Maternal mental health in the context of community based home visiting: “Acting urgently, building slowly”

On 12 June 2014, Professor Mark Tomlinson from Stellenbosch University, South Africa, gave a seminar to DFID health advisors on maternal mental health in the context of community based home visiting. The seminar highlighted that in low and middle income countries women and girls carry a significant care burden. They are twice as likely as men to suffer from depression and greater risk of experiencing gender-based violence. Despite mental health disorders accounting for a significant proportion of years lived with a disability, under half of African countries do not have a mental health policy and only a third have a mental health plan.

Mark’s presentation can be viewed as an audio slideshow here:

This brief interview with Mark gives an overall summary:

The slides from Mark’s presentation are available to download as a PDF here.

Key resources

The paper referenced in the presentation was a briefing summary of the case study of a maternal mental health intervention in South Africa, the Philani Mentor Mothers Programme. The case study is a contribution to the Empowerment of Women and Girls theme of the Accountable Grant at the Institute of Development Studies. In particular, it relates to the sub-theme that focuses on the health of women and girls in rapidly urbanising settings in South Africa and Kenya. The case study in this sub-theme discusses the particular health conditions that have been identified to affect women and girls in low-income urban settings, with a focus on identifying key ‘good practice’ and cutting edge interventions.

The paper concludes that the finding on depression in the Philani RCT raises important questions regarding generalist versus specialist Community Health Workers. While there may be benefits for the infants and children of women with depression it appears that unless mental illness is directly targeted and treated, the benefits for women’s mental health may be marginal. However, specialist interventions for maternal depression are likely to be too expensive for many Low and Middle Income Countries and, therefore, evidence is needed for how specifically targeted interventions for moderate to severe depression can be integrated into primary health care and other delivery platforms. What is needed now and in the post-2015 arena is a more explicit acknowledgement and focus on the tension between urgent action and building slowly.

In the face of high HIV burden in South Africa, acting urgently is understandable given that policymakers need rapid demonstrable outputs from their interventions. There is however no quick fix for health systems strengthening, or building effective human resources. The Philani approach epitomises the ability to engage with the tension rather than being seduced into the ‘quick technological fix’ or the temptation to reduce the quality of recruitment, training and supervision in order to ‘extend reach’. The Philani approach is one that focuses on quality (not on volume) and according to one respondent being staffed by enthusiastic, dynamic and motivated people ‘is the difference between a good and a bad system’. Women are at the centre of the Philani approach, and Philani’s core value (perhaps) is that behaviour change occurs in the context of a supportive relationship. An Evidence Report summarising this paper is also available to download here.

The Urbanisation and Health section of the Interactions website includes relevant resources and links to evidence focused on health of women and girls. Interactions details up to date development research processes. The site focuses on collaborative research being done by the Institute of Development Studies and a range of global partners on three gender-justice themes in twelve countries between 2012 and 2016. The main aim of the research is to examine how to build an enabling environment for the empowerment of women and girls. Interactions is a pilot product which explores how Eldis content, web production and editorial skills can be used to enhance the reach, relevance and, ultimately, impact of an ongoing collaborative research process by promoting engagement with stakeholders from the outset.

Speaker Biography

Mark Tomlinson is a Professor in the Department of Psychology at Stellenbosch University, South Africa.  He has completed epidemiological work investigating the association between postpartum depression and the mother-infant relationship, and the impact of postpartum depression on infant and child development.  He has also completed a randomised controlled trial to improve the quality of the mother-infant relationship and infant attachment in a peri-urban settlement on the outskirts of Cape Town, South Africa.  He is currently involved in a community based trial aimed at preventing mother to child transmission of HIV and reducing neonatal deaths; and another aimed at reducing alcohol use, reducing HIV/TB and improving the nutritional status of women in the antenatal and postnatal period. He has a particular interest in infant and child development in conditions of high social adversity, as well as developing community based prevention programmes.  Recently, he has begun to focus on the health system challenges of scaling up services for infants and children.

Mark is a Research Director at PRIME, which is a consortium of research institutions and Ministries of Health in five countries in Asia and Africa (Ethiopia, India, Nepal, South Africa & Uganda), with partners in the UK and the World Health Organization (WHO). PRIME is supported by the UK government’s Department for International Development (DFID), and is a six year programme which was launched in May 2011.

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