Innovation summary

In the upper east region of northern Ghana, a large population of people with psychosocial disabilities exist, including those with mental illness and epilepsy. There was a high rate of discrimination in their communities and because they were not aware of their rights, they were unable to stand up for themselves. The majority of people with psychosocial disabilities in the area could not afford their medications and the relapse rate was high.

The Presbyterian Community Based Rehabilitation (PCBR) programme based in Sandema, of this reason began to establish self-help groups (SHGs) with the aim of providing mutual support, and enabling people to re-enter the community, both socially and economically in 2008.

Now, with over 23 SHGs in Sandema & throughout the upper east region, the groups provide an important source of support to persons with psychosocial disabilities and their families. Through the groups, members have been able to challenge discrimination, share support and advice, and attain financial security in a resource poor setting.

Impact summary

  • 23 SHGs established in the upper east region of Ghana, each with up to 100 members
  • 15 advocacy campaigns led by SHG members resulting in an observed decrease in the level of discrimination against people with psychosocial disabilities in Northern Ghana
  • Approximately $260 USD (840 Ghana Cedis) per client per year of medication

Innovation details

The PCBR project team started by raising awareness in the clinics where the clients and their caregivers went for their health care and medication. The PCBR team explained the need for the individuals to come together and to form a social support group who helped themselves.

A typical SHG is composed of elected Chairman, Vice Chairman, Secretary, Treasurer and Organizing Secretary. The groups hold meetings once a month. The meetings are chaired by a chairman and guided by a constitution.  A typical meeting is opened by a prayer and the reading of the minutes of previous meeting, followed by general health talk (led by a health worker), discussion on common problems (e.g. drug adverse effects), financial matters (e.g. managing the revolving loan scheme). The meeting is usually closed with singing and dancing as well as a closing prayer.

Mental health service users are the center of this programme. Over half of all the members are women, who have even greater need for finding independent means of livelihood. Persons with psychosocial disabilities have actively participated in the formation of the SHGs, organization structure and decision making process. They themselves are responsible for defining the agenda of the meetings, thematic priorities and advocacy initiatives.

The SHGs promote self-help, self-reliance and independent decision-making.  The activities aim at strengthening the entrepreneurial capacity of the individual members supporting their independent livelihood and other workshops focus on improvement of daily living skills. The success is visible: the SHG members report that they are more aware of their own rights and that the discrimination by family members and the community reduced as they gained financial independence. 

Key drivers

Nothing about us without us

Mental health services users are the center of the groups. Persons with psychosocial disabilities actively participate in the formation of the SHGs, organizational structure and decision making process. They themselves are responsible for defining the agenda of the meetings, priorities and advocacy initiatives. 

Respectful, structured support

The groups have benefited from clear initial guidance on how to run groups, learned from existing successful groups elsewhere, and had regular input when requested from the local CBR programme. Having a mutually respectful relationship with others who can offer experience and support while allowing autonomy has been useful for the groups.

Promotion of empowerment and independence

A SHG is a successful way of promoting empowerment, self-reliance and independent decision-making. As well as the strength people find from sharing with others, there are initiatives aimed at strengthening the capacity of individual members to have an independent livelihood, as well as to improve daily living skills and to maintain good health and promote recovery.


High levels of poverty

Membership within the SHGs requires a small membership fee.  Despite keeping the member contributions to a minimum, the high level of poverty in the area restricts certain clients from joining the groups. 

Uncooperative attitudes of family members

Some clients have been discouraged by their family members from joining the groups, either because they do not want them to become independent or to associate with other people with psychosocial disabilities.  The attitudes of such family members have prevented the groups from growing as much as they could have grown.

Inconsistent participation

Attendance at meetings fluctuated at the beginning of the programme. It took some time for the clients and their family members to be convinced that their participation would be beneficial. 

Expectations of financial gains

New members sometimes have high expectations that being a member will bring financial gain to themselves.  These expectations have to be managed carefully in order to maintain commitment from group members. 

Small budget

The financial constraints of a small budget is an ongoing challenge of the innovation. 


This model is currently being replicated in two large mental health programmes in Nigeria – the Amaudo Mental Health Awareness Programme and the Benue state Comprehensive Community Mental Health Programme – with considerable successes. The Amaudo programme has nine SHGs while the Benue programme has four SHGs. There are plans to establish groups in all of the 23 Local Government Areas in Nigeria’s Benue state.

Within Ghana, there are plans to scale-up SHGs into five more districts in the upper east region: Bolgatanga Municipal, Bongo, Talensi, Nabdam and Bawku West.

Evaluation methods

The intervention was evaluated through a qualitative study aimed at identifying factors related to the success of the Sandema network of SHGs and related to the challenges of their work undertaken thus far. The study used a community-based participatory research approach having researchers and community members partner together to identify questions of mutual interest, conduct inquiries that reflect mutual input and produce outcomes that provide mutual benefit.1 The participatory research approach incorporated research capacity building with the PCBR Project Coordinator and local research assistants that will allow participation of the SHG network in the research itself.

The study design utilized qualitative methods in the form of 6 focus groups and 4 key informant interviews to highlight participants’ experiences and viewpoints regarding the successes and challenges of the PCBR SHGs in Builsa North district.

Cost of implementation

In 2014, the overall cost of the programme was $5,200 USD (20,000 Ghana Cedis).

The programme started with contributions from the members of the first established SHGs.   Loans were given to individual members using these contributions. When Basic Needs saw what the SHGs were able to do with their own contributions, Basic Needs offered to provide financial support to encourage the initiative.  The support served as a moral boost to them and made other groups to start their own groups. Later, CBM also contributed financial resources which went towards training and mobilizing more SHGs in the Upper East Region.

Impact details

SHG members report that they are more aware of their own rights and that the discrimination by family members and the community reduced significantly as a result of their active participation in the SHGs.  They feel more confident to challenge discrimination, and to take initiatives that will improve their lives.

Human rights are an abstract idea but feeling confident in a group has been an inspiration for people to successfully demand their rights in a way they would never have done on their own. An example is a group demanding justice from police when a member has been beaten.  When a member is having problems with their family or community, a delegation from their group can go to mediate on their behalf.

In addition to the emotional support that people who share difficult experiences can give each other, the groups act as units that have been  able to manage a common fund through which many people have been able to improve their economic status (part of an EU grant managed by BasicNeeds). This means that 41 people have regained a position and respect in society that they had lost due to stigma before they joined the groups.

In addition to seeing their personal income grow through the provision of small loans, the SHGs have successfully lobbied district assemblies for poverty reduction strategy funds to be allocated to them as a vulnerable group. A total of about 62 people benefited from the funds in four quarters. 

The members of the SHGs recognized key barriers that prevented them to fully enjoy their human rights, from peoples’ attitudes to institutional policies. With effective advocacy and lobbying they have been able to incorporate mental health services in local government hospitals and establish mental health services at primary healthcare level. Moreover, the SHGs have been able to establish the provision of free psychotropic drugs for clients by advocating to the Ghana Health Service and National Health Insurance Scheme. The SHGs have also become members of the Mental Health Society of Ghana (MEHSOG) which has been instrumental in the passing of the mental health Act by the Ghanaian Parliament.


  1. Israel B, Schulz A, Parker E, Becker A. (1998) Review of community-based research: assessing partnership approaches to improve public health. Annual Review of Public Health.19:173-202.
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