Innovation summary

In Nigeria’s Benue State, services for mental and neurological disorders have historically been available through one tertiary facility and a small number of heavily overburdened community rehabilitation facilities run by local faith-based organisations. The Benue State Comprehensive Community Mental Health Programme (CCMHP) was initiated in 2011 as a public-private partnership to scale up services in primary care.

Trained community psychiatric nurses (CPNs) operate outpatient clinics in special primary care facilities known as Comprehensive Health Centres, which offer an enhanced package of health services. CPNs also conduct outreach visits to patients’ homes, raise awareness in communities, and support local self-help groups. Community health extension workers (CHEWs) at other primary health care facilities are trained in World Health Organisation mental health Gap Action Programme (mhGAP) intervention guidelines for Nigeria, and are also equipped to detect, manage and treat cases. 

Impact summary

  • Mental health services available in primary care and community based rehabilitation facilities across 16 of the 23 local government areas (LGAs) in Benue State

Innovation details

In order to scale up services in primary care, two sets of health workers are trained to detect, manage and treat priority mental health disorders and epilepsy: community psychiatric nurses (CPNs) and community health extension workers (CHEWs). CCMHP uses a drug revolving fund (DRF) to supply these workers with essential medicines, and both CHEWs and CPNs provide family education and support, though CPNs are trained in a broader range of psychosocial interventions.

A consultant psychiatrist from the Federal Medical Centre conducts quarterly site visits for the purposes of clinical supervision, while CCMHP staff make monthly visits to monitor implementation. Officers in charge (OICs) of each clinic and Heads of Department (HODs) for health in each local government area provide further oversight.

In addition to the clinical services offered in primary care, community-based activities raise awareness, improve detection, and support the rehabilitation and empowerment of service users, as described further below.

Services provided by Community Psychiatric Nurses (CPNs)

In each local government area, a nurse is identified to participate in an 18-month course on psychiatric nursing. After qualifying as a CPN he or she is assigned space and materials to establish an outpatient clinic within a special primary health care facility known as a Comprehensive Health Centre. The CPN also conducts mobile outreach, raises awareness in communities, and helps to organise self-help groups. A minimum of two days each week are reserved for clinic activities, and two reserved for outreach. CCMHP provides each CPN with a motorcycle to facilitate access to remote communities in what are often very large local government areas.

Services provided by Community Health Extension Workers (CHEWs)

In order to improve the accessibility of services and increase detection in primary care, non-specialist CHEWs from additional primary health care facilities volunteer to undergo a 5-day mental health Gap Action Programme (mhGAP) training. CHEWs already undergo basic training on community mental health as part of their degree qualifications, but mhGAP further equips them to identify priority mental and neurological disorders, refer severe cases, and manage non-severe cases on an outpatient basis, through a combination of pharmacological treatment and family education and support. Unlike CPNs, CHEWs do not provide outreach services, as they are intended to remain accessible within the clinic as much as possible.

Community-based services

  • Self-help groups are organised for service users and caregivers to support each other, advocate for their rights, and participate in economic empowerment activities (including a group loan scheme).
  • Advocates are trained to raise awareness, identify cases to refer to the appropriate provider, and follow-up on those receiving treatment in the community.
  • Community-based rehabilitation facilities operated by the Methodist Church Nigeria and supported by CCMHP offer inpatient care for indigent cases and support their reintegration, reuniting service users with their families and offering long-term outpatient care and follow-up.

Key drivers

Partnership and engagement

Although CCMHP was originally launched as a public-private partnership, over time even more partners have come on board, offering their diverse skills and expertise to the programme. Service users are actively engaged through self-help groups and the CCMHP-supported, state-level stakeholder alliance, which also includes members of community-based organisations (CBOs). These CBOs have since adopted mental health as areas of focus in their own work and started raising awareness about the programme.

Monitoring, evaluation and information systems

With technical support from the MIND ME Africa project, CCMHP is testing a programme-level monitoring and evaluation package integrated into a state-level mental health information system. The Benue State Ministry of Health and Human Services is driving efforts to integrate this mental health information system into the existing district health information system, as part of a state-wide pilot that could eventually be scaled up nation-wide. 



The programme has experienced significant challenges holding state and local governments accountable for contributions of material, financial and human resources as agreed in various memoranda of understanding (MOU), which delays the activation of clinics and creates challenges for both providers and programme staff in the routine provision of services. This challenge is compounded by political instability, industrial actions and the falling price of oil (on which government budgets are dependent).


The state has not assigned a clinical officer as agreed in MOU, and provisions for clinical and programmatic supervision by CBM Nigeria have proven inadequate, given the high need and geographic reach of the programme. While CPNs report satisfaction with supervision provided by non-clinical staff, some gaps in quality of clinical services have been observed. The consultant psychiatrist of the Federal Medical Centre was recently contracted to conduct quarterly supervision visits to each clinic, though given the need for close supervision especially of CHEWs, this may not be enough.

Supply chains

Pharmaceutical quality control is a major challenge country-wide. CCMHP procures drugs from a single trusted supplier, but any gaps in the supply chain can result in expired drugs or incomplete orders. Procurement of basic consumables like file folders and paper for record-keeping and fuel for outreach is intended to take place at the local government level, as per the programme’s MOU, but imprest is rarely supplied to pay for these everyday expenses. 


Four additional CPNs have completed training, and are awaiting the activation of their clinics. State government have expressed their desire to see more CPNs trained, perhaps even assigning two CPNs to each clinic to increase manpower. Plans are also underway for additional CHEWs to receive mhGAP training. However, any further training should be accompanied by further scale-up of supervision structures for quality assurance. 


The Benue State Comprehensive Community Mental Health Programme (CCMHP) is a public-private partnership initiated between the Methodist Church Nigeria, the Benue State Ministry of Health and Human Services, and the international disability charity CBM International. Additional partners include:

  • Federal Medical Centre, Makurdi
  • Federal Neuropsychiatric Hospital, Kaduna
  • Benue State University Teaching Hospital, Makurdi
  • NKST Church
  • CHAN Medi-Pharm
  • Mental Health Awareness, Advocacy Foundation of Nigeria
  • Centre for Global Mental Health, London
  • Local Government Service Commission, Makurdi
  • Local governments throughout Benue State

Evaluation methods

In collaboration with MIND ME Africa, CCMHP is testing a mental health monitoring and evaluation package which should enable a longitudinal analysis of clinical outcomes (symptom severity and functioning). Programme evaluation is planned for late 2015.

Cost of implementation

CCMHP operates with an annual programme budget of approximately 30-40 million naira (about $162,000 USD-$216,000 USD, though exchange rates are fluctuating significantly).

Impact details

  • Mental health services available in primary care across 16 of the 23 local government areas (LGAs)  in Benue State
    • 5 CPNs operate mental health clinics in Comprehensive Community Health Centres in their respective LGAs
    • 21 CHEWs in 13 LGAs trained in mhGAP modules for priority  conditions
  • Two CPNs run community rehabilitation facilities providing inpatient and outpatient services
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