Innovation details
Zanmi Lasante has worked with the Haitian Ministry of Health (Ministère de la Santé Publique et de la Population--MSPP) in Haiti since 1987, creating and reinforcing a service delivery platform to deliver comprehensive HIV/TB care across 11 facilities serving a catchment area of over 1.3 million people in the Central Plateau and Lower Artibonite Valley. When Haiti was struck by a devastating earthquake in 2010, ZL collaborated with the MSPP to develop a model community based service for the nation and more formally expanded its own Mental Health Program1–3,5.
ZL has methodically built up a comprehensive system of integrated mental health services encompassing interpersonal therapy (IPT) and other treatment modalities6. Historically, the problem with acute disaster responses in low-resource settings, and as they relate to mental health, has been that they have often tended to be carried out with insufficient attention to the key components necessary for sustainable delivery of care. The systems approach piloted by ZL in Haiti provides a comprehensive and innovative approach to implementation that could be replicated in other resource-limited settings, including other Partners In Health sites.
Key components of the work include:
- Developing or adapting and testing screening tools for depression, epilepsy/seizures, psychosis/bipolar, and child/adolescent developmental and behavioural disorders consistent with the WHO mhGAP Intervention Guide
- Training providers (physicians, nurses, psychologists/social workers) across the continuum of care on curriculums, materials, and protocols iteratively developed across four priority disorder care pathways
- Providing refresher trainings for all cadres of providers across all 11 sites, with a focus on patient safety and quality improvement
- Integrating mental health curriculum within the residency program at the Hopital Universitaire de Mirebalais (HUM) and the Family Medicine residency program at the Hopital St. Nicholas of St Marc
- Including community health workers &traditional healers in mental health screening, referral, and treatment tasks
- Developing a system for sustained supervision, including Interpersonal Therapy (IPT) supervision and training with IPT world expert Helena Verdeli from Teachers College Columbia University
- Developing a system for monitoring and evaluation and data collection
- Deepening the data collection system to allow for the collection of patient-level data and tracking of symptoms and clinical outcomes over time in an electronic database, using data to drive quality improvement
- Deepening the system for sustained supervision, with a focus on ensuring patient safety
- Reducing stigma related to mental illness among providers, families and local communities
- Working closely with the MSPP in implementation and advocacy
ZL is now working closely with the MSPP to build on this work and ensure quality is equitable across the system by:
- Developing a plan to roll out a Psychiatry Residency program at HUM, in recognition of the importance of formal education and accreditation in attracting young providers to mental health work
- Informing national mental health planning