Mental health conditions contribute to approximately 14% of the total global burden of disease but there is a substantial treatment gap in both developed and developing countries. Treatment of mental health conditions in low resource settings such as Nigeria, one of Africa's most populous countries, is particularly challenging where that are few mental health professionals. For example Nigeria has a population of ~150 million but only 0.06 psychiatrists and 0.02 psychologists per 100,000 people.
In order to address the treatment gap the World Health Organization (WHO) has developed a manual, known as the Mental Health Gap Action Programme Intervention Guide (mhGAP-IG), which is designed to help scale up the coverage of mental health services in low resource settings by providing guidance for non-specialists to provide mental health services. In a new Health in Action article published in PLOS Medicine Jibril Abdulmalik from the University of Ibadan, Nigeria and colleagues describe their experience of contextualizing and adapting the WHO's mhGAP-IG for Nigeria.
The authors describe the multi-step process used to adapt the mhGAP-IG for the Nigerian context, which could be a valuable guide for other countries considering adapting the mhGAP-IG for their context. The process involved a situational analysis of mental health services, focus group discussions, workshops and pilot testing.
The initial analysis for Osun State in Nigeria revealed, "that there was no budgetary allocation for mental health, no designated desk officer for mental health in the state Ministry of Health, and mental health services were only available at the tertiary federal teaching hospitals located in the state. The primary health care workers knew very little about mental health conditions and there were no mental health services in the secondary facilities of the state."
The long term impact of the guide is still to be determined and the author's note, "[m]onitoring and evaluation mechanisms are also in place to review the implementation process of the mhGAP-IG over time. Only when this is done in a systematic manner will the overall effectiveness and impact of this process become clear."
They add, "[n]egotiations and longer term planning efforts are also in place to ensure national financing and budgeting mechanisms are clearly drawn up, in order to guarantee its sustainability and successful nationwide scaling up."
The case study is part of the PLOS Medicine series on Global Mental Health Practice: http://www.
Funding: The European Union provided financial support to the mhGAP implementation project through a grant to the World Health Organization. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: EM, LK, and MTY work for the World Health Organization. All other authors have declared that no competing interests exist. The views expressed in this report are the sole responsibility of the authors and do not necessarily represent the decisions, policy, or views of the World Health Organization.
Citation: Abdulmalik J, Kola L, Fadahunsi W, Adebayo K, Yasamy MT, et al. (2013) Country Contextualization of the Mental Health Gap Action Programme Intervention Guide: A Case Study from Nigeria. PLoS Med 10(8): e1001501. doi:10.1371/journal.pmed.1001501
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College of Medicine, University of Ibadan