Strengthening the Mental Health System in Zimbabwe: A Scoping Review of Policy and Health System Barriers to Achieving SDG 3

Öz

Mental health is crucial for achieving Sustainable Development Goal 3 (SDG 3), yet it remains overlooked in many low- and middle-income countries. In Zimbabwe, the burden of mental disorders is increasing despite the existence of a national health strategy, raising concerns about the readiness of the health system to deliver equitable and effective mental health care. This scoping review synthesises evidence on the policy and health-system barriers influencing progress toward SDG 3 mental health targets in Zimbabwe. Guided by the Health Policy and Systems Analysis (HPSA) framework and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines, 12 peer-reviewed studies published between 2014 and 2025 were reviewed. Data were charted and analysed across key HPSA themes, including governance, financing, workforce, service delivery, and health information systems. The review identified several persistent system-level challenges. Although mental health policy frameworks exist, their implementation is limited by weak accountability mechanisms, insufficient decentralisation, and fragmented leadership. Chronic underfunding, combined with reliance on donor support, undermines the sustainability of services. Shortages and uneven distribution of skilled mental health professionals restrict access to care, particularly in rural areas. Task-sharing initiatives have improved access but remain inadequately supported and are not fully integrated into the health system. In addition, weak mental health information systems limit the use of data for planning and monitoring. Broader challenges, including stigma, urban–rural inequalities, and poor intersectoral coordination, further constrain progress. Progress toward SDG 3 mental health targets in Zimbabwe requires stronger governance and accountability, increased domestic financing, investment in community-based mental health workforces, and better integration of mental health indicators into routine health information systems. Zimbabwe’s experience offers useful lessons for other resource-constrained settings.

Anahtar Kelimeler

• Mental Health System
• Sustainable Development Goal 3
• Zimbabwe

Zimbabve’de Ruh Sağlığı Sisteminin Güçlendirilmesi: SKA 3’e Ulaşmada Politika ve Sağlık Sistemi Engellerine İlişkin Bir Kapsam İncelemesi

Öz

Ruh sağlığı, Sürdürülebilir Kalkınma Amacı 3’e (SKA 3) ulaşılması açısından kritik öneme sahip olmasına rağmen, birçok düşük ve orta gelirli ülkede ihmal edilmeye devam etmektedir. Zimbabve’de ulusal bir sağlık stratejisinin varlığına karşın ruhsal bozuklukların yükünün artması, sağlık sisteminin hakkaniyetli ve etkili ruh sağlığı hizmeti sunmaya ne ölçüde hazır olduğu konusunda endişelere yol açmaktadır. Bu kapsam belirleme derlemesi, Zimbabve’de SKA 3 kapsamındaki ruh sağlığı hedeflerine yönelik ilerlemeyi etkileyen politika ve sağlık sistemi engellerine ilişkin kanıtları sentezlemektedir. Sağlık Politikası ve Sistemleri Analizi (HPSA) çerçevesi rehberliğinde ve Kapsam Belirleme Derlemeleri için PRISMA Uzantısı (PRISMA-ScR) kılavuzları doğrultusunda raporlanan çalışmada, 2014-2025 yılları arasında yayımlanmış 12 hakemli çalışma incelenmiştir. Veriler; yönetişim, finansman, sağlık iş gücü, hizmet sunumu ve sağlık bilgi sistemleri dâhil olmak üzere temel HPSA temaları kapsamında sınıflandırılmış ve analiz edilmiştir. Derleme, sistem düzeyinde süregelen çeşitli sorunları ortaya koymuştur. Ruh sağlığına ilişkin politika çerçeveleri mevcut olmakla birlikte, bu politikaların uygulanması zayıf hesap verebilirlik mekanizmaları, yetersiz yerelleşme ve parçalı liderlik nedeniyle sınırlı kalmaktadır. Donör desteğine bağımlılıkla birleşen kronik finansman yetersizliği, hizmetlerin sürdürülebilirliğini zayıflatmaktadır. Nitelikli ruh sağlığı profesyonellerinin eksikliği ve dengesiz dağılımı, özellikle kırsal bölgelerde bakıma erişimi kısıtlamaktadır. Görev paylaşımı girişimleri erişimi artırmış olsa da yeterince desteklenmemekte ve sağlık sistemine tam olarak entegre edilememektedir. Ayrıca, zayıf ruh sağlığı bilgi sistemleri, planlama ve izleme süreçlerinde verinin kullanımını sınırlandırmaktadır. Damgalanma, kentsel-kırsal eşitsizlikler ve zayıf sektörler arası koordinasyon gibi daha geniş kapsamlı sorunlar da ilerlemeyi kısıtlamaktadır. Zimbabve’de SKA 3 kapsamındaki ruh sağlığı hedeflerine yönelik ilerleme; daha güçlü yönetişim ve hesap verebilirlik, artırılmış yerel finansman, toplum temelli ruh sağlığı iş gücüne yatırım ve ruh sağlığı göstergelerinin rutin sağlık bilgi sistemlerine daha iyi entegre edilmesini gerektirmektedir. Zimbabve deneyimi, kaynak kısıtı bulunan diğer ortamlar için yararlı dersler sunmaktadır.

Anahtar Kelimeler

• Ruh Sağlığı Sistemi
• Sürdürülebilir Kalkınma Amacı 3
• Zimbabve

Kaynakça

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