Closing The Treatment Gap: Insights Into Implementation Strategies for Task-Shared Counselling for Depression and Unhealthy Alcohol use In South Africa

Abstract Background: Task-shared psychological counselling can be an effective approach to meet mental health needs in low-resource settings. Evidence on how to sustain and scale such approaches is required. This study was nested in the Project MIND cluster randomised controlled trial which investigated integrating a new, task-shared counselling service in 24 primary care facilities in South Africa. The current study aimed to describe and distil experiences of primary healthcare managers in whose facilities counselling was implemented.Methods: Focus group discussions and in-depth interviews were conducted with 15 Primary Health Care (PHC) facility and operational managers (urban and rural facilities). Interviewers used a semi-structured topic guide to explore overall experiences of the programme and barriers to wider implementation. Normalisation process theory guided analysis.Results: Managers highlighted their relational work in communicating with staff on the value of the new intervention, to reduce resistance. Their leadership role in promoting support for the intervention, teamwork and onward referral of clients was key to embedding this new approach. Managers emphasized the need for reorientation and upskilling of staff to be foster openness to mental health practice and for counsellors to have adequate time to provide quality counselling. Strengthening within-facility referrals and referrals to external organisations were both noted as crucial for sustained implementation, as well as cycles of monitoring and feedback.Conclusion: This study presents experiences and perceptions of health care managers developed into a multicomponent implementation approach for embedding a task-shared package of care for problem alcohol use and depression in primary care.