Innovation summary

The treatment gap in mental health is estimated to be above 80% in LMIC, compared with less than 40% in HIC - this is mainly due to lack of specialized human resources1. In our 4 pilot rural clinics, there are nurses and clinical officers without a doctor, and none of them have any mental health training.

This innovation uses specially designed software mounted on mobile phones to overcome barriers of distance and travel, in order to train, supervise and support primary health care workers to deliver WHO mental health treatment gap intervention guidelines (mhGAP-IG) at the Point of Care.

We trained non-mental health workers to deliver a mobile based and evidence based intervention (mhGAP-IG) on depression at the primary health care level, in order to increase access to treatment for depression.

 

Impact summary

  • Over 1000 patients accessing primary health care services in four rural facilities will have access to mental health services
  • Approximately 25% of patients screened are expected to score positive for depression and they will all receive intervention based on mhGAP-IG
  • 40% of patients with depression are expected to show resolution of symptoms 3 months post intervention
  • Reduced travel costs between the consultant and health care workers will be evident as a result of phone consultation/communication
  • $78,162 USD funded over a period of 18 months

 

“Many of depression cases often go undetected”

 

   - Health care worker in a rural health care facility 

 

Innovation details

This project aims at testing the applicability of a model that seeks to utilize mobile technology to train, supervise, support and monitor application of mhGAP-IG depression module on non-mental health workers in four rural and remote health care facilities in Kenya.

Focus Group Discussions (FGDs) were conducted to assess health care workers' current practice and also to discuss their role, experiences and any difficulties, barriers and suggested solutions in treating patients with mental disorders, particularly depression. Non-mental health workers were later trained on how to assess and manage depression using mobile based mhGAP-IG, and how to work closely with a mental health specialist for consultation, monitoring, supervision and support. They were also trained in how to send their data electronically and safely to a central computer/server. This has reduced time and travel barriers, and facilitated continuous dialog between the health care workers and the consultant, as well as improving access to quality care for patients. Consequently, there will be continuous monitoring of quality of practice based on the objective mhGAP-IG, rather than subjective clinical diagnosis and sporadic inspection of records on site visits. This will be done through onsite supervisory visits, calls and frequent data checks as data uploads at a central server at Africa Mental Health Foundation.

The ease of the screening and diagnostic matrix on mobile phones means that the innovation will not unduly interfere with the already busy schedules of the health workers. This technique, along with the increase in mental health literacy as a result of the intervention will result in:

  • Increased screening, diagnosis and management of patients with depression
  • Dual management and creation of a health information system for depression and other medical conditions

These factors will lead to better clinical and functional outcomes of service users.

Beck’s Depression Inventory will be used to assess patient health outcomes at an interval of 0, 6 and 12 weeks. Community health workers will be used to trace defaulters where necessary. Therefore, integrating e-medicine into routine practice will increase access to treatment for depression.

 

Key drivers

Local government (stakeholders) support

We had meetings with the District Health Management Team who adopted the project (integrated it into primary health care). The District Medical Officer of Health was instrumental in ensuring that all health care workers in the study sites were trained and the clinic was running concurrently i.e. the same training was conducted on separate days.

Use of mobile technology thus improving patient access and reducing paperwork

Due to popularity and mobility of mobile technology, it has been shown to provide clinical management support (diagnosis and patient treatment) where there are no specialist clinicians2. As a result, patients are able to access mental health services at the primary health care level and data/patient records are stored electronically.

Frequent supervisory visits at inception of the project

This was imperative in order to address any challenges and provide possible solutions to ensure successful project implementation and sustainability with reduced challenges.

Willingness of health care workers to integrate and improve mental health services into routine practice

All health care workers willing to participate in the study were trained. This was a key driver especially during training sessions as it was a participatory approach. It also facilitated routine assessment and management of depression by the trained health care workers.

 

Challenges

  • Low internet connectivity in the rural facilities for purposes of data upload. This has led to reduced continuous flow of data to a central server leading to delayed quality checks at Africa Mental Health Foundation.

  • Staff transfers to other facilities leading to reduced number of staff providing health care services at the study sites. However, we have conducted trainings for any newly deployed staff at those facilities.

 

Continuation

Our involvement with all stakeholders throughout the process to identify and resolve barriers to uptake will produce a product that will be acceptable for further uptake socially and clinically.

 

Partners

  • Ministry of Health (Kenya)

 

Funders 

 

Evaluation methods

Change in health outcomes of patients with depression will be evaluated using Beck’s Depression Inventory at various intervals (0 (baseline), 6 and 12 weeks) post mhGAP-IG intervention.

Therefore, outcome measures will include attitudes and symptoms of depression; and suicidal thoughts reduction.

Health care workers, patients and their families were reached through training and community awareness meetings and assessed for change in attitude and knowledge on depression.

The applicability of the technology will be evaluated through Focus Group Discussions which will be conducted at the end of the project. Health care workers who have used the application will be involved in the discussions in order to share their experiences in regards to use of the mobile technology.

 

Cost of implementation

The budget for implementation is $78,162 USD for a period of 18 months.

 

Impact details

  • Out of 25% of patients who screened positive for depression on mhGAP-IG, 40% are expected to have improved health outcomes at 3 months. Therefore, community members will have improved access to care for depression.

  • 50% health care workers, patients and their families reached through training and community awareness meetings are expected to show change in attitude and knowledge on depression.

 

References

  1. Bertolote JM et al. (2004) Psychiatric diagnoses and suicide: Revisiting the evidence. Crisis: Journal of Crisis Intervention & Suicide, 25(4): 147–155.
  2. Free C et al. (2013) The Effectiveness of Mobile-Health Technologies to Improve Health Care Service Delivery Processes: A Systematic Review and Meta-Analysis. PLoS medicine, 10(1). e1001362.

 

Research

Tools

Associates

Christine Musyimi Principal Investigator
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Country

Kenya

Affiliated organizations

Africa Mental Health Foundation

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