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Evaluation of district mental healthcare plans: the PRIME consortium methodology
Mary J De Silva1, Sujit D Rathod1, Charlotte Hanlon1
1Mary J. De Silva, MSc, PhD, Sujit D. Rathod, MSC, PhD, Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK; Charlotte Hanlon, MRCPsych, PhD, Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia and Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Erica Breuer, MPH, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; Dan Chisholm, PhD, Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland; Abebaw Fekadu, MD, PhD, MRCPsych, Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia and Department of Psychological Medicine, Centre for Affective Disorders and the Affective Disorders Research Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Mark Jordans, PhD, Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK and HealthNet TPO, Research and Development Department, Amsterdam, The Netherlands; Fred Kigozi, MBChB, MMed, Butabika National Referral and Teaching Hospital/Makerere University, Kampala Uganda; Inge Petersen, PhD, School of Applied Human Sciences, Howard College, University of KwaZulu-Natal, South Africa; Rahul Shidhaye, MD(Psych), MHS, Centre for Mental Health, the Public Health Foundation of India, India and Maastricht University/CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands; Girmay Medhin, MSc, PhD, Department of Psychological Medicine, Centre for Affective Disorders and the Affective Disorders Research Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London,
Background:
Few studies have evaluated the implementation and impact of real-world mental health programmes delivered at scale in low-resource settings.
Aims:
To describe the cross-country research methods used to evaluate district-level mental healthcare plans (MHCPs) in Ethiopia, India, Nepal, South Africa and Uganda.
Method:
Multidisciplinary methods conducted at community, health facility and district levels, embedded within a theory of change.
Results:
The following designs are employed to evaluate the MHCPs: (a) repeat community-based cross-sectional surveys to measure change in population-level contact coverage; (b) repeat facility-based surveys to assess change in detection of disorders; (c) disorder-specific cohorts to assess the effect on patient outcomes; and (d) multilevel case studies to evaluate the process of implementation.
Conclusions:
To evaluate whether and how a health-system-level intervention is effective, multidisciplinary research methods are required at different population levels. Although challenging, such methods may be replicated across diverse settings.
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