Health Care Platform Interventions

Excerpt

Evidence-based interventions often fail to achieve their goal, not so much because of an inherent flaw in the interventions, but because of the unpredictable behavior of the system around them. Every intervention, from the simplest to the most complex, has an effect on the overall system, and the overall system has an effect on every intervention (Savigny and Adam 2009). As a result of this, the current Disease Control Priorities series has shifted its focus from a strictly disorder-oriented intervention analysis (vertical approach) to a more horizontal approach focusing on health system strengthening.

This chapter seeks to identify cost-effective interventions that can be appropriately packaged for one or more specific mental, neurological, and substance use (MNS) disorders, as well as for different levels or platforms of the health or welfare system. A platform is the level of the health or welfare system at which interventions can be appropriately, effectively, and efficiently delivered. A particular platform is defined on the basis of where the intervention will be delivered (the setting) and who will deliver the intervention (service provider). There are essentially three major platforms for the provision of interventions: population, community, and health care. A specific delivery channel—such as a school—can be the vehicle for the delivery of a particular intervention on a specified platform (the community platform). Similarly, a primary health care center is the delivery channel for a specified platform (the health care platform). Identifying the set of interventions that fall within a particular delivery channel will help decision makers to identify potential opportunities, synergies, and efficiencies. This identification will also reflect how resources are often allocated in practice, for example, to schools or primary health care services, rather than to specific interventions or disorders.

Chapter 10 of this volume (Petersen and others 2015) considers the evidence relating to interventions that improve mental health at the population and community levels. This chapter outlines the main elements and features of a health care platform and its delivery channels, namely, informal health care, primary health care, and specialized services. We consider evidence-based interventions that can be delivered in general health care settings and mental health care settings, as well as broader health system–strengthening strategies for more effective and efficient delivery of services on this platform.