Browsing by Author "Van Bortel, Tine"
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Item Metadata only Anticipated and experienced stigma and discrimination in the workplace among individuals with major depressive disorder in 35 countries: qualitative framework analysis of a mixed-method cross-sectional study(BMJ, 2024-06-19) Van Bortel, Tine; Wickramasinghe, Nuwan Darshana; Treacy, Samantha; Khan, Nashi; Ouali, Uta; Sumathipala, Athula; Svab, Vesna; Nader, Doaa; Kadri, Nadia; Monteiro, Maria Fatima; Knifton, Lee; Quinn, Neil; Audenhove, Chantal Van; Lasalvia, Antonio; Bonetto, Chiara; Thornicroft, Graham; Weeghel, Jaap van; Brouwers, EvelienObjectives Workplace stigmatisation and discrimination are significant barriers to accessing employment opportunities, reintegration and promotion in the workforce for people with mental illnesses in comparison to other disabilities. This paper presents qualitative evidence of anticipated and experienced workplace stigma and discrimination among individuals with major depressive disorder (MDD) in 35 countries, and how these experiences differ across countries based on their Human Development Index (HDI) level. Design Mixed-method cross-sectional survey. Participants, setting and measures The qualitative data were gathered as part of the combined European Union Anti-Stigma Programme European Network and global International Study of Discrimination and Stigma Outcomes for Depression studies examining stigma and discrimination among individuals with MDD across 35 countries. Anticipated and experienced stigma and discrimination were assessed using the Discrimination and Stigma Scale version 12 (DISC-12). This study used responses to the open-ended DISC-12 questions related to employment. Data were analysed using the framework analysis method. Results The framework analysis of qualitative data of 141 participants identified 6 key ‘frames’ exploring (1) participants reported experiences of workplace stigma and discrimination; (2) impact of experienced workplace stigma and discrimination; (3) anticipated workplace stigma and discrimination; (4) ways of coping; (5) positive work experiences and (6) contextualisation of workplace stigma and discrimination. In general, participants from very high HDI countries reported higher levels of anticipated and experienced discrimination than other HDI groups (eg, less understanding and support, being more avoided/shunned, stopping themselves from looking for work because of expectation and fear of discrimination). Furthermore, participants from medium/low HDI countries were more likely to report positive workplace experiences. Conclusions This study makes a significant contribution towards workplace stigma and discrimination among individuals with MDD, still an under-researched mental health diagnosis. These findings illuminate important relationships that may exist between countries/contexts and stigma and discrimination, identifying that individuals from very high HDI countries were more likely to report anticipated and experienced workplace discrimination.Item Metadata only Dementia care pathways in prisons – a comprehensive scoping review(Springer, 2024-01-20) Treacy, Samantha; Martin, Steven; Samarutilake, Nelum; Phillips, Veronica; Underwood, Ben R.; Van Bortel, TineBackground The number of older people in prison is growing. As a result, there will also be more prisoners suffering from dementia. The support and management of this population is likely to present multiple challenges to the prison system. Objectives To examine the published literature on the care and supervision of people living in prison with dementia and on transitioning into the community; to identify good practice and recommendations that might inform the development of prison dementia care pathways. Methods A scoping review methodology was adopted with reporting guided by the PRISMA extension for scoping reviews checklist and explanation. Results Sixty-seven papers were included. Most of these were from high income countries, with the majority from the United Kingdom (n = 34), followed by the United States (n = 15), and Australia (n = 12). One further paper was from India. Discussion The literature indicated that there were difficulties across the prison system for people with dementia along the pathway from reception to release and resettlement. These touched upon all aspects of prison life and its environment, including health and social care. A lack of resources and national and regional policies were identified as important barriers, although a number of solutions were also identified in the literature, including the development of locally tailored policies and increased collaboration with the voluntary sector. Conclusion To our knowledge, this is the most comprehensive and inclusive review of the literature on dementia care pathways in prison to date. It has identified a number of important areas of concern and opportunities for future research across the prison system, and its operations. This will hopefully lead to the identification or adaptation of interventions to be implemented and evaluated, and facilitate the development of dementia care pathways in prisons.Item Metadata only Development and psychometric validation of new questionnaires assessing experienced discrimination and internalised stigma among people with Covid-19(Cambridge University, 2022-05-26) Bonetto, Chiara; Pace, Davide; Bodini, Luca; Colombi Morena; Van Bortel, Tine; Lasalvia, AntonioAims: To develop and validate two new standardised measures assessing, respectively, experienced discrimination (Covid-19 Experienced DISCrimination scale, CEDISC) and internalised stigma (COvid-19 INternalised Stigma scale, COINS) in people who had been infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or had developed coronavirus disease 2019 (Covid-19) disease. Methods: Both the CEDISC and the COINS were developed in Italian and tested for ease of use, comprehension, acceptability, the relevance of items and response options within a focus group session. Online cross-sectional validation survey was conducted among adults infected with SARS-CoV-2 or who developed Covid-19 disease, members of a closed Facebook discussion group in Italy. Exploratory factor analysis (EFA) with Promax oblique rotation; the Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy and the Bartlett's test of sphericity were used to assess the suitability of the sample for factor analysis. Reliability was assessed as internal consistency using Cronbach's alpha and as test–retest reliability using weighted kappa and intraclass correlation coefficient (ICC). Precision was examined by Kendall's tau-b coefficient. Results: Overall, 579 participants completed the CEDISC, 519 also completed the COINS, 155 completed the retest for both scales after two weeks. The 12 items of the CEDISC converged over a 2-factor solution (‘social life’ and ‘close relations’) accounting for 49.2% of the variance (KMO = 0.894; Bartlett's test p < 0.001); the 13 items of the COINS converged over a 3-factor solution (‘self-perception’, ‘close relations’ and ‘social life’) accounting for 67.7% (KMO = 0.827; Bartlett's test p < 0.001). Cronbach's α was 0.848 for the CEDISC, and 0.837 for the COINS. The CEDISC showed three items (25%) with kappa between 0.61 and 0.80 and seven (58.4%) between 0.41 and 0.60, with only two items scoring 0.21 and 0.40; the COINS had ten items (76.9%) with kappa ranging from 0.41 to 0.60, and three items below 0.31. ICC was 0.906 (95% CI, 0.871–0.932) for the, CEDISC and 0.860 (95% CI, 0.808–0.898) for the COINS. Kendall's tau-b ranged from 0.360 to 0.556 (p < 0.001) for the CEDISC and from 0.290 to 0.606 (p < 0.001) for the COINS. Conclusions: Both the CEDISC and the COINS are two valid and reliable scales to be used in studies examining the role of stigma and discrimination of people infected with SARS-CoV-2 and Covid-19 patients, and in research evaluating interventions designed to mitigate stigma in this population. (PsycInfo Database Record (c) 2024 APA, all rights reserved)Item Metadata only Disease Control and Ebola in West Africa: a Qualitative Evidence Synthesis(University of New South Wales, 2022-12-15) Bell, Anthony John; Van Bortel, Tine; Chng, Nai Rui; Wells, ValerieAims: The West African Ebola Virus Disease (EVD) outbreak of 2014-2016 was the most disastrous EVD epidemic in history. We aimed to investigate and provide unique theoretical insights which could help inform future responses to EVD outbreaks. Methods: After searching five key databases in May 2021 and February 2022 (Medline, Embase, PubMed, Scopus and Cumulative Index of Nursing and Allied Health Literature (CINAHL)), 412 papers were collected. Following abstract and full text screening, 35 papers were identified for inclusion. Coded data was synthesised in accordance with the protocol set out by Thomas and Hardon. Findings: Regarding geographical context, most fieldwork underpinning included studies was conducted within Western Urban Area in Sierra Leone, suggesting that some geographical discrepancy exists within the literature base. In terms of quality, some issues were identified regarding researcher reflexivity, ethical procedures and data analysis. Following thematic synthesis, it was found that beliefs and/or practices relating to distrust, fear, socio-cultural considerations and denial hindered engagement with control measures. By contrast, experiencing the virus first-hand and engaging with survivors prompted the uptake of such measures. Building from these findings, we then proposed an amendment to Barry Hewlett’s Evolutionary Cultural Anthropology (ECA) framework, shedding light on the determinants of such beliefs and/or practices. Conclusion: Our review provides a systematic mapping of which beliefs and/or practices either promoted or hindered response efforts during the outbreak as well as an authentic and holistic way of understanding why such beliefs and/or practices emerged, by synthesising Hewlett’s ECA framework with our findings. By drawing from our cross contextual analysis, health professionals throughout West Africa and beyond could use this work in further reflecting on and guiding the implementation of control measures prior or during future EVD outbreaks.Item Metadata only Inequalities and mental health during the Coronavirus pandemic in the UK: a mixed-methods exploration(Springer, 2023-09-20) Lombardo, Chiara; Guo, Lijia; Solomon, Susan; Crepaz-Keay, David; McDaid, Shari; Thorpe, Lucy; Martin, Steven; John, Ann; Morton, Alec; Davidson, Gavin; Kousoulis, Antonis A.; Van Bortel, TineBackground The World Health Organisation declared the novel Coronavirus disease (COVID-19) a global pandemic on 11th March 2020. Since then, the world has been firmly in its grip. At the time of writing, there were more than 767,972,961 million confirmed cases and over 6,950,655 million deaths. While the main policy focus has been on controlling the virus and ensuring vaccine roll-out and uptake, the population mental health impacts of the pandemic are expected to be long-term, with certain population groups affected more than others. Methods The overall objectives of our ‘Coronavirus: Mental Health and the Pandemic’ study were to explore UK adults’ experiences of the Coronavirus pandemic and to gain insights into the mental health impacts, population-level changes over time, current and future mental health needs, and how these can best be addressed. The wider mixed-methods study consisted of repeated cross-sectional surveys and embedded qualitative sub-studies including in-depth interviews and focus group discussions with the wider UK adult population. For this particular inequalities and mental health sub-study, we used mixed methods data from our cross-sectional surveys and we carried out three Focus Group Discussions with a maximum variation sample from across the UK adult population. The discussions covered the broader topic of 'Inequalities and mental health during the Coronavirus pandemic in the UK’ and took place online between April and August 2020. Focus Groups transcripts were analysed using thematic analysis in NVIVO. Cross-sectional survey data were analysed using STATA for descriptive statistics. Results Three broad main themes emerged, each supporting a number of sub-themes: (1) Impacts of the pandemic; (2) Moving forward: needs and recommendations; (3) Coping mechanisms and resilience. Findings showed that participants described their experiences of the pandemic in relation to its impact on themselves and on different groups of people. Their experiences illustrated how the pandemic and subsequent measures had exacerbated existing inequalities and created new ones, and triggered various emotional responses. Participants also described their coping strategies and what worked and did not work for them, as well as support needs and recommendations for moving forward through, and out of, the pandemic; all of which are valuable learnings to be considered in policy making for improving mental health and for ensuring future preparedness. Conclusions The pandemic is taking a long-term toll on the nations’ mental health which will continue to have impacts for years to come. It is therefore crucial to learn the vital lessons learned from this pandemic. Specific as well as whole-government policies need to respond to this, address inequalities and the different needs across the life-course and across society, and take a holistic approach to mental health improvement across the UK.Item Metadata only Patient and public involvement (PPI) in prisons: the involvement of people living in prison in the research process – a systematic scoping review(BioMed Central, 2021-11-11) Treacy, Samantha; Martin, Steven; Samarutilake, Nelum; Van Bortel, TineBackground Patient and Public Involvement (PPI) in health and social care research is increasingly prevalent and is promoted in policy as a means of improving the validity of research. This also applies to people living in prison and using social care services. Whilst evidence for the effectiveness of PPI was limited and reviews of its application in prisons were not found, the infancy of the evidence base and moral and ethical reasons for involvement mean that PPI continues to be advocated in the community and in prisons. Objectives To conduct a review of the literature regarding the involvement of people or persons living in prison (PLiP) in health and social care research focused on: (i) aims; (ii) types of involvement; (iii) evaluations and findings; (iv) barriers and solutions; and (v) feasibility of undertaking a systematic review. Methods A systematic scoping review was undertaken following Arksey and O’Malley’s (International Journal of Social Research Methodology 8: 19-32, 2005) five-stage framework. A comprehensive search was conducted involving ten electronic databases up until December 2020 using patient involvement and context related search terms. A review-specific spreadsheet was created following the PICO formula, and a narrative synthesis approach was taken to answer the research questions. PRISMA guidelines were followed in reporting. Results 39 papers were selected for inclusion in the review. The majority of these took a ‘participatory’ approach to prisoner involvement, which occurred at most stages during the research process except for more ‘higher’ level research operations (funding applications and project management), and only one study was led by PLiPs. Few studies involved an evaluation of the involvement of PLiP, and this was mostly PLiP or researcher reflections without formal or independent analysis, and largely reported a positive impact. Barriers to the involvement of PLiP coalesced around power differences and prison bureaucracy. Conclusion Given the very high risk of bias arising from the available ‘evaluations’, it was not possible to derive firm conclusions about the effectiveness of PLiP involvement in the research process. In addition, given the state of the evidence base, it was felt that a systematic review would not be feasible until more evaluations were undertaken using a range of methodologies to develop the field further.Item Metadata only Perceived causes of mental illness and views on appropriate care pathways among Indonesians(BioMed Central, 2021-09-23) Anjara, Sabrina Gabrielle; Brayne, Carol; Van Bortel, TineBackground The mental health system in Indonesia comprises attempts to modernise a colonial relic. There is still a disconnect between available services and help-seeking behaviours at the grassroots level. This study aims to explore the perceptions of Javanese people on the aetiology of mental illness and their ideas on how to deal with individuals who may have mental illness. Methods This qualitative study involves semi-structured interviews, embedded in a cluster randomised trial examining the clinical and cost-effectiveness of primary mental health services. Interviews were conducted with Indonesian and Javanese. The recruitment procedure was aligned to the trial. Participants were primary care patients recruited from 21 sites across Yogyakarta province. Interviews were recorded, transcribed, and translated into English. Thematic analysis was used to analyse the interview transcripts. Results 75 participants took part in the study: 51 women (68%) and 24 men (32%). Key themes emerged around perceived causes of mental health problems (including ‘extrinsic factors’; ‘intrinsic factors’; and ‘spiritual factors’), and perceived appropriate pathways of care (‘modern medical science’; ‘social support and activities’; and ‘religious or spiritual interventions’). Gender potentially influenced some of the responses. Conclusions Themes indicate the variety of preconceptions towards mental health problems and assumptions regarding the best management pathways. Some of these preconceptions and assumptions support the utility of modern medical care, while the rest promote spiritual or religious healers. Participants’ ideas of the appropriate care pathways largely correspond to their perception of what the symptoms are caused by. Despite hints to some understanding of the bio-psycho-social model of mental illness, most participants did not capture the complexity of mental health and illness, indicating the importance of contextual (especially culturally and religiously-aligned) public education around mental health, illness and care.Item Metadata only Post-traumatic stress and depression following a landslide linked to the 2018 floods in Kerala, India: Relevance of screening(Weston Medical, 2023-01-02) Kumar, Manoj Therayil; Kar, Nilamadhab; Namboodiri, Vasudevan; Joy, Aloka; Sreeenivasan, Dhanya; Kumar, Sebind; Van Bortel, TineThere is scant information on early manifestation of trauma due to catastrophic natural events and its relation with stress-related disorders. The specific objective of this study was to estimate and compare the prevalence of post-traumatic stress and depression on day 3 (D3) and week 6 (W6) following the 2018 flood in Kerala, India. In a cross-sectional study, symptoms of post-traumatic stress and depression were studied at D3 using primary care Post-Traumatic Stress Disorder screen for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (PC-PTSD-5), and then at W6 using PC-PTSD-5, Screening Questionnaire for Disaster Mental Health, PTSD Checklist for DSM-5 (PCL-5), and Becks Depression Inventory. Majority (70 percent) were screen positive at D3 (n = 20) compared with 30 percent at W6 (n = 50), with a decreased frequency of all symptoms. Being PC-PTSD-5 screen positive at W6 was significantly associated with the presence of threat to life, physical injury, and death of relatives or neighbors. According to PCL-5, at W6, 46 percent had possible PTSD. Except damage to property, other disaster related or sociodemographic variables were not associated with the risk of having PTSD. Positive predictive value of PC-PTSD-5 (D3) for PTSD (PCL-5) at W6 was 64.3 percent. Depression and possibility of PTSD were significantly associated. A considerable proportion of victims continued to have posttraumatic stress and depression although the frequency decreased over time. A simple screening measure may help to identify victims with possible PTSD.Item Metadata only PROTECT: Relational safety based suicide prevention training frameworks(Wiley, 2019-12-26) Ray, Manaan Kar; Wyder, Marianne; Crompton, David; Kousoulis, Antonis A.; Arensman, Ella; Hafizi, Sepehr; Van Bortel, Tine; Lombardo, ChiaraPreventing suicide is a global priority, and staff training is a core prevention strategy. However, frontline pressures make translating training into better care and better outcomes difficult. The aim of the paper was to highlight challenges in suicide risk assessment and management and introduce training frameworks to assist with mindful practice so professionals can strike a balance between risk and recovery. We combined the scientific literature with contemporary practice from two successful initiatives from Cambridgeshire, UK: 333 – a recovery-oriented model of inpatient/community crisis care and PROMISE – a programme to reduce coercion in care by enhancing patient experience. The resulting PROTECT (PROactive deTECTion) frameworks operationalize ongoing practice of relational safety in these programmes. PROTECT is a combination of novel concepts and adaptations of well-established therapeutic approaches. It has four training frameworks: AWARE for reflection on clinical decisions; DESPAIR for assessment; ASPIRE for management; and NOTES for documentation. PROTECT aims to improve self-awareness of mental shortcuts and risk-taking thresholds and increase rigour through time-efficient cross-checks. The training frameworks should support a relational approach to self-harm/suicide risk detection, mitigation, and documentation, making care safer and person-centred. The goal is to enthuse practitioners with recovery-oriented practice that draws on the strengths of the person in distress and their natural circle of support. It will provide the confidence to engage in participatory approaches to seek out unique individualized solutions to the overwhelming psychological pain of suicidal distress. Future collaborative research with people with lived and carer experience is needed for fine-tuning.Item Metadata only Resilience across the UK during the Coronavirus pandemic(Mental Health Foundation, 2020-09-03) Kousoulis, Antonis; McDaid, Shari; Crepaz-Keay, David; Solomon, Susan; Lombardo, Chiara; Yap, Jade; Weeks, Lauren; O’Sullivan, Chris; Baird, Rachel; Grange, Richard; Giugliano, Toni; Van Bortel, Tine; John, Ann; Lee, Sze; Morton, Alec; Davidson, Gavin; Morillo, Hannah-Resilience enables us as individuals, communities, nations and as a country, to cope with the stress of the coronavirus pandemic. -This study shows that most people (64%) say they are coping well with the stress of the pandemic. However, many are struggling with the current crisis. -Of those who have experienced stress due to the pandemic, almost nine out of ten (87%) are using at least one coping strategy. -People have used a wide range of strategies to cope; these most often included going for a walk, spending time in green spaces, and staying connected with others. -We found that some people are resorting to potentially harmful ways of coping, including increased alcohol consumption, substance misuse, and over-eating, putting their mental and physical health at greater risk. -While each nation has made available mental health literacy resources in response to COVID-19, this study’s findings point to where more policy and investment could be targeted to support people and communities to remain resilient in the face of local or national restrictions related to the coronavirus pandemic.Item Metadata only The COVID-19 pandemic, financial inequalities and mental health in the UK(Mental Health Foundation, 2020-05-01) Kousoulis, Antonis; McDaid, Shari; Crepaz-Keay, David; Solomon, Susan; Lombardo, Chiara; Yap, Jade; Weeks, Lauren; O’Sullivan, Chris; Baird, Rachel; Grange, Richard; Giugliano, Toni; Thorpe, Lucy; Van Bortel, Tine; John, Ann; Lee, Sze; Morton, Alec; Davidson, Gavin; Knifton, Lee; Rowland, MarkWe all can experience mental health problems, whatever our background or walk of life. But the risk of experiencing mental ill-health is not equally distributed across our society. Those who face the greatest disadvantages in life also face the greatest risk to their mental health. The distribution of infections and deaths during the COVID-19 pandemic, the lockdown and associated measures, and the longer-term socioeconomic impact are likely to reproduce and intensify the financial inequalities that contribute to the increased prevalence and unequal distribution of mental ill-health. This briefing discusses the mental health effects of these financial inequalities in the context of the COVID-19 pandemic. It draws evidence from the ‘Coronavirus: Mental Health in the Pandemic’ research – a UK-wide, long-term study of how the pandemic affects people’s mental health. The study is led by the Mental Health Foundation, in collaboration with the University of Cambridge, Swansea University, the University of Strathclyde and Queen’s University Belfast.Item Metadata only The divergence of mental health experiences during the Coronavirus pandemic in the UK(Mental Health Foundation, 2020-07-02) Kousoulis, Antonis; McDaid, Shari; Crepaz-Keay, David; Solomon, Susan; Lombardo, Chiara; Yap, Jade; Weeks, Lauren; O’Sullivan, Chris; Baird, Rachel; Grange, Richard; Giugliano, Toni; Thorpe, Lucy; Van Bortel, Tine; John, Ann; Lee, Sze; Morton, Alec; Davidson, GavinThe Coronavirus: Mental Health in the Pandemic study provides unique insights into the mental health effects of the pandemic since mid-March, with five waves of data collected so far across the UK specifically focused on mental health and well-being. We want to use good quality evidence to influence the actions that we need to take as a country to prevent a mental health crisis in the years to come. While we have all been affected by the COVID-19 crisis, the evidence from the Foundation’s Coronavirus: Mental Health in the Pandemic (‘our’) study shows a divergence in people’s experience depending on their social and/or economic context in society. As has been said: we are all in the same storm, but we are not all in the same boat. Even as the measures taken to curb the spread of COVID-19 change, with reduced restrictions for most and sustained isolation for a minority, with some having been affected directly by the virus and many less so, some returning to normal work life and many others experiencing changed employment status, differences in the mental health impact will persist and likely increase.Item Metadata only The long term mental health impact of covid-19 must not be ignored(BMJ, 2020-05-05) Kousoulis, Antonis A.; Van Bortel, Tine; Hernandez, Priscila; John, AnnItem Metadata only Using the GHQ-12 to screen for mental health problems among primary care patients: psychometrics and practical considerations(BioMed Central, 2020-08-10) Anjara, S. G.; Bonetto, C.; Van Bortel, Tine; Brayne, C.Background This study explores the factor structure of the Indonesian version of the GHQ-12 based on several theoretical perspectives and determines the threshold for optimum sensitivity and specificity. Through a focus group discussion, we evaluate the practicality of the GHQ-12 as a screening tool for mental health problems among adult primary care patients in Indonesia. Methods This is a prospective study exploring the construct validity, criterion validity and reliability of the GHQ-12, conducted with 676 primary care patients attending 28 primary care clinics randomised for participation in the study. Participants’ GHQ-12 scores were compared with their psychiatric diagnosis based on face-to-face clinical interviews with GPs using the CIS-R. Exploratory and Confirmatory Factor Analyses determined the construct validity of the GHQ-12 in this population. The appropriate threshold score of the GHQ-12 as a screening tool in primary care was determined using the receiver operating curve. Prior to data collection, a focus group discussion was held with research assistants who piloted the screening procedure, GPs, and a psychiatrist, to evaluate the practicality of embedding screening within the routine clinic procedures. Results Of all primary care patients attending the clinics during the recruitment period, 26.7% agreed to participate (676/2532 consecutive patients approached). Their median age was 46 (range 18–82 years); 67% were women. The median GHQ-12 score for our primary care sample was 2, with an interquartile range of 4. The internal consistency of the GHQ-12 was good (Cronbach’s α = 0.76). Four factor structures were fitted on the data. The GHQ-12 was found to best fit a one-dimensional model, when response bias is taken into consideration. Results from the ROC curve indicated that the GHQ-12 is ‘fairly accurate’ when discriminating primary care patients with indication of mental disorders from those without, with average AUC of 0.78. The optimal threshold of the GHQ-12 was either 1/2 or 2/3 point depending on the intended utility, with a Positive Predictive Value of 0.68 to 0.73 respectively. The screening procedure was successfully embedded into routine patient flow in the 28 clinics. Conclusions The Indonesian version of the GHQ-12 could be used to screen primary care patients at high risk of mental disorders although with significant false positives if reasonable sensitivity is to be achieved. While it involves additional administrative burden, screening may help identify future users of mental health services in primary care that the country is currently expanding.