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Integrating mental health services into primary healthcare platforms is an established health systems strategy in low-to-middle-income countries. In South Africa, this was pursued through the Programme for Improving Mental Health Care (PRIME), a multi-country initiative that relied on task-sharing as a principle implementation strategy. Towards better describing the implementation processes, qualitative comparative analysis was adopted to explore causal pathways in the intervention. This study aimed to explore factors that could have influenced key outcomes of an integrated mental healthcare intervention in South Africa. Drawing from an embedded multiple case study design, the analysis used qualitative comparative analysis. Focusing on nine PHC clinics in the Dr Kenneth Kaunda District as cases, with depression reduction scores set as outcome measures, trial data variables were modelled in a hypothetical causal process. A fuzzy-set qualitative comparative analysis was performed by 1) developing the research questions, 2) developing the fuzzy set, 3) testing necessity and 4) testing sufficiency. These steps were undertaken collaboratively among the research team. The data were calibrated during several meetings among team members to gain a degree of consensus. Necessity analyses suggested that none of the causal conditions exceeded the threshold of necessity and triviality, and confirmed the inclusion of relevant variables in line with the proposed models. Sufficiency analyses produced two configurations, which were subjected to standard and specific analyses. Ultimately, the results suggested that none of the causal conditions were necessary for a reduction in depression scores to occur, while programme fidelity was identified as a sufficient condition for a reduction in scores to occur. The study highlights the importance of understanding implementation pathways to enable better integration of mental health services within primary healthcare in low-to-middle-income settings. It underlines the importance of programme fidelity in achieving the goals of implementation. [ABSTRACT FROM AUTHOR]

Informal women workers are vulnerable to poverty and job insecurity, but little is known about how they manage multiple childcare and work responsibilities without maternity protection. We explore perspectives of informal working mothers about the role played by their child's father. A longitudinal mixed-methods study was conducted among women informal workers. In-depth interviews (IDIs) were conducted at transition points from pregnancy until after women returned to work. Focus group discussions (FGDs) explored the social support systems participants relied on. Twenty-four informal workers were enrolled; 87 IDIs conducted; 14 women participated in three FGDs. Participants had low-paid, insecure informal jobs. Twenty-three participants were in a relationship with the child's father, and nine were living with him. Fathers played a central role providing emotional, practical and financial support, particularly fathers living in the same household. Most resident fathers took a strong practical role caring for the household and for the baby but traditional practices limited non-resident father's ability to provide emotional or practical support. Most fathers had low incomes and were unable to provide financial support, so many women returned to work early. Fathers are willing to provide substantial support that is crucial for family well-being, but non-residence is a barrier. [ABSTRACT FROM AUTHOR]