Mental Health Beyond Facilities (mhBeF) GMH 0091-04:

PI: Florence Baingana (Makerere University School of Public Health, Uganda

Co-PI: Sonia Chehil, Dalhousie University, Canada

Co-Investigators: Mark Jordans, TPO-Nepal,

Patrick Onyango-Mangen, TPO-Uganda, Juliet Nakku, Butabika Hospital, Uganda,

Janice Cooper and Brandon Kort, The Carter Center, Liberia.

Developing the ToC

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Overview

• Objectives of the Meeting• Background to the Project• Project objectives and Conceptual Framework• Achievements so far• Lessons learned• Challenges

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Objectives of the Meeting

1. To share details of the Project2. To disseminate the formative research

results3. To share achievements of the Project in

the first Year4. To share planned activities for Year 2

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Background

• Global Burden of mental disorders – GBD 27% of YLD, 14% of DALY– World Economic Forum

• Conflicts, HIV and AIDS, poverty, lead to high burden in LMIC.

• Data from Uganda, Kinyanda, Tugumisirize, MakSPH SHSSP II

• Gap between burden and the cost-effective interventions

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Background

• Weak Community Mental health systems in most of the developing world

• Community MHS weakest component of MHS in Uganda (MakSPH/SHSSP II 2010)

• High levels of stigma, make it difficult for people with mental disorders to go to school or to get jobs/get gainfully employed.

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Intermediate OutcomesIntervention UltimateOutcomes

Capacity Building for clinical care

Stigma Reduction

IMPROVED FUNCTIONING1. Improved individual functioning (EQ5D,GAF)2. Improved Household Economic Status (monthly income)

1. Observed clinical skills evaluation at each care level2. Quality of documentation3. Inter-rater reliability of diagnoses and evidence based treatment according diagnosis and national services4. Patient service use and symptom burden

1. Providers: Reduction in clinical expressed stigma 2. Community: Reduction in expressed stigma3. Consumers: Reduction in self- , anticipated- , and experienced-stigma 4. Policy makers: New legislation, policy, and funding

Cross-National Monitoring & Evaluation Innovation

Cross-National Training & Stigma-Reduction Design

CONCEPTUAL FRAMEWORK

Objective 1Develop CCMHS Package

Objective 2Train for the delivery of the CCMHS Package

Objective 3Delivery of the CCMHS Package

Objective 4Evaluation of effectiveness of the CCBMH Package

Empowerment of PSGs

Study SitesUganda•Erute South HSD (Study site)•Erute North HSD (some health units) Control site

Nepal•Pyutan District

Liberia•5 Districts of Sinoe County

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Presentation 2

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Achievements

• Inception workshop held in Kampala February 2013 with all project partners.

• Formative research carried out in all three countries

• Drafts of CCMHS Package manual completed• IT Consultants hired

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Way Forward• Working to get IRB clearance by the end of

October 2013, latest mid November 2013.• Do the baseline assessment of the health system

maybe end of November or early December• Train all cadres second week of January 2014• Annual meeting in Liberia February 2014• Roll out services as soon as training is complete,

so end of January 2014• T0 of the cohort will begin as soon as HCW begin

to see clients.

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Challenges

• Working across 3 countries, we have to move at the pace of everyone else.

• Different skills levels and resources in the three countries

• Procurement processes of Makerere University can sometimes cause delays.

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What works well• Cooperation of all partners, within Uganda

and in each of the countries• Cooperation between all the project staff in

countries and between countries• Enthusiasm for the work that they are doing

by all staff in all countries• Extreme interest by all the consultants, eg

Biostatistician, IT and for the Manual.

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