Enhancing the Capacity of Providers in Mental Health Integration (ECaP-MHI) in Rural Uganda: The Adaptation Process

Abstract

Purpose

Uganda adopted the World Health Organization (WHO) model of creating district health management teams (DHMT) comprised of public health officials and administrators to supervise health service delivery at the community level. The purpose of this study was to characterize the perspectives of the DMHT in providing support supervision to primary health-care providers implementing mental health integration using the pre-recorded material. Our aim was to identify barriers to individual uptake and contextual fit, and to solicit solutions for co-designed improvements.

Methods

We conducted a qualitative exploratory study using one-on-one interviews informed by the Practical Robust Implementation and Sustainability Model.

Results

Members of the DHMT identified a systemic gap in supporting mental health integration into primary care, and reported limited knowledge in how to supervise mental health integration and lacked data on mental health delivery and outcomes. They recommended training of the DHMT in supervising mental health integration supported by standard outcome reports, pre-recorded instructional material by psychiatrists, checklists to help guide and standardize the process, and use of visual aids illustrating mental disorders and treatments for low-health literacy populations.

Conclusion

Implementing integrated mental health care using the WHO model of DHMTs as external facilitators and supervisors of primary health-care providers is potentially feasible and scalable, provided that substantial reforms occur such as training in how to provide supervision, standard collection of outcome reports, and practical tools to help guide and facilitate the process.

Keywords:

• district health management team
• Practical Robust Implementation and Sustainability Model
• integration of mental health services
• primary healthcare

Abbreviations

DHMT, District Health Management Team; ECaP-MHI, Enhancing the Capacity of Providers in Mental Health Integration; HMIS, Health Management Information System; MOH, Ministry of Health; PHC, Primary Health Care; PRISM, Practical Robust Implementation and Sustainability Model.

Data Sharing Statement

This work is still ongoing, but will be available on request from the corresponding author when the Post-doctoral program is completed.

Ethics Approval and Consent to Participate

Ethical approval was provided by two Institutional Review Boards, ie, Gulu University Research Ethics Committee under application number GUREC-2021-128 (local IRB where the study took place) and Harvard University-Area Committee on the Use of Human Subjects under IRB registration - IRB00000109, Federal Wide Assurance - FWA00004837 (where the primary author is a Post-doctoral Fellow). The study was registered with the Uganda National Science and Technology (HS1847ES) a regulatory body that grants permission for research studies to be conducted in the country. The researchers upheld the rules and regulations as provided by GUREC and Harvard IRB ethical framework for research involving human participants. Permission to conduct this study at the Ogur Health Center IV in Lira district was obtained from the District Health Officer and the health facility managers (in-charges). All the study participants provided written informed consent before each in-depth interview was conducted. Privacy of participants was ensured by the use of codes on the interview transcripts in addition to conducting the interviews in private spaces.

Consent for Publication

All participants consented to publication of their responses anonymized.

Acknowledgments

We recognize the great work done by Vicky Atim (research assistant) and Peter Odongo (data clerk, Ogur Health Center IV) our research assistants; this work would not been completed without your dedication to the data collection.

Author Contributions

All authors made a significant contribution to the work reported (ie, in the conception, study design, execution, acquisition of data, analysis and interpretation); took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

Dr Jessica Haberer reports grants from NIH, during the conduct of the study; grants from NIH, personal fees from Merck, other from Natera, outside the submitted work. The authors declare no other competing interests in this work.

Additional information

Funding

This study was funded by the Harvard University Center for African Studies, where the lead author is a postdoctoral research fellow. The funding agency had no role in the design of the study or in the collection, analysis, interpretation of data and writing of the manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Harvard University Center for African Studies. JEH has a K24MH114732 award and spent part of her time providing mentorship on this study.