Emerald (Emerging mental health systems in low- and middle-income countries)


Work package 4 of the EMERALD Project is concerned with the processes within health systems that are necessary to facilitate improved mental health outcomes, including for example legislation, policies and implementation plans, and to identify best practices for developing and implementing mental health plans in LAMICs from district through to national level. Country teams participating in this work package together with South Africa and Uganda are Ethiopia, Nigeria, India and Nepal. This work package has 3 objectives that are described below.


Project activities ended 31 October 2017 (Total duration of project 60 months)

Objective 1: Month 01-48
To identify optimal institutional, legal and policy contexts as well as processes for implementation of integration policy and service integration plans in LAMICs (both in better integrated and in more fragile health systems)

Progress of Objective 1
Qualitative interviews have been conducted with key stakeholders (including policy-makers, district managers, district service providers and service users) to understand contextual factors that enable/inhibit the development of mental health policies, plans and legislature, as well as capacity-building needs to aid implementation and to inform the development of short courses

Objective 2: Month 06-48
To identify best practices for addressing resource requirements, capacity development needs, and supervision requirements to improve help seeking, identification, referral and follow-up to recovery for mental disorders in low, low-middle and upper-middle income countries, including key barriers to access to scaled up services (including stigma and discrimination as (i) sources of demand limitation and (ii) key barriers among policy makers)

Progress of Objective 2
Quantitative baseline, midline and end line surveys (ACIC) as well as qualitative interviews (process evaluation interviews) were completed after the implementation of district mental health care plans to assess the impact of integration on system level characteristics.

Objective 3: Month 18-60
To evaluate health system synergies / implications of scaled-up service provision in LAMICs. Following the implementation of the mental health care plans, qualitative interviews with key informants will be conducted with key stakeholders (including policy-makers, district managers, service providers and service users), in order to understand factors that facilitated/acted as barriers to the implementation of mental health policies, plans and legislation for integrated mental health care, as well as their perspectives on how integrated mental health care has improved overall health care (for example improved quality of communication with service users, improved service user satisfaction with care), how it has impacted on the functioning of the different components of care, including factors that facilitated or acted as barriers to integrated care at a systems level (for instance information, human resources), as well as issues relating to stigma and discrimination.

Progress of objective 3
Qualitative interviews with key stakeholders (policy-makers, district managers, service providers and service users) have been conducted and analysed. Quantitative PACIC interviews have been conducted with mental health service users. PACIC data has been cleaned and analysed.