Innovation summary

Today nearly 75% of the 450 million people worldwide with mental illness and epilepsy live in the developing world, and 85% of these people have no access to treatment. This urgent and currently unmet need for better treatment and expanded access to care for those living with mental disorders in resource poor settings is what the ‘BasicNeeds Model’ seeks to address.

The goal of this programme is to increase the momentum in the adoption and reach of BasicNeeds’ work with people with mental illness and epilepsy (PWMIE) and to investigate the cost-effectiveness of implementing the BasicNeeds Model through a social franchise compared to direct implementation by BasicNeeds.

The investment for this 3 year grant from Grand Challenges Canada will enable organisations in Ghana, Kenya and Nigeria to deliver the BasicNeeds Model for Mental Health and Development themselves, under a social franchise agreement, with ongoing training and assistance from BasicNeeds UK, BasicNeeds Ghana and BasicNeeds Kenya.

Impact summary

  • 10,000 PWMIEs reached in Ghana, Nigeria and Kenya

  • 3 social franchisees implement the BasicNeeds Model

  • 5 policies will be influenced

 “Through the social franchise, Caritas Nyeri aims to help participants re-establish a normal life like any other human being. We are keen to learn from this partnership so that we can lead in the area of mental health advocacy within Kenya and beyond.”

 

Rev. Fr. Boniface Mwangi, Director of Caritas Nyeri [BasicNeeds social franchisee] in Kenya

This transition to scale innovation is funded by Grand Challenges Canada.

Innovation details

There are two innovations in this programme – the BasicNeeds Model for Mental Health and Development, and the social franchise.

By working in partnership with local partners and people with mental illness, the BasicNeeds Model uses meaningful work and community support, as well as treatment to help improve lives.

As the largest international NGO working in this space, our evidence based model of intervention is effective, locally owned, can be replicated and is transferable.

Built into the BasicNeeds Model for Mental Health and Development is the ability to make change on an individual and systems level, where service delivery is linked to policy change and sustainable outcomes.  Through the innovation of the BasicNeeds Model, men, women, boys and girls with PWMIE and their carers benefit from improved quality of life4 (This includes improved health outcomes, increased confidence, increased knowledge and skills enabling access to livelihoods opportunities, ability to self-advocate and reduction in stigma.  BasicNeeds has demonstrated through the implementation of the BasicNeeds Model, that policy and practice systems change is achievable at every level,5 from traditional healers to Ministries of Health and national government.  It has enabled the conditions for national policy reform in Kenya, Laos PDR, India, Uganda, Tanzania, Sri Lanka, and Vietnam.  Moreover, the implementation of the BasicNeeds Model successfully leverages resources from governments (health workers, clinics, medication, government staff time) and from beneficiaries (increased income increasing ability to purchase medicines) contributing to sustainability and affordability.  This Model, with its unique and competitive features, is already making a significant contribution to the effort to close the treatment gap for PWMIE.

Supplementing the BasicNeeds Model with a Social Franchise Approach

BasicNeeds is the first to use an innovative social franchise approach to scale the BasicNeeds Model in an effort to improve and save the lives of many thousands more PWMIE globally.  We believe the social franchise is an effective and efficient method to scaling the BasicNeeds Model. With support from the International Centre for Social Franchising and the Social Franchise Company, we have developed a franchise financial model, researched and benchmarked against other franchise systems.  We have also developed a franchise package which BasicNeeds, the franchisor provides to franchisees.  This package includes:

  • comprehensive training on the BasicNeeds Model and its implementation via a new online training resource built for franchisees (developed in conjunction with Maudsley Learning)
  • access to an international Quality Assurance and Impact Assessment (QA-IA) system
  • access to international peer practitioner, research and policy networks via the ‘BasicNeeds family’ networks
  • association with the BasicNeeds brand and profile

In exchange for support from BasicNeeds, the franchisor, the franchisee provides:

  • local expertise, contacts and resources
  • leadership and interest in mental health and development
  • access to potential beneficiaries, organizational capacity and capability to deliver effectively and efficiently and with a degree of independence

The competitive unique features of the system are:

  • it encourages local leadership in community based mental health by partnering with local organizations as franchisees and building on their in-country capacity and resources to deliver the BasicNeeds Model
  • the roll out of the franchise package means the costs to BasicNeeds of replication and increased impact remain relatively low
  • both franchisee, BasicNeeds, local government and other global stakeholders all benefit from the generation of further field evidence and increasing the prominence and influence of mental illness and epilepsy on national and global health development priorities 

Key drivers

Operational model
The Mental Health and Development Model is wide in scope and inclusive of affected persons, carers & family, community, government and other key stakeholders

Using local resources
Clinical services and opportunities for work/income generation are facilitated through government and other local facilities and resources

Empowerment
Self-advocacy is promoted by organizing and building capacities of affected persons

Challenges

The programme is currently (Jan 2016) at the beginning of year 2 of a three year programme. Initial challenges have included:

  • Recruitment of appropriate social franchisees
  • Inconsistent supplies of psychotropic medicines/ problems in procurement

Continuation

The BasicNeeds Model is currently implemented in many other settings.

Countries include: Ghana, Uganda, Tanzania, Kenya, South Sudan, India, Sri Lanka, Nepal, Pakistan, China, Lao PDR and Vietnam.

We are currently conducting a feasibility study of implementing the BasicNeeds Model in the United States.

BasicNeeds is also gradually recruiting new social franchisees, with two operating in Nepal and India (as of Jan 2016). 

Partners

Funders

Evaluation methods

A full evaluation of the programme is being conducted during the course of the grant.  This will specifically examine the impact and economic evaluation of the BasicNeeds Model for Mental Health and Development in Ghana, comparing the Model delivered under the social franchise approach by Voice Ghana (social franchisee) to the traditional approach delivered by BasicNeeds Ghana.  

In Kenya and Nigeria, the implementation and impact of the BasicNeeds Model will be evaluated by auditing a sample of the Monitoring and Evaluation (M&E) data that is routinely collected by franchisees Caritas (Kenya) and the new social franchisee in Nigeria (name to be confirmed once due diligence is complete). 

Cost of implementation

This innovation has been funded $2 million CAD. 

Full cost-effectiveness of the GCC project will be described in the final evaluation report as it is not available yet, however the cost of implementing the BN Model has been assessed in other settings:

WISH study

 “In 2012 the cost of implementing the BasicNeeds’ model in 11 countries was £1,947,129. Based on direct field level costs on the ground in 2012 the approximate cost per affected individual was £20 and cost per beneficiary (affected person + primary carer + family members) was £ 4”6

BasicNeeds Return on Investment: case study in India (2013)

For every INR500 (US$8.3, £5.1) invested on a person each month over a one year period, the earning power of that person increased by an average of INR6287 (US$10.4, £6.4

The following impact was achieved:

a) Earning power / quantitative:

  • An average monthly increase in income of INR425 (US$7, £4.3 ) for  60% of those who were earning at Baseline
  • New income with an average monthly income of INR1992 (US$33.2, £20.3 ) for the 29.5% who started earning only after joining BN’s programme​

​b) Qualitative

  • Reduction in symptoms (92% of participants reported reduced symptoms)
  • Increased ability to gain membership and participate in community groups (27% vs. 7% at Baseline)
  • Increased access to treatment (from 2.5% of individuals taking treatment at Baseline to 82% after BN)

The estimated value of the other resources leveraged in the reported quarter is INR1, 752,665 (US$28,269; £27,353). This comprises the free medicines, psychiatric consultation from the state government.

Impact details

7,000 men, women, boys and girls with mental illness and epilepsy (PWMIE) and 5,600 carers reached in Ghana; 2,000 PWMIE and 1600 carers reached in Kenya and 1,000 PWMIE and 800 carers reached in Nigeria. 8,000 beneficiaries will be enabled to effectively manage their illness and able to partake in productive work

3 social franchisees will acquire the skills to implement the BasicNeeds Model for Mental Health and Development

5 policies will be influenced and recommendations developed at a local level As of September 2015, Voice Ghana worked with 634 people with mental illness and 2,111 family members. 

Comments

Thanks for sharing the next stage in your Journey. I'm also thinking about the challenge of how to scale up after a successful pilot - how best to control the quality Whilst allowing innovative good ideas in practice to spread, but I am at a much earlier stage on my journey with Ladder4Life. I look forward to hear g how you get on.
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Ghana, Kenya, Nigeria

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