Innovation summary

Ghana currently faces a 97% treatment gap in mental health services. Epilepsy constitutes about 10% of the Outpatient Department (OPD) cases in three psychiatric hospitals within Ghana, all located in the southern part of the country. Data from the community shows that the disease contributes to about 37.2% of new cases and 66.3% of re-attendance in the Upper West Region of Ghana. 

The goal of this project is to improve the management of the epilepsy and maternal depression, reduce the treatment gap and improve the quality of life of affected persons, through the use of the continuous quality improvement (CQI) methodology to develop mental health identification and treatment packages for test use in two districts. Information technologies will also be used to increase access to care for maternal depression and epilepsy.

Impact summary

  • Approximately 42 frontline workers have been trained on how to apply the continuous quality improvement methodology 
  • 100 persons with epilepsy will be identified; 50% will see an 10% increase in their seizure free days. 100 mothers with maternal depression will be identified; at least 50% receive a positive clinical response within 12 weeks of identification
  • Total cost of the research project is approximately $184,656.52 USD funded over two years 

This innovation is funded by Grand Challenges Canada.

Innovation details

The program focuses on targeted activities to achieve the following objectives:

Raising Mental Health Awareness

The teams are creating awareness in communities and the OPD through health education on stigma and discrimination and on the range of high quality services available at various health facilities for people experiencing a mental health problem. Media outlets such as community radios and information centers feature anti-stigma messages as well.

Activities use evidence based interventions for specific groups (community groups, healthcare providers and young adults).  Results will be evaluated on the impact on patient outcomes.

  • Community groups: 

Health education is carried out in the community on stigma and discrimination relating to epilepsy. Community radio and information centers are also used to send the message.

  • Healthcare Providers: 

Project team members with knowledge in quality improvement methodology meet to brainstorm on ways to attract patients to the health facility. The caregivers have weekly meetings and receive monthly site visits for coaching and mentoring from project officers. 

Skills and Knowledge Development of Health Providers

Frontline staff members – health staff working in the participating hospitals – have been trained in continuous quality improvement methodology to identify the gaps that are impeding care  given to patients with epilepsy. This enables them to come up with change ideas (innovative ways of increasing identification and managing the cases) which are tested using the Plan – Do – Study – Act (PDSA) cycles. An idea is only made a permanent part of the system if it is tried and tested under various conditions and has been proven to work.

To raise mental health skills, knowledge and information of healthcare providers, face-to-face and virtual educational strategies for community health workers and clinicians (community health centers and district health level clinicians) have been developed, consisting of: 

  • Capacity building trainings with support and supervision follow-up, aligned with resources and needs of the local settings
  • Learning sessions are conducted every four months to share experiences of team members, as well as a refresher session on the continuous quality improvement methodology

Because data is important in this project, teams have been trained in data quality assessment to address the difficulties with validating and entering data in the District Health Information Management System (DHIMS2). The following components are covered:

  • Ensuring that data on mental health is an integral component of the existing District Health Information System (DHIS)
  • Developing and introducing a community health worker’s information system to allow for proper reporting and managing medication supplies
  • Compiling, managing and analyzing all information at the district level

Creating Accessible Mental Health 

Introduction of an IT innovation component enables patients with epilepsy to reach out to caregivers as and when seizures occurs. Patients use mobile phones to send data to frontline staff about the date, time and duration of their seizures.

Key drivers

Involvement of Key Stakeholders

Cross cutting multi-disciplinary team members have been selected from all departments of the hospital, to ensure development of the project is well-rounded. Additionally, management and staff of facilities have been included in designing the project where project is being implemented give support to create a sense of ownership of the project.  

Leadership role of the Ghana Health Service/ Mental Health Authority as a key partner to integrate successful changes into the public health system.  

Strategic Design of the Project

The quality improvement methodology used in the implementation of the project ensures that healthcare professionals do not implement new interventions but develop efficient and innovative ways of accomplishing routine but poorly performed tasks that are already known to the health system. 


  • Stigma associated with mental health problems
  • Unavailability of medicines for epileptics 
  • Data collection of non-routine data to inform decisions


This project will serve as the foundation on maternal depression research, as there is currently very little research/data on this topic in Ghana. Through this project, the team will understand the incidence of maternal depression in Ghana, and its relevance to maternal and child health. 

The quality improvement methodology embedded in the project provides assurance for sustainability. Plans for scale up at the district level are already being developed and the team believes that this project can serve as a model for other mental health interventions in Ghana and elsewhere.

Evaluation methods

This innovation aims at increasing identification for epilepsy by identifying 100 persons and managing them appropriately with 50% of them having a 10% increase in their seizure free days. Similarly, the project seeks to identify 100 mothers at ANC/PNC who have maternal depression using the PHQ-9. Following identification, their cases will be managed as needed so that 50% will see a reduction in the symptom severity score of the initial PHQ-9 (reduced score between 0 – 4) post 12 weeks.

The project uses a time series analytic framework with run charts to analyze the effect of changes tested. The data is viewed over time and then run chart rules are used to understand how well the system is responding to the changes being made to the provision of mental health care in the participating facilities.

Cost of implementation

Total cost of the research project is approximately $184,656.52 USD ($250,000 CAD). This project can be viewed as cost effective because the basis of this intervention is to strengthen and embed routine functions into the existing health system, instead of creating new interventions. 

Impact details

Approximately 42 frontline workers have been trained on how to apply the continuous quality improvement methodology. 100 persons with epilepsy will be identified; 50% will see an 10% increase in their seizure free days. 100 mothers with maternal depression will also be identified; at least 50% receive a positive clinical response within 12 weeks of identification.

The total cost of the research project is approximately $184,656.52 USD funded over two years.

126 out of 249 mothers have been identified through the PHQ-9 as maternally depressed.

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