Browsing by Author "Jordans, Mark"

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Evaluation of performance and perceived utility of mental healthcare indicators in routine health information systems in five low- and middle-income countries
(Cambridge University Press., 2019-08-06) Jordans, Mark; Chisholm, Dan; Semrau, Maya; Gurung, Dristy; Abdulmalik, Jibril; Ahuja, Shalini; Mugisha, James; Mntambo, Ntokozo; Kigozi, Fred; Petersen, Inge; Shidhaye, Rahul; Upadhaya, Nawaraj; Lund, Crick; Thornicroft, Graham; Gureje, Oye
In most low- and middle-income countries (LMIC), routine mental health information is unavailable or unreliable, making monitoring of mental healthcare coverage difficult. This study aims to evaluate a new set of mental health indicators introduced in primary healthcare settings in five LMIC. Method A survey was conducted among primary healthcare workers (n = 272) to assess the acceptability and feasibility of eight new indicators monitoring mental healthcare needs, utilisation, quality and payments. Also, primary health facility case records (n = 583) were reviewed by trained research assistants to assess the level of completion (yes/no) for each of the indicators and subsequently the level of correctness of completion (correct/incorrect – with incorrect defined as illogical, missing or illegible information) of the indicators used by health workers. Assessments were conducted within 1 month of the introduction of the indicators, as well as 6–9 months afterwards. Results Across both time points and across all indicators, 78% of the measurements of indicators were complete. Among the best performing indicators (diagnosis, severity and treatment), this was significantly higher. With regards to correctness, 87% of all completed indicators were correctly completed. There was a trend towards improvement over time. Health workers' perceptions on feasibility and utility, across sites and over time, indicated a positive attitude in 81% of all measurements. Conclusion This study demonstrates high levels of performance and perceived utility for a set of indicators that could ultimately be used to monitor coverage of mental healthcare in primary healthcare settings in LMIC. We recommend that these indicators are incorporated into existing health information systems and adopted within the World Health Organization Mental Health Gap Action Programme implementation strategy.
Experience of implementing new mental health indicators within information systems in six low- and middle-income countries
(Cambridge University Press: BJPsych Open Emerald Series, 2019-08-06) Ahuja, Shalini; Hanlon, Charlotte; Chisholm, Dan; Semrau, Maya; Gurung, Dristy; Abdulmalik, Jibril; Mugisha, James; Mntambo, Ntokozo; Kigozi, Fred; Petersen, Inge; Shidhaye, Rahul; Upadhaya, Nawaraj; Lund, Crick; Evans-Lacko, Sara; Thornicroft, Graham; Gureje, Oye; Jordans, Mark
Successful scale-up of integrated primary mental healthcare requires routine monitoring of key programme performance indicators. A consensus set of mental health indicators has been proposed but evidence on their use in routine settings is lacking. Aims To assess the acceptability, feasibility, perceived costs and sustainability of implementing indicators relating to integrated mental health service coverage in six South Asian (India, Nepal) and sub-Saharan African countries (Ethiopia, Nigeria, South Africa, Uganda). Method A qualitative study using semi-structured key informant interviews (n = 128) was conducted. The ‘Performance of Routine Information Systems’ framework served as the basis for a coding framework covering three main categories related to the performance of new tools introduced to collect data on mental health indicators: (1) technical; (2) organisation; and (3) behavioural determinants. Results Most mental health indicators were deemed relevant and potentially useful for improving care, and therefore acceptable to end users. Exceptions were indicators on functionality, cost and severity. The simplicity of the data-capturing formats contributed to the feasibility of using forms to generate data on mental health indicators. Health workers reported increasing confidence in their capacity to record the mental health data and minimal additional cost to initiate mental health reporting. However, overstretched primary care staff and the time-consuming reporting process affected perceived sustainability. Conclusions Use of the newly developed, contextually appropriate mental health indicators in health facilities providing primary care services was seen largely to be feasible in the six Emerald countries, mainly because of the simplicity of the forms and continued support in the design and implementation stage. However, approaches to implementation of new forms generating data on mental health indicators need to be customised to the specific health system context of different countries. Further work is needed to identify ways to utilise mental health data to monitor and improve the quality of mental health services.
Scaling up integrated primary mental health in six low- and middle-income countries: obstacles, synergies and implications for systems reform
(BJPsych Open Emerald Series., 2019-08-06) Petersen, Inge; Rensburg, André van; Kigozi, Fred; Semrau, Maya; Hanlon, Charlotte; Abdulmalik, Jibril; Kola, Lola; Fekadu, Abebaw; Gureje, Oye; Gurung, Dristy; Jordans, Mark; Mntambo, Ntokozo; Mugisha, James; Muke, Shital; Petrus, Ruwayda; Shidhaye, Rahul; Ssebunnya, Joshua; Tekola, Bethlehem; Upadhaya, Nawaraj; Patel, Vikram; Lund, Crick; Thornicroft, Graham
There is a global drive to improve access to mental healthcare by scaling up integrated mental health into primary healthcare (PHC) systems in low- and middle-income countries (LMICs). Aims To investigate systems-level implications of efforts to scale-up integrated mental healthcare into PHC in districts in six LMICs. Method Semi-structured interviews were conducted with 121 managers and service providers. Transcribed interviews were analysed using framework analysis guided by the Consolidated Framework for Implementation Research and World Health Organization basic building blocks. Results Ensuring that interventions are synergistic with existing health system features and strengthening of the healthcare system building blocks to support integrated chronic care and task-sharing were identified as aiding integration efforts. The latter includes (a) strengthening governance to include technical support for integration efforts as well as multisectoral collaborations; (b) ring-fencing mental health budgets at district level; (c) a critical mass of mental health specialists to support task-sharing; (d) including key mental health indicators in the health information system; (e) psychotropic medication included on free essential drug lists and (f) enabling collaborative and community- oriented PHC-service delivery platforms and continuous quality improvement to aid service delivery challenges in implementation. Conclusions Scaling up integrated mental healthcare in PHC in LMICs is more complex than training general healthcare providers. Leveraging existing health system processes that are synergistic with chronic care services and strengthening healthcare system building blocks to provide a more enabling context for integration are important.