Exploring integrated community-based collaborative care in South Africa: A qualitative study on health care providers’ experiences
1
University of the Witwatersrand, Johannesburg, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A2622
ABSTRACT
BACKGROUND:
Community-based collaborative care (CBCC) is an internationally recognised model of integrated care that emphasises multidisciplinary teamwork and coordinated service delivery to reduce mental health treatment gaps and promote universal health coverage.(1-2) While many countries have adopted policies to integrate mental health into primary health care (PHC), evidence on how different integration approaches shape collaboration in practice remains limited, especially in low and middle income countries.(3) This study explores healthcare providers’ experiences of collaboration within two differently organised integrated care settings in South Africa.
METHODS:
Qualitative interviews were conducted with 29 healthcare providers across two PHC clinics that integrated community psychiatry services. Data were analysed thematically, guided by three core components of CBCC (multidisciplinary teams, communication, and case management). In Clinic-1, community psychiatry services are ‘co-located’ in an outbuilding behind the main PHC clinic, and operate independently. In Clinic-2, these services are ‘physically integrated’ within the PHC clinic using same management, resources, and systems.
RESULTS:
Both clinics had multidisciplinary teams, with case management functions conducted on an ad hoc basis by various staff members. The physically integrated clinic, despite having fewer resources, poor infrastructure, and greater caseload, had higher levels of communication and collaboration between PHC and community psychiatry staff. This was facilitated by shared clinical records, physical proximity, and strong facility management with mental health experience. In contrast, the co-located clinic had poor coordination, weak management, unclear roles, unclear reporting structures, and reinforced professional hierarchies which constrained collaboration within the multidisciplinary team.
CONCLUSIONS:
The findings demonstrate that while integrated care models can facilitate collaboration, integration alone does not guarantee collaboration. Key ingredients such as competent management, role clarity, professional buy-in, and communication systems are crucial to facilitate collaboration. These insights offer transferable lessons for health systems seeking to strengthen community-based mental health care within PHC, especially in resource-constrained settings.
Community-based collaborative care (CBCC) is an internationally recognised model of integrated care that emphasises multidisciplinary teamwork and coordinated service delivery to reduce mental health treatment gaps and promote universal health coverage.(1-2) While many countries have adopted policies to integrate mental health into primary health care (PHC), evidence on how different integration approaches shape collaboration in practice remains limited, especially in low and middle income countries.(3) This study explores healthcare providers’ experiences of collaboration within two differently organised integrated care settings in South Africa.
METHODS:
Qualitative interviews were conducted with 29 healthcare providers across two PHC clinics that integrated community psychiatry services. Data were analysed thematically, guided by three core components of CBCC (multidisciplinary teams, communication, and case management). In Clinic-1, community psychiatry services are ‘co-located’ in an outbuilding behind the main PHC clinic, and operate independently. In Clinic-2, these services are ‘physically integrated’ within the PHC clinic using same management, resources, and systems.
RESULTS:
Both clinics had multidisciplinary teams, with case management functions conducted on an ad hoc basis by various staff members. The physically integrated clinic, despite having fewer resources, poor infrastructure, and greater caseload, had higher levels of communication and collaboration between PHC and community psychiatry staff. This was facilitated by shared clinical records, physical proximity, and strong facility management with mental health experience. In contrast, the co-located clinic had poor coordination, weak management, unclear roles, unclear reporting structures, and reinforced professional hierarchies which constrained collaboration within the multidisciplinary team.
CONCLUSIONS:
The findings demonstrate that while integrated care models can facilitate collaboration, integration alone does not guarantee collaboration. Key ingredients such as competent management, role clarity, professional buy-in, and communication systems are crucial to facilitate collaboration. These insights offer transferable lessons for health systems seeking to strengthen community-based mental health care within PHC, especially in resource-constrained settings.
| eISSN: | 2654-1459 |
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