centers completed training in the Mental Health Gap Action Programme (mhGAP). In 2020, 5,000 urban Health Extension Workers (HEWs) participated in refresher training, which includes mental health and NCDs. A similar curriculum for rural health workers is in development. Ethiopia's experience has many lessons learned about stakeholder buy-in, roles, training, logistics, and sustainability that are transferable to other countries. Lessons include that "buy-in" by leaders of public health care facilities requires consistent and persistent nurturing. Ensure the gradual and calibrated integration of MH/SA services so that the task-sharing will not be viewed as "task dumping." Supervision and mentorship of the newly trained is important for the delivery of quality care and acquisition of skills.