private-sector focus has remained on specialist mental health
services, and allocated budgets have been spent largely on
boosting numbers of specialists, by supporting medical
colleges, and by introducing additional seats in all the
psychiatric specialties. Less progress has been made in
developing non-specialist health workers. Bureaucrats and
experts suggest specialists have augmented managerial and
supervisory responsibilities towards a greatly expanded
non-specialist workforce, but they warn that psychiatrists (in
government and the private sector) are resistant to taking on
managerial roles (van Ginneken, unpublished). Current service
provision by non-specialists is—according to these experts—of
poor quality, and they suggest improving the training with less
didactic initial training and regular ongoing formal and
informal training. They also suggest assessing the feasibility
and eff ect of care provided by non-specialists. Four key
challenges exist for the government.