Innovation details
There is a growing evidence base for the use of stepped-care models to deliver care for depression in low- and middle-income countries (LMIC).3-4 Evidence from Nigeria suggests that interventions combining antidepressants with psychotherapy and proactive management in primary care settings are cost-effective and can provide 30% better coverage than other models of care.5 mhGAP-IG also recommends antidepressants, brief psychological therapy and psycho-education to be delivered in a stepped-care model.2
This project aims to implement a cost-effective and scalable intervention for depression in Nigeria by integrating mhGAP-IG into the local primary care deliver structure using a stepped-care model. The intervention is adapted and enhanced to improve its effectiveness in a Nigerian context. A Theory of Change exercise was used to plan the delivery of the intervention in partnership with local communities. In order to provide proactive management in this setting, m-health systems were adopted to assess and support retention in care and adherence to medication.
The project was formerly launched in 2012. Presently the following stages have been completed:
- Identifying potential and actual influences on the progress and effectiveness of the implementation project
- Developing and refining the integrated intervention package, adding m-health for proactive adherence management
- Training of primary health care workers in a select geographical district of Lagos state to deliver the intervention
The next stage of the project will include:
- Implementing the intervention in the district
- Evaluating the intervention implementation and its clinical and cost-effectiveness
Reviewing the results of the evaluation and presenting the results to the scientific community and to policymakers with the aim of adoption for full scale-up