From Year 3 of the Hub, a shared research project will be initiated In consultation with other NIMH regional hubs. Although the exact details of this project will be determined by networking with other funded NIMH hubs, at this point AFFIRM envisions establishing a regional primary care sentinel network, concentrated initially In Uganda, in health centres linked to the INDEPTH Demographic Surveillance Site in Mayuge, and expanding to sites in Ethiopia, South Africa and other network Hubs. This program will focus on the framework required for effective and sustainable delivery of integrated mental healthcare, and the generic knowledge and skills required by non-specialist health workers.
The specific aims i nclude: 1) Establishing a regional network of sentinel Primary Health Care (PHC) sites, in different hub partner countries, covering urban, semi-rural and rural locations, and representing different levels of development in terms of integration of mental health care into primary care; 2) Estimating the extent and type of the baseline mental health caseload In sentinel PHCs, and appraising pre-existing MHIS. This will be achieved through visits to each of the PHCs, and discussions with clinical staff, district information officers, programme managers and MoH. 3) Establishing a procedure for developing a feasible MHIS for PHC settings, based on recommended by WHO, and processes used in the MHaPP program in two South African provinces; 4) Piloting and evaluating the implementation of the MHIS in the sentinel PHC; 5) Exploring the process of diagnosis and development of initial management plans by trained community health care workers (CHWs) in PHC and; 5) Developing the capacity of the sentinel sites as a research framework for the evaluation of enhancements in integrated mental healthcare.
Increased evidence suggests that integrating mental health services into primary care can be highly effective in the assessment and management of mental disorders. This needs to be accompanied with system change, including, new investment in training PHC personnel and improved information systems for monitoring routine care. The shared project will seek to implement and evaluate this framework across the regional hubs offering the potential for better case management of mental disorders in LMICs.
|De Silva, Mary J; Breuer, Erica; Lee, Lucy et al. (2014) Theory of Change: a theory-driven approach to enhance the Medical Research Council's framework for complex interventions. Trials 15:267|