Table 3

Facilitators and barriers to mhGAP-IG implementation success identified by qualitative studies

System levelFacilitatorsBarriers
Service userAbility to see traditional healers alongside biomedical care.31
Community awareness raising.32
Cultural differences with the biomedical model.33
Different perspectives on appropriate treatment.34–36
Rural residence, distance from health facilities, thinking that problems will self-resolve, concerns about treatment costs.37
Resistance to treatment.38
StaffHealth worker motivation.39
Sharing research findings collaboratively.40
Resistance from faculty members.41
Time constraints and workload.42 43
Stigma.38 39 43
Mistrust of informal health providers, cultural misunderstandings.38
ServiceSupervision.39 42 44
Onward referral.32
Reliable psychotropic medicine procurement.32 39 44
Trained female community health volunteers.32
Scarcity of specialist staff to deliver supervision.39 45
Lack of financial resources38 41
Limited referral systems.38
Staff turnover, lack of confidential space for consultation.39
LeadershipStrong political and organisational support.35 36 39 40 Lack of institutional support.41