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At the coalface of collaborative mental health care: A qualitative study of governance and power in district‐level service provision in South Africa
Author(s) -
Janse van Rensburg André,
Khan Rabia,
Wouters Edwin,
Rensburg Dingie,
Fourie Pieter,
Bracke Piet
Publication year - 2018
Publication title -
the international journal of health planning and management
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.672
H-Index - 41
eISSN - 1099-1751
pISSN - 0749-6753
DOI - 10.1002/hpm.2593
Subject(s) - mental health , referral , public relations , corporate governance , legislature , business , nursing , political science , public administration , medicine , psychiatry , finance , law
Summary Globally, there is an urgency to address fragmented mental health systems, especially in low‐to‐middle income countries. State and non‐state mental health service collaboration is a central strategy to strengthen care. The study was undertaken to analyse the power in governance processes of public mental health service provision. Semi‐structured interviews were conducted with state and non‐state actors in mental health care in a South African district. Transcriptions were thematically analysed using the Framework for Assessing Power in Collaborative Processes. Findings suggested that collaborative processes were significantly state‐owned, in terms of funding models, administrative and legislative jurisdiction, and state hierarchical referral structure. No formal agreements were in place, elevating the importance of key network actors to bring less‐endowed NGOs into the service network. Fragmentation between the Departments of Health and Social Development was telling in district forums. Resistance to power structures unfolded, some participants sidestepping traditional hierarchies to leverage funding and support. The paper highlights the complexities and different facets of power in integrated mental health care in a South African district, adding to growing literature on the social mechanisms that influence collaboration.

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