Low- and middle-income countries face the challenge of combating communicable diseases, maternal morbidity and mortality, as well as the rising burden of non-communicable diseases. The high co-morbidity of common mental disorders with chronic conditions threatens to compromise the huge global investment in anti-retroviral treatment and maternal healthcare through interference with self-care and adherence. This application seeks funding for a Southern African Research Consortium for Mental health INTegration (S- MhINT). S-MhINT is a research and capacity building consortium in Southern Africa that aims to strengthen regional mental health integration into primary health, antenatal, and chronic care platforms using implementation science in under-resourced areas of eastern South Africa, central Mozambique, and southern Tanzania. Mental health policy analyses suggest that the diffusion of a policy innovation from one country to another is optimal when countries 1) perceive a high degree of commonality with respect to the burden of illness; and 2) are close geographically, which promotes social learning and peer comparison. South Africa, Mozambique and Tanzania were chosen as consortium partners because of their close proximity and similar disease profiles. S-MhINT builds on our years of investment into several rigorous research programs focused on integrating mental health care into primary healthcare systems in sub- Saharan Africa. S-MhINT has the following overall aims:
Aim 1. To establish and engage a trans- disciplinary research consortium of academics, government representatives, non-governmental organizations in South Africa, Mozambique and Tanzania to address the burden of common mental disorders in primary health care settings;
Aim 2. To examine multi-level influences on the uptake, implementation, effectiveness and sustainability of an existing scale up of an integrated mental health package for chronic disorders at primary health care level in two different districts having different resource capacities in South Africa;
Aim 3. To build implementation science and dissemination research capacity in South Africa, Mozambique and Tanzania, recruiting service providers, managers, and policy makers as trainees, providing real world opportunities, mentorship, and necessary knowledge to conduct optimal scale-up of evidence-based integrated mental health care. The University of KwaZulu-Natal and University of Washington have partnered with Muhimbili University of Health and Allied Sciences in Tanzania; non- governmental organizations of Health Alliance International in Mozambique and Management and Development for Health in Tanzania and the South African Federation for Mental Health; and Ministries/Departments of Health in South Africa, Tanzania, and the Beira Operations Research Center, the research arm of the Mozambique Ministry of Health. These organizations have been working for decades to support primary health systems improvement in under-resourced areas of Mozambique, Tanzania, and South Africa.
. In this project, we will study how to smoothly scale up treatment of mental health issues in primary care settings, by navigating bottlenecks in primary care systems. We will also work to train others in researching these models of scale up. Our work benefits people who live in under resourced settings and suffer from mental health and other chronic health issues.
