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Toolkit for the Integration of Mental Health into General Healthcare

Monitoring icon

Cross Cutting Component. Monitoring, Evaluation, Accountability & Learning

Monitoring, evaluation, accountability and learning (MEAL) is part of the planning, designing and day to day management of integrated mental health programming. An effective MEAL system supports program managers in tracking progress, making program adjustments, discovering unplanned effects of programming, and showing outcomes of mental health integration. MEAL also supports accountability to stakeholders through information sharing and feedback mechanisms.

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Breaking Down the MEAL System

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System for Monitoring, Evaluation, Accountability and Learning (MEAL)

System

Analyze situation & assess needs

A situational analysis and needs assessment are carried out to determine whether an integrated mental health program is appropriate and feasible and, if so, to inform its planning and design through systematically collecting and analyzing data. This includes information about mental health needs, capacities, resources and national efforts for mental health system strengthening, and overall sustainability of planned services. > Access Toolkit Section: Step 1. Assess & Plan for MH Integration

Design Program

  • Develop/Adapt Program Objectives. Findings from a situational analysis and/or needs assessment are used to design and tailor the program to the local context. This includes being consistent with government guidelines and global best practices, building on any existing or emerging mental health components of a system, and meeting identified needs while also considering existing resources.
  • Develop/Adapt Logical Framework & Indicators. This includes the development of a logical framework, and associated activities for monitoring and evaluation (M&E) as well as, program specific quantitative and qualitative indicators. Indicators track key elements of program performance as well as results. Some donors also require specific M&E templates and additional elements such as outlining a Theory of Change (TOC) that helps you check the validity of your assumptions by setting end objectives and working backwards to ensure that activities, outputs and outcomes will link to program objectives. > → See MHIN TOC practical guide & example ToC map for integrating mental health into primary care in India, Nepal, Ethiopia, Uganda and South Africa – the PRIME study. A free 20-minute course by Save the Children on Theory of Change is available on DisasterReady.

Collect Baseline

This is the measurement of the initial conditions as determined by project indicators, that occurs before the start of a program. Baselines can help monitor changes and contribute to program evaluation by making comparisons with later follow up data. Relevant data that is still current and was acquired in the situational analysis and needs assessment phase can also be used as part of the baseline.

When no formal baseline is completed, or the baseline data is incomplete, the following strategies may be employed:

  • Consult and utilize existing secondary data (e.g. WHO AIMS, AIMS country reports, WHO proMIND, MH Atlas, MHIN, and mhpss.net) from other NGOs, government or community organizations (e.g. survey data, health registers or project activity records).
  • Utilize recall of staff and/or affected populations (e.g. asking staff about past training, activities, practices for addressing mental health problems).

Implement & Monitor

This includes the systematic monitoring of mental health programs over time. It involves the ongoing collection and review of data to provide program managers and other staff with indications of progress against program plans and towards program objectives. This information should be used to improve program implementation through adjustments to programs activities, timelines and stakeholder engagement.

Review and Evaluate

This helps determine to what extent programs are meeting or have met their goals. Evaluation is essential to planning strategies, improving programs, demonstrating results, and justifying resource allocations.

  • A formative evaluation with a focus on improvement is carried out during the life of the program.
  • An end of project evaluation takes place towards the end of the program and is used to reveal its overall impact.

Accountability & Learning

  • Learning includes systematic documentation and use of lessons learned, recommendations, and observations, that emerge from monitoring, evaluation and accountability mechanisms to improve program design, and to publish and communicate results internally and externally. Reporting, reflection and learning should occur throughout the whole program cycle.
  • Accountability to stakeholders, service users and wider communities involves ongoing participation, information sharing, and development of feedback mechanisms, to guide program design and implementation in line with local priorities.
  • Community Participation and Stakeholder Engagement in MEAL is essential to identify and address challenges and gaps as they arise, in ways that are appropriate for the community and context. This can lead to increased relevance of programming, transparency, accountability, sustainability and ownership. Communities and stakeholders can be engaged and participate in:
    • Needs assessments and situational analyses.
    • Resource mobilization.
    • Discussing the program design and planned activities. outcomes and impact.
    • Data collection for monitoring and for evaluation.
    • Providing feedback and suggestions in a safe and dignified manner (e.g. through feedback and complaint mechanisms).
    • Interpretation of MEAL data to make recommendations.
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Identifying Indicators for Integrated Mental Health Programs

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Results

Key Considerations for developing indicators:

  • Carefully consider the time and resources required to collect specific indicators and ensure that the information collected is practical and useful for documenting and informing programming.
  • Ensure that indicators are prioritized to inform programming and demonstrate outcomes; avoid overburdening the community with data collection that is not useful or effective.
  • Support the standardization of core indicators for mental health integration programs among agencies and partners.
  • Whenever possible, track indicators using >data collection systems that already exist, instead of external systems that will require special efforts to maintain.
  • Indicators should be SMART: Specific, Measurable / Quantifiable, Attainable, Relevant, Time-bound; they should be well defined, so that they are understood, and data is collected and interpreted in a consistent manner.

>>> Examples of indicators across levels of MH integration are available in the SAMPLE IMC Mental Health Integration Results Framework.

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RESOURCES

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Category

  • Key Guidance Apply Key Guidance filter
  • Specific Tools & Materials Apply Specific Tools & Materials filter
  • MEAL Resources from other Sectors Apply MEAL Resources from other Sectors filter
  • Key Publications & Readings Apply Key Publications & Readings filter

Audience

  • Implementing agencies Apply Implementing agencies filter
  • Governments Apply Governments filter
  • Donors Apply Donors filter

Language

  • English Apply English filter
  • French Apply French filter
  • Arabic Apply Arabic filter
  • Spanish Apply Spanish filter
  • Other Apply Other filter
  • Toolkit Homepage
  • Step 1. Assess & Plan for Mental Health Integration.
  • Step 2. Build Capacity of General Healthcare Workers.
  • Step 3. Strengthen Mental Health Services & Systems.
  • Cross cutting component. Monitoring, Evaluation, Accountability & Learning.
  • Cross cutting component. Advocate, Coordinate and Network.
  • Cross cutting component. Sustain Mental Health Services.
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  • IASC (Field Test Version) A Common Monitoring and Evaluation Framework for Mental Health and Psychosocial Support in Emergency Settings

    Category: Key Guidance, Monitoring & Evaluation

    Audience: Implementing agencies

    Read this document for guidance on assessment, research, design, implementation and monitoring and evaluation of mental health and psychosocial support (MHPSS) programs in emergency settings. Annex 5 is a sample framework for a health program to treat persons with mental disorders in primary health clinics.

    Also, view supplementary orientation materials on the common M&E framework that were developed for use in various workshops in emergency settings, including Jordan, Iraq, South Sudan, and Ukraine. Access supplementary materials here.

    For more information, background documents, or updated versions of the materials, please contact the IASC MHPSS RG co-chairs at mhpss.refgroup@gmail.com or hannaf@who.int. 

    • PDF icon Access here
    • PDF icon Access in Arabic
  • WHO (2007) Monitoring And Evaluation of Mental Health Policies and Plans

    Category: Key Guidance, Monitoring & Evaluation

    Audience: Implementing agencies

    Utilize this module, which is part of the WHO Mental Health Policy and Service Guidance Package, for different ways of evaluating mental health policies and plans. It describes a five-step process for conducting evaluations and examines how results of an evaluation can be utilized to improve policies and plans.

    • PDF icon Access here
  • WHO (2018) mhGAP Operations Manual

    Category: Key Guidance, Monitoring & Evaluation

    Audience: Implementing agencies, Governments, Donors

    Use the mhGAP Operations Manual for practical, step-by-step guidance for integrating mental and physical health services, with relevant sections to monitoring & evaluation [See section 4 starting on page 53].

    • PDF icon Access here
  • MHIN (2014) Theory of Change for Complex Mental Health Interventions - A Practical Guide

    Category: Key Guidance, Theory of Change

    Audience: Implementing agencies, Governments, Donors

    Use this guide for a practical overview of the process of developing a Theory of Change (TOC), focusing on using a stakeholder-driven, workshop approach to achieve this.

    Also, view supplementary TOC e-presentations here & example ToC map for integrating mental health into primary care in India, Nepal, Ethiopia, Uganda and South Africa – the PRIME study.

    • PDF icon Access here
  • CHS Alliance, Group URD and the Sphere Project (2014) Core Humanitarian Standard on Quality and Accountability

    Category: Key Guidance, Accountability

    Audience: Implementing agencies, Governments, Donors

    Read this resource when planning for greater accountability to communities and persons affected by crisis. As a core standard, the CHS describes the essential elements of principled, accountable and high-quality humanitarian action.

    Note: Access the latest version of the Sphere Handbook (2018) on their project website. View the draft version of CHS (2018) here with accompanying CHS Guidance Notes & Indicators & Videos.

    • PDF icon Access here
  • ALNAP & CDA (2014) Closing the Loop: Effective Feedback in Humanitarian Contexts, Practitioner Guidance

    Category: Key Guidance, Accountability

    Audience: Implementing agencies, Governments, Donors

    Use this guidance when designing or implementing feedback mechanisms in a humanitarian program, and in particular in cases where such mechanisms are established to operate at the level of the individual program or project, operate in the context of ongoing humanitarian operations, provide usable information, and/or deal with a broad caseload.

    • PDF icon Access here
  • CARE (2013) The Community Score Card (CSC): A Generic Guide for Implementing CARE’s CSC Process to Improve Quality of Services

    Category: Key Guidance, Accountability

    Audience: Implementing agencies, Governments, Donors

    Use the CSC toolkit, created by CARE Malawi to provide CSC practitioners from various institutions with practical CSC implementation guidance. The toolkit is generic in nature and can be applied in any sector, including mental health.

    • PDF icon Access here
  • World Bank Sample Indicators for Social Accountability (SA) Activities

    Category: Key Guidance, Accountability

    Audience: Implementing agencies, Governments, Donors

    Read this sample for illustrative social accountability indicators at the project level, presented through a table that provides a sample of indicators that were used for SA activities in World Bank–funded projects.

    • PDF icon Access here
  • IFRC (2016) Psychosocial Monitoring and Evaluation (M&E) Framework

    Category: Specific Tools & Materials, M&E Frameworks

    Audience: Implementing agencies, Governments, Donors

    Access this framework, developed for use by MHPSS programming managers to design relevant M&E systems for psychosocial programs, to help in program planning and the development of strategies, and to mainstream global reporting of progress on PS programs. Access through IFRC PScentre here.

    Supplementary materials:

    • Guidance note and overview
    • Indicator guide – M&E Framework
    • Toolbox – M&E Framework
  • World Health Organization and UNHCR (2012) Assessing Mental Health and Psychosocial Needs and Resources: Toolkit for Humanitarian Settings

    Category: Specific Tools & Materials, M&E Tools

    Audience: Implementing agencies, Governments, Donors

    Use this comprehensive toolkit for general guidance on MHPSS assessments, as well as various tools for assessing MHPSS problems and resources.

    • PDF icon Access Toolkit here
    • PDF icon Access in Arabic
    • PDF icon Access in French
    • PDF icon Access in Russian
    • PDF icon Access in Spanish

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This Toolkit is made possible by the generous support of the American people through the United States Agency for International Development (USAID).

The content are the responsibility of International Medical Corps and do not necessarily reflect the views of USAID or the United States Government.

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