Maternal Mental Health in the Context of Community-based Home Visiting in a Re-engineered Primary Health Care System: A Case Study of the Philani Mentor Mothers Programme

This document examines a case study of the Philani Mentor Mothers Programme - a maternal mental health intervention in South Africa. Specifically, it describes the context of global health, mental health in South Africa, and a case study of a generalist health intervention (with a maternal mental health component) by a South African NGO, Philani, within the current fluid South African health system. It analyses what the Philani experience has to offer in terms of lessons to overcome the significant obstacles to holistic and equitable health care delivery that exist in South Africa and elsewhere. 

The Philani Maternal, Child Health and Nutrition Project was established in 1979 in the ‘informal’ settlements on the outskirts of Cape Town as an intervention to prevent malnutrition, rehabilitate underweight children and promote good health. In 2008, a cluster randomised control trial was conducted and it found that:

• there are significant benefits for mothers and infants over the first 18 months of life, specifically in the areas of children’s health and cognitive intelligence, maternal adherence to health care, and HIV prevention strategies.
• while there might be benefits for child development in the context of perinatal depression, the primary preventive nature of community-based platforms such as Philani may not impact on moderate or severe depression.

The document concludes that:

• despite some benefits for the infants and children of women with depression it appears that unless mental illness is directly targeted and treated, the benefits for women’s mental health may be marginal.
• specialist interventions for maternal depression are likely to be too expensive for many lower and middle income countries (LMIC) and, therefore, evidence is needed for how specifically targeted interventions for moderate to severe depression can be integrated into primary health care and other delivery platforms.
• there is no quick fix for health systems strengthening, or building effective human resources. The Philani approach focuses on quality, and believes that behaviour change occurs in the context of a supportive relationship.
• unless we begin to examine ‘how’ rather than the ‘what’ of interventions, we will not be able to improve holistic population health in LMIC.