The Philani Plus (+) Intervention Program
Like the PMHP, the Philani Plus (+) Intervention Program also employs a task-shifting approach to address the high prevalence of maternal mental disorders and bridge the current treatment gap. Unlike the PMHP however, the Philani Programme’s task-shifting approach seeks to move mental health care beyond the clinics into a community setting. As touched on in the introduction, pregnant women face many barriers in accessing and utilising clinic services. The development of community-based health care is thus one way of confronting these challenges (Lewin et al. 2008).
In South Africa, however, and indeed many LMICs, community-based health services tend to be highly fragmented, involving interventions which target single diseases and outcomes (le Roux et al. 2013). There are a number of reasons for this, including disease prioritisation dictated by lack of resources, and the way in which global funding tends to focus on single diseases rather than, for example, family health or wellness. This fragmentation has led to a duplication of services, ineffectual surveillance, and unnecessary increased financial burden for people who are forced to undergo multiple interventions rather than one comprehensive service (Cecchini et al. 2010). Indeed, such separation ignores the fact that pregnant women frequently experience the co-occurrence of various chronic conditions which share many epidemiological features and risk factors (O’Connor et al. 2011). Ultimately this separation of services reinforces the common barriers to health care access and utilisation that community services are attempting to address.
Taking heed of these limitations, the Philani Plus (+) Intervention Program provides mothers and their children with simultaneous support for multiple health conditions and behaviours, including maternal depression and associated risk factors. The original Philani Programme was developed by a non-governmental organisation Philani over 30 years ago within informal settlements in Cape Town (Rotheram-Borus et al. 2011; Tomlinson 2014). Established as a community health worker (CHW) home-visiting programme, the focus was on preventing malnutrition, rehabilitating underweight children and promoting good health. The Philani Plus (+) Intervention Program builds on this original programme by integrating content and activities to address HIV, alcohol misuse and mental health. CHWs referred to as ‘Mentor Mothers’ (MMs) are recruited from the township neighbourhoods and trained to deliver a variety of home-based interventions. Each MM systematically visits all mothers in her assigned neighbourhood to identify those most at risk for health problems and who might not present at clinics. For those mothers who are identified as at risk, typically four antenatal and four postnatal visits are then carried out, or more depending on specific needs.
In the following section, we provide details of the intervention, including how MMs are chosen, trained and supported, as well as how care is provided through a person-centred and pragmatic problem-solving approach. We also consider the costs, benefits and potential transferability of the programme.