Structural and health system determinants of mental health in Tanzania: mapping policy recommendations to the WHO comprehensive mental health action plan 2013-2030.

内容摘要

Mental health disorders are a major public health concern in Tanzania, where most people in need of care do not receive treatment and mental health services remain severely under-resourced. Despite a growing body of country-level research, no prior review has mapped the evidence on structural determinants of mental health conditions and policy recommendations within the WHO Comprehensive Mental Health Action Plan 2013-2030. This scoping review aimed to identify structural and health system factors associated with mental health conditions in Tanzania and map policy recommendations reported in the included studies against the objectives of the WHO Comprehensive Mental Health Action Plan 2013-2030. Following the Joanna Briggs Institute framework for scoping reviews, five electronic databases (Embase, MEDLINE, PsycINFO, Web of Science, and Scopus) were searched for peer-reviewed empirical studies published in English up to June 2025. Screening and full-text assessment were conducted independently by multiple reviewers using Covidence. Data were extracted using a standardized extraction form and synthesized through deductive thematic analysis organized within the domains of the WHO Comprehensive Mental Health Plan. In this review, 74 studies met the inclusion criteria. Depression and anxiety were the most frequently studied mental health conditions. The main structural and health system factors associated with mental health conditions were poverty, food insecurity, and health-system weaknesses. Policy recommendations primarily emphasized service integration and community-level promotion, whereas governance reform, sustainable financing, and culturally adapted measurement tools were less frequently addressed. The findings highlight persistent gaps in leadership, governance, financing, and mental health information systems. Addressing these gaps requires coordinated, system-oriented strategies aligned with all levels of the WHO framework, particularly stronger attention to governance and financing, which were less frequently addressed in the recommendations from the included studies.