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Cost-effectiveness of the Mental Health and Development model for schizophrenia-spectrum and bipolar disorders in rural Kenya

Published online by Cambridge University Press:  21 May 2015

V. de Menil*
Department of Social Policy, London School of Economics and Political Science, UK
M. Knapp
Personal Social Services Research Unit, London School of Economics and Political Science, UK
D. McDaid
Personal Social Services Research Unit, London School of Economics and Political Science, UK
S. Raja
Policy and Practice Directorate, BasicNeeds, India
J. Kingori
BasicNeeds Kenya
M. Waruguru
BasicNeeds Kenya
S. K. Wood
Policy and Practice Directorate, BasicNeeds, India
S. Mannarath
Policy and Practice Directorate, BasicNeeds, India
C. Lund
Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa
*Address for correspondence: V. de Menil, PhD, Department of Social Policy, London School of Economics and Political Science, London, UK (Email:



The treatment gap for serious mental disorders across low-income countries is estimated to be 89%. The model for Mental Health and Development (MHD) offers community-based care for people with mental disorders in 11 low- and middle-income countries.


In Kenya, using a pre-post design, 117 consecutively enrolled participants with schizophrenia-spectrum and bipolar disorders were followed-up at 10 and 20 months. Comparison outcomes were drawn from the literature. Costs were analysed from societal and health system perspectives.


From the societal perspective, MHD cost Int$ 594 per person in the first year and Int$ 876 over 2 years. The cost per healthy day gained was Int$ 7.96 in the first year and Int$ 1.03 over 2 years – less than the agricultural minimum wage. The cost per disability-adjusted life year averted over 2 years was Int$ 13.1 and Int$ 727 from the societal and health system perspectives, respectively, on par with antiretrovirals for HIV.


MHD achieved increasing returns over time. The model appears cost-effective and equitable, especially over 2 years. Its affordability relies on multi-sectoral participation nationally and internationally.

Original Articles
Copyright © Cambridge University Press 2015 

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