03114nas a2200217   4500000000100000008004100001653001800042653004000060653002900100100001400129700001300143700001400156700001600170700001800186700001500204700001300219245010200232856007200334490000700406520248300413       2019                            d10aMental Health10aMental health systems strenghtening10aService user involvement1 aMugisha J1 aHanlon C1 aKnizek BL1 aSsebunnya J1 aVancampfort D1 aKinyanda E1 aKigozi F00aThe experience of mental health service users in health system strengthening: lessons from Uganda  uhttps://ijmhs.biomedcentral.com/track/pdf/10.1186/s13033-019-0316-50 v133 a<p><strong>Background: </strong>Mental, neurological and substance use disorders are a public health burden in Uganda. Mental health service user involvement could be an important strategy for advocacy and improving service delivery, particularly as Uganda redoubles its eforts to integrate mental health into primary health care (PHC). However, little is known on the most efective way to involve service users in mental health system strengthening.<br />
<strong>Methods:</strong> This was a qualitative key informant interview study. At national level, 4 interviews were conducted with national level health workers and 3 service user organization representatives. At the district level, 2 interviews were conducted with district level health workers and 5 service user organization representatives. Data were analyzed using content thematic analysis.<strong><br />
Findings:</strong> Overall, there was low mental service user participation in health system strengthening at both national and district levels. Health system strengthening activities included policy development, implementation of programs and research. Informants mentioned several barriers to service user involvement in mental health system strengthening. These were grouped into three categories: institutional, community and individual level factors. Institutional level barriers included: limited funding to form, train and develop mental health service user groups, institutional stigma and patronage by founder members of user organizations. Community level barriers included: abject poverty and community stigma. Individual level barriers included: low levels of awareness and presence of self-stigma. Informants also recommended some strategies to enhance service user involvement.<br />
<strong>Conclusion:</strong> The Uganda Ministry of Health should develop a strategy to improve service user participation in mental health system strengthening. This requires an appreciation of the importance of service users in improving service delivery. To address the barriers to service user involvement identifed in this study requires concerted eforts by the Uganda Ministry of Health and the district health services, specifcally with regard to attitudes of health workers, dealing with stigma at all levels, raising awareness about the rights of service users to participate in health systems strengthening activities, building capacity and fnancial empowerment of service user organizations.</p>