The overall goal is to establish a Hub for research and capacity development to improve the delivery of cost effective interventions for mental disorders in sub-Saharan Africa. There is growing international consensus that a task shifting approach is required in low and middle-income countries (LMIC) in which low cost interventions are delivered by general health workers, supervised by mental health specialists, through routine health care delivery systems. We propose to establish the AFrica Focus on Intervention Research for Mental health (AFFIRM) program, in 5 African countries: South Africa, Ghana, Uganda, Zimbabwe, Malawi and Ethiopia, with the following four specific aims: 1) To investigate strategies for narrowing the treatment gap for mental disorders in sub-Saharan Africa;2) To build individual and institutional capacity for intervention research in sub-Saharan Africa;3) To establish a network of collaboration between researchers, NGOs and government agencies that facilitates the translation of research knowledge into policy and practice;4) To collaborate with other regional NIMH hubs. The primary innovation of AFFIRM will be that it will integrate research, capacity building and network development with a shared goal of improving the delivery of cost-effective mental health interventions in sub-Saharan Africa. The Hub will bring together a range of multi-disciplinary researchers, policy makers and NGO practitioners, and build on previous partnerships, such as the MHaPP, with a focus on empirically testing innovative models of task shifting in low resource PHC settings. We will implement the AFFIRM program through three overlapping phases. The inception phase (1st 6 months) will involve establishing the Administrative core at the Centre for Public Mental Health, University of Cape Town;developing a detailed protocol for each of the research sites (Ethiopia and South Africa);conducting a capacity building needs assessment among all AFFIRM partners and making contact with other regional hubs. The implementation phase, carried out in years 1-4, will involve piloting and conducting the research, implementing the capacity-development plan and carrying out the shared projects. The final stage, conducted in years 3-5 will be evaluation and dissemination.

Public Health Relevance

Despite the high burden of mental disorders in Africa, resources for services are limited and inappropriately used, capacity for mental health research is limited and there is a lack of evidence for how task-shifting can be employed in routine clinical settings in Africa, despite its cost-effectiveness. Through carrying out research on task-shifting and simultaneously building research capacity- building, the proposed Hub aims to improve the delivery of cost-effective interventions for mental disorders in sub-Saharan Africa.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Program--Cooperative Agreements (U19)
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Special Emphasis Panel (ZMH1)
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Pringle, Beverly
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University of Cape Town
South Africa
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