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Factors influencing mental health integration into primary health care in low- and middle-income countries: A qualitative synthesis
Vol 4, Issue 3, 2026
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Abstract
The integration of mental health services into primary health care is a globally recognised strategy for closing the treatment gap in low- and middle-income countries, where up to 90 % of people with mental disorders receive no care. However, existing reviews remain largely descriptive and do not explain how factors across health system levels interact. This qualitative evidence synthesis examined individual, interpersonal, organisational, and policy-level factors influencing mental health service integration into primary health care across LMICs. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 and Joanna Briggs Institute guidelines, six databases were searched from 2000 to 2025, yielding 29 included studies. Data were coded inductively and mapped onto the Socio-Ecological Model. Key barriers included stigma, low mental health literacy, workforce shortages, inadequate infrastructure, and fragmented governance. Key facilitators included community engagement, inter-professional collaboration, and sustained government commitment. A consistent policy-to-individual cascade was identified, whereby financing and governance constraints reduce organisational capacity, weaken provider performance, and erode patient trust. Findings highlight the need for sustained mental health financing, task sharing, continuous workforce training, and embedded community engagement within primary health care structures.
Keywords
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Supporting Agencies
Ebenezer Owiredu Nkansah, Department of Health Policy, Management and Economics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi; Daniel Boateng, Department of Epidemiology and Biostatistics, School of Public Health, Kw
Copyright (c) 2026 Ebenezer Owiredu Nkansah , Daniel Boateng, Ruth Owusu-Antwi, Peter Agyei-Baffour, Edward Tieru Dassah
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Prof. Kittisak Wongmahesak
North Bangkok University (Thailand)
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