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Scaling-up services for psychosis, depression and epilepsy in sub-Saharan Africa and South Asia: development and application of a mental health systems planning tool (OneHealth)

Part of: Special Articles

Published online by Cambridge University Press:  19 September 2016

D. Chisholm ,
M. Heslin Open the ORCID record for M. Heslin [Opens in a new window] ,
S. Docrat ,
S. Nanda ,
R. Shidhaye ,
N. Upadhaya ,
M. Jordans ,
J. Abdulmalik ,
S. Olayiwola  and
O. Gureje
...Show all authors
D. Chisholm*
Affiliation:
Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
M. Heslin
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
S. Docrat
Affiliation:
Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
S. Nanda
Affiliation:
Public Health Foundation of India, India
R. Shidhaye
Affiliation:
Public Health Foundation of India, India
N. Upadhaya
Affiliation:
Transcultural Psychosocial Organization (TPO), Nepal
M. Jordans
Affiliation:
Transcultural Psychosocial Organization (TPO), Nepal
J. Abdulmalik
Affiliation:
Department of Psychiatry, University of Ibadan, Nigeria
S. Olayiwola
Affiliation:
Department of Psychiatry, University of Ibadan, Nigeria
O. Gureje
Affiliation:
Department of Psychiatry, University of Ibadan, Nigeria
D. Kizza
Affiliation:
Butabika National Referral and Teaching, Mental Hospital, Uganda
J. Mugisha
Affiliation:
Butabika National Referral and Teaching, Mental Hospital, Uganda
F. Kigozi
Affiliation:
Butabika National Referral and Teaching, Mental Hospital, Uganda
C. Hanlon
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, Ethiopia
M. Adugna
Affiliation:
Federal Ministry of Health, Ethiopia
R. Sanders
Affiliation:
Avenir Health, Glastonbury, Connecticut, USA
C. Pretorius
Affiliation:
Avenir Health, Glastonbury, Connecticut, USA
G. Thornicroft
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
C. Lund
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
*
*Address for correspondence: D. Chisholm, Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland. (Email: [email protected])
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Abstract

Background.

Although financing represents a critical component of health system strengthening and also a defining concern of efforts to move towards universal health coverage, many countries lack the tools and capacity to plan effectively for service scale-up. As part of a multi-country collaborative study (the Emerald project), we set out to develop, test and apply a fully integrated health systems resource planning and health impact tool for mental, neurological and substance use (MNS) disorders.

Methods.

A new module of the existing UN strategic planning OneHealth Tool was developed, which identifies health system resources required to scale-up a range of specified interventions for MNS disorders and also projects expected health gains at the population level. We conducted local capacity-building in its use, as well as stakeholder consultations, then tested and calibrated all model parameters, and applied the tool to three priority mental and neurological disorders (psychosis, depression and epilepsy) in six low- and middle-income countries.

Results.

Resource needs for scaling-up mental health services to reach desired coverage goals are substantial compared with the current allocation of resources in the six represented countries but are not large in absolute terms. In four of the Emerald study countries (Ethiopia, India, Nepal and Uganda), the cost of delivering key interventions for psychosis, depression and epilepsy at existing treatment coverage is estimated at US$ 0.06–0.33 per capita of total population per year (in Nigeria and South Africa it is US$ 1.36–1.92). By comparison, the projected cost per capita at target levels of coverage approaches US$ 5 per capita in Nigeria and South Africa, and ranges from US$ 0.14–1.27 in the other four countries. Implementation of such a package of care at target levels of coverage is expected to yield between 291 and 947 healthy life years per one million populations, which represents a substantial health gain for the currently neglected and underserved sub-populations suffering from psychosis, depression and epilepsy.

Conclusions.

This newly developed and validated module of OneHealth tool can be used, especially within the context of integrated health planning at the national level, to generate contextualised estimates of the resource needs, costs and health impacts of scaled-up mental health service delivery.

Keywords

Economic issuesepidemiologyhealth service researchmental health
Type
Special Article
Information
Epidemiology and Psychiatric Sciences , Volume 26 , Issue 3 , June 2017 , pp. 234 - 244
Copyright
Copyright © World Health Organization under license to Cambridge University Press 2016 

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References

Alem, A, Kebede, D, Fekadu, A, Shibre, T, Fekadu, D, Beyero, T, Medhin, G, Negash, A, Kullgren, G (2009). Clinical course and outcome of schizophrenia in a predominantly treatment-naive cohort in rural Ethiopia. Schizophrenia Bulletin 35, 646–654.Google Scholar
Chisholm, D, Saxena, S (2012). Cost effectiveness of strategies to combat neuropsychiatric conditions in sub-Saharan Africa and South East Asia: mathematical modelling study. British Medical Journal 344, e609.Google Scholar
Chisholm, D, Lund, C, Saxena, S (2007). Cost of scaling up mental healthcare in low- and middle-income countries. British Journal of Psychiatry 191, 528–535.Google Scholar
Chisholm, D, Burman-Roy, S, Fekadu, A, Kathree, T, Kizza, D, Luitel, NP, Petersen, I, Shidhaye, R, De Silva, M, Lund, C (2015). Estimating the cost of implementing district mental healthcare plans in five low- and middle-income countries: the PRIME study. British Journal of Psychiatry 208 (Suppl. 56), s71–s78.CrossRefGoogle ScholarPubMed
Federal Democratic Republic of Ethiopia Ministry of Health (2012). National Mental Health Strategy 2012/13–2015/16. Federal Democratic Republic of Ethiopia Ministry of Health: Ethiopia.Google Scholar
Gilbert, B, Patel, V, Farmer, P, Lu, C (2015). Assessing development assistance for mental health in developing countries: 2007–2013. PLoS Medicine 12, e1001834.Google Scholar
Hanlon, C, Luitel, NP, Kathree, T, Murhar, V, Shrivasta, S, Medhin, G, Ssebunnya, J, Fekadu, A, Shidhaye, R, Petersen, I, Jordans, M, Kigozi, F, Thornicroft, G, Patel, V, Tomlinson, M, Lund, C, Breuer, E, De Silva, M, Prince, M (2014). Challenges and opportunities for implementing integrated mental health care: a district level situation analysis from five low- and middle-income countries. PLoS ONE 9, e88437.Google Scholar
Hyman, S, Chisholm, D, Kessler, R, Patel, V, Whiteford, H (2006). Mental disorders. In Disease Control Priorities in Developing Countries, 2nd edn, Chapter 31 (ed. Jamison, DT, Breman, JG, Measham, AR, Alleyne, G, Claeson, M, Evans, DB, Jha, P, Mills, A and Musgrove, P), pp. 605–626. Oxford University Press and The World Bank: New York.Google Scholar
Kebede, D, Alem, A, Shibre, T, Fekadu, A, Fekadu, D, Kullgren, G, Jacobbson, L (2000). The Butajira-Ethiopia study on the incidence, course and outcome of schizophrenia and bipolar disorders. I. Descriptions of study settings, methods and preliminary results. Schizophrenia Research 41, 78.CrossRefGoogle Scholar
Patel, V, Chisholm, D, Parikh, R, Charlson, F, Degenhardt, L, Dua, T, Ferrari, AL, Hyman, S, Laxminarayan, R, Levin, C, Lund, C, Medina-Mora, M, Petersen, I, Scott, J, Shidhaye, R, Vijayakumar, L, Thornicroft, T, Whiteford, H (2015). Addressing the burden of mental, neurological, and substance use disorders: key messages from Disease Control Priorities, 3rd edn. Lancet 387, 1672–1685.CrossRefGoogle Scholar
Salomon, J, Vos, T, Hogan, DR, Gagnon, M, Naghavi, M, Mokdad, A, Begum, N, Shah, R, Karyana, M, Kosen, S, Farje, MR, Moncada, G, Dutta, A, Sazawal, S, Dyer, A, Seiler, J, Aboyans, V, Baker, L, Baxter, A, Benjamin, EJ, Bhalla, K, Bin Abdulhak, A, Blyth, F, Bourne, R, Braithwaite, T, Brooks, P, Brugha, TS, Bryan-Hancock, C, Buchbinder, R, Burney, P, Calabria, B, Chen, H, Chugh, SS, Cooley, R, Criqui, MH, Cross, M, Dabhadkar, KC, Dahodwala, N, Davis, A, Degenhardt, L, Díaz-Torné, C, Dorsey, ER, Driscoll, T, Edmond, K, Elbaz, A, Ezzati, M, Feigin, V, Ferri, CP, Flaxman, AD, Flood, L, Fransen, M, Fuse, K, Gabbe, BJ, Gillum, RF, Haagsma, J, Harrison, JE, Havmoeller, R, Hay, RJ, Hel-Baqui, A, Hoek, HW, Hoffman, H, Hogeland, E, Hoy, D, Jarvis, D, Karthikeyan, G, Knowlton, LM, Lathlean, T, Leasher, JL, Lim, SS, Lipshultz, SE, Lopez, AD, Lozano, R, Lyons, R, Malekzadeh, R, Marcenes, W, March, L, Margolis, DJ, McGill, N, McGrath, J, Mensah, GA, Meyer, AC, Michaud, C, Moran, A, Mori, R, Murdoch, ME, Naldi, L, Newton, CR, Norman, R, Omer, SB, Osborne, R, Pearce, N, Perez-Ruiz, F, Perico, N, Pesudovs, K, Phillips, D, Pourmalek, F, Prince, M, Rehm, JT, Remuzzi, G, Richardson, K, Room, R, Saha, S, Sampson, U, Sanchez-Riera, L, Segui-Gomez, M, Shahraz, S, Shibuya, K, Singh, D, Sliwa, K, Smith, E, Soerjomataram, I, Steiner, T, Stolk, WA, Stovner, LJ, Sudfeld, C, Taylor, HR, Tleyjeh, IM, van der Werf, MJ, Watson, WL, Weatherall, DJ, Weintraub, R, Weisskopf, MG, Whiteford, H, Wilkinson, JD, Woolf, AD, Zheng, ZJ, Murray, CJ, Jonas, JB (2012). Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010. Lancet 380, 2129–2143.CrossRefGoogle ScholarPubMed
Semrau, M, Evans-Lacko, S, Alem, A, Ayuso-Mateos, JL, Chisholm, D, Gureje, O, Hanlon, C, Jordans, M, Kigozi, F, Lempp, H, Lund, C, Petersen, I, Shidhaye, R, Thornicroft, G (2015). Strengthening mental health systems in low- and middle-income countries: the Emerald programme. BMC Medicine 13, 79.Google Scholar
Stenberg, K, Chisholm, D (2012). Resource needs for addressing noncommunicable disease in low- and middle-income countries: current and future developments. Global Heart 7, 53–60.Google Scholar
Whiteford, H, Degenhardt, L, Rehm, J, Baxter, A, Ferrari, A, Erskine, HE, Charlson, FJ, Norman, R, Flaxman, A, Johns, N, Burstein, R, Murray, CJL, Vos, T (2013). Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet 382, 1575–1586.Google Scholar
WHO (2010). mhGAP (Mental Health Gap Action Programme) Intervention Guide. World Health Organization: Geneva.Google Scholar
WHO (2015). Mental Health Atlas 2014. World Health Organization: Geneva.Google Scholar
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