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Experience of implementing new mental health indicators within information systems in six low- and middle-income countries

  • Shalini Ahuja (a1), Charlotte Hanlon (a2), Dan Chisholm (a3), Maya Semrau (a4), Dristy Gurung (a5), Jibril Abdulmalik (a6), James Mugisha (a7), Ntokozo Mntambo (a8), Fred Kigozi (a9), Inge Petersen (a10), Rahul Shidhaye (a11), Nawaraj Upadhaya (a12), Crick Lund (a13), Sara Evans-Lacko (a14), Graham Thornicroft (a15), Oye Gureje (a16) and Mark Jordans (a17)...

Abstract

Background

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.

Declaration of interest

None.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.

Corresponding author

Correspondence: Shalini Ahuja, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, Camberwell, London SE5 8AF, UK. Email: shalini.ahuja@kcl.ac.uk

References

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1Delaney, RK, Cooper, LJ, Nshemerewire, S. The practice of child mental health nurses. In: IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions, 2018.
2Ryan, G, De Silva, M, Terver, JS, Ochi, OP, Eaton, J. Information systems for global mental health. Lancet Psychiatry 2015; 2(5): 372–3.
3World Health Organization (WHO). Mental Health Action Plan 2013–2020. WHO, 2013 (https://www.who.int/mental_health/publications/action_plan/en/).
4Upadhaya, N, Jordans, MJ, Abdulmalik, J, Ahuja, S, Alem, A, Hanlon, C, et al. Information systems for mental health in six low and middle income countries: cross country situation analysis. Int J Ment Health Syst 2016; 10: 60.
5Gururaj, G, Benegal, V, Rao, G, Pathak, K, Singh, L, Mehta, R, et al. National Mental Health Survey of India, 2015–16: Prevalence, patterns and outcomes. National Institute of Mental Health and Neuro Sciences, NIMHANS, Publication No. 129. 2016.
6Ahuja, S, Shidhaye, R, Semrau, M, Thornicroft, G, Jordans, M. Mental health information systems in resource-challenged countries: experiences from India. Br J Psyhchiatry Int 2018; 15(2): 43–6.
7Proctor, E, Silmere, H, Raghavan, R, Hovmand, P, Aarons, G, Bunger, A, et al. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health 2011; 38(2): 6576.
8Ndetei, D, Jenkins, R. The implementation of mental health information systems in developing countries: Challenges and opportunities. Epidemiologia e Psichiatria Sociale 2009; 18: 1216.
9Semrau, M, Evans-Lacko, S, Alem, A, Ayuso-Mateos, JL, Chisholm, D, Gureje, O, et al. Strengthening mental health systems in low- and middle-income countries: the Emerald programme. BMC Med 2015; 13: 79.
10Jordans, MJ, Chisholm, D, Semrau, M, Upadhaya, N, Abdulmalik, J, Ahuja, S, et al. Indicators for routine monitoring of effective mental healthcare coverage in low- and middle-income settings: a Delphi study. Health Policy Plann 2016; 31(8): 1100–6.
11Jordans, M, Chishlom, D, Semrau, M, Gurung, D, Abdulmalik, J, Ahuja, S, et al. Evaluation of performance and perceived utility of mental healthcare indicators in routine health information systems in five low- and middle-income countries. BJPsych Open 2019, this issue.
12Aqil, A, Lippeveld, T, Hozumi, D. PRISM framework: a paradigm shift for designing, strengthening and evaluating routine health information systems. Health Policy Plann 2009; 24(3): 217–28.
13Bryman, A. Social Research Methods. Oxford University Press, 2012.
14Lund, C, Tomlinson, M, De Silva, M, Fekadu, A, Shidhaye, R, Jordans, M, et al. PRIME: a programme to reduce the treatment gap for mental disorders in five low- and middle-income countries. PLoS Med 2012; 9(12): e1001359.
15Hanlon, C, Fekadu, A, Jordans, M, Kigozi, F, Petersen, I, Shidhaye, R, et al. District mental healthcare plans for five low-and middle-income countries: Commonalities, variations and evidence gaps. Br J Psychiatry 2018; 208(s56): s47s54.
16World Health Organization (WHO). mhGAP Mental Health Gap Action Programme: Scaling Up Care for Mental, Neurological, and Substance Use Disorders. WHO, 2008 (https://www.who.int/mental_health/evidence/mhGAP/en/).
17Petersen, I, Fairall, L, Bhana, A, Kathree, T, Selohilwe, O, Brooke-Sumner, C, et al. Integrating mental health into chronic care in South Africa: the development of a district mental healthcare plan. Br J Psychiatry 2016; 208(Suppl 56): s2939.
18Braun, V, Clarke, V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3(2): 77101.
19Gale, KN, Heath, G, Cameron, E, Rashid, S, Redwood, S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Medl Res Methodology 2013; 13: 117.
20Ministry of Health and Family Welfare, Government of India. New Pathways New Hope: National Mental Health Policy of India 2014. Ministry of Health and Family Welfare, 2014 (https://www.nhp.gov.in/sites/default/files/pdf/national%20mental%20health%20policy%20of%20india%202014.pdf).
21Lauriks, S, Buster, MC, de Wit, MA, Arah, OA, Klazinga, NS. Performance indicators for public mental healthcare: a systematic international inventory. BMC Public Health 2012; 12: 214.
22Hotchkiss, D, Aqil, A, Lippeveld, T, Mukooyo, E. Evaluation of the performance of routine information system management (PRISM) framework: evidence from Uganda. BMC Health Serv Res 2010; 10: 188.
23Odhiambo-Otieno, GW. Evaluation of existing district health management information systems a case study of the district health systems in Kenya. Int J Med Inform 2005; 74(9): 733–44.
24Eslami, A, Scheepers, H, Rajendran, D, Sohal, A. Health information systems evaluation frameworks: a systematic review. Int J Med Inform 2017; 97: 195209.
25Zwaanswijk, M, Verheij, RA, Wiesman, FJ, Friele, RD. Benefits and problems of electronic information exchange as perceived by health care professionals: an interview study. BMC Health Serv Res 2011; 11: 256.
26World Health Organization (WHO). Mental Health Information Systems. WHO, 2005 (https://www.who.int/mental_health/policy/mnh_info_sys.pdf).
27World Health Organization (WHO). Framework and Standards for Country Health Information Systems (2nd edn). WHO, 2012 (https://www.who.int/healthinfo/country_monitoring_evaluation/who-hmn-framework-standards-chi.pdf).
28Duke Global Health Institute. OPAL - Optimizing Provider Attitudes and Competence in Learning Mental Health Systems. Duke Global Health Institute, 2017 (https://globalhealth.duke.edu/projects/opal-optimizing-provider-attitudes-and-competence-learning-mental-health-systems).
29National Institute for Health Research (NIHR). ASSEST: Health System Strengthening in Sub-Saharan Africa. NIHR, 2017 (https://www.healthasset.org).
30Kpobi, L, Swartz, L, Ofori-Atta, AL. Challenges in the use of the mental health information system in a resource-limited setting: lessons from Ghana. BMC Health Serv Res 2018; 18(1): 98.
31Capblanch, X, Ronveaux, O, Doyle, V, Remedios, V, Bchir, A. Accuracy and quality of immunization information systems in forty-one low income countries. Trop Med Int Health 2009; 14(1): 210.
32Upadhaya, N, Jordans, MJD, Pokhrel, R, Gurung, D, Adhikari, RP, Petersen, I, et al. Current situations and future directions for mental health system governance in Nepal: findings from a qualitative study. Int J Ment Health Syst 2017; 11: 37.

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Experience of implementing new mental health indicators within information systems in six low- and middle-income countries

  • Shalini Ahuja (a1), Charlotte Hanlon (a2), Dan Chisholm (a3), Maya Semrau (a4), Dristy Gurung (a5), Jibril Abdulmalik (a6), James Mugisha (a7), Ntokozo Mntambo (a8), Fred Kigozi (a9), Inge Petersen (a10), Rahul Shidhaye (a11), Nawaraj Upadhaya (a12), Crick Lund (a13), Sara Evans-Lacko (a14), Graham Thornicroft (a15), Oye Gureje (a16) and Mark Jordans (a17)...
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