Academic journal article South African Journal of Psychiatry

Needs-Based Gap Analysis for Service Transformation in the Eastern Cape

Academic journal article South African Journal of Psychiatry

Needs-Based Gap Analysis for Service Transformation in the Eastern Cape

Article excerpt

The central decision for [all organisations] is, what is the best way to portion out available resources ... to meet all the demands--the needs--that compete for them ... the most effective way is to make needs assessment the first stage in planning. (Bella Ruth Witkin) [1]

In the development of a mental health plan, it is imperative to determine 'need', the nature and extent of the need, and how to measure and plan to meet this need. Kaufman and Stakenas [2] defined a needs assessment as 'a formal systematic attempt to determine and close the more important gaps between "what is" and "what should be".'

Needs assessments are conducted to assist planners to 'identify and select the right job before doing the job right.' [2] A needs-based approach is independent of past use and therefore allows for equitable and efficient resource allocation. Dreesch et al. [3] draw attention to the limitations of a needs-based approach, which include projection of unattainable staff requirements, extensive data collection and norms updating as technology advances.

The World Health Organization (WHO) [4] states that the needs of the population can be determined by utilising prevalence and incidence studies, and determining what communities identify as problems.

The first national epidemiological survey in South Africa (SA) was conducted between 2003 and 2004. [5] This study surveyed 619 households in the Eastern Cape (EC) and determined 12-month and lifetime prevalence estimates for certain classes of mental illnesses. These classes were anxiety disorders, mood disorders (major depressive disorder) and substance use disorders.

In 2008, the WHO launched the Mental Health Gap Action Programme (mhGAP). [6] This programme set eight priority conditions, which included epilepsy, schizophrenia and other psychotic disorders, depression, dementia, suicide, illicit substance use disorder and mental disorders in children. The SA study included two of these, viz. depression and substance use disorders. [5]

Risk factors provide a fertile substrate for the predisposition to mental illness and therefore affect prevalence rates. The EC has several high-risk factors, including an overall HIV prevalence rate of 16.8%, compared with 7.9% for the Western Cape. [7] The HIV prevalence rate in the EC among antenatal attendees was 29.9%.'81 In 2010, there were 781 713 and 62 029 new cases of HIV and TB, respectively, reported in the province. [8] The districts with the highest HIV prevalence rates are located in the eastern region of the province, with an average prevalence rate of 31.1%. [9]

Poverty is another risk factor, with the average household income of USD3 340/annum (7 June 2010), making the province a low-to-middle-income region according to the World Bank. [10] The further east a household is, the poorer it is (low-to-middle income: USD2 360/annum) and the further west a household is, the wealthier it is (upper-to-middle income: USD4 650/annum). [10] West away [11] observed that poverty in the EC is worse now than at the dawn of liberal democracy, and suggested that this is owing to a renewal of segregationist policies.

The province has higher than national murder and substance-related crime rates. The provincial murder rate stands at 39/100 000 (national figure 32/100 000) and has a drug-associated crime rate of 293/100 000 (national figure 232/100 000). [9] The effect of these factors is reflected in the prevalence rate for depression, where the SA Stress and Health (SASH) study rate is almost double that of the WHO figure. [5,12]

This research article focuses on a needs analysis for the treatment of three severe psychiatric conditions, viz. schizophrenia, bipolar mood disorder and depression. Prevalence rates for these disorders are readily available from WHO studies and a national epidemiological study. [5,12] These disorders have been rated as having the highest disability from the eight priority conditions set by the WHO. …

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