Hi Simon, [ https://www.hifa.org/dgroups-rss/support-systems-47-meeting-information-... ]
The Mental Health Leadership and Advocacy Programme (mhLAP) in Anglophone West Africa has been driven by evidence right from design, through implementation to evaluation. I will give a bit of narration that may help you to appreciate the kinds of information or evidence that stakeholders brought to discussions in these bodies and how these kinds of information were used.
The mhLAP project emerged based on a landmark series of papers on global mental health published by the Lancet medical journal that established psychosocial disabilities as a priority in addressing unmet health needs globally. Following from these publications, the project reasoned that the highly effective and low-cost treatment that reduces symptoms, which allow people with mental illness to function well in society, is only available to a tiny minority of people in the countries covered by this project. And this is so because of the strong circular link that exists at a personal and on national economic scale between poverty and psychosocial disability. In addition, the discrimination (and sometimes frank abuse of human rights, for example chaining of people with psychotic disorders) that exists at all levels results into social exclusion of people with psychosocial disabilities. Nevertheless, it is possible to empower a broad base of stakeholders to challenge this situation through advocacy to politicians, political-office holders and decision-takers of public policy aimed at scaling up services and addressing human rights issues in policy and planning for mental health.
Given this rationale, the project set out to do the following activities:
(i) Conduct an annual Mental Health Leadership Training and Workshop;
(ii) Develop a National Stakeholders Council in each country; and
(iii) Support advocacy to raise awareness about mental health and engage in the review of mental health policy, plans and legislation in each country
For the annual mhLAP training course and workshop that took place over the 10-year period starting in 2010, participants were drawn from a broad-range of stakeholders ranging from professionals (Psychiatrists including Residents in training, Clinical Psychologists, Social Workers etc.) through media practitioners and CSOs especially those concerned with human rights, to Service Users and their Care givers; as well as government partners (heads of public health departments, designated officials with mental health responsibilities etc.), legislators and other related public policy makers. As many of the mental health realities in sub-Saharan Africa (SSA) were noted to be similar; other than the 5 project countries: Ghana, Gambia, Liberia, Nigeria, and Sierra Leone, participants from Namibia, Niger, Kenya, South Africa, Cameroon, Cote d’Ivoire etc. have undertaken the training courses that were conducted in Ibadan, Nigeria. The curriculum of the training course was said to have been informed by current best evidence in the field of public health and health system development. However, the core content although with local adaptation was believed to have been derived from an antecedent (a similar training course) that is being run by the Centre for International Mental Health at the University of Melbourne, Australia. Apart from core subject matters such as burden of mental illness, neurological and substance use disorders, social determinants of mental health, mental health policy and legislation, organization, and financing of mental health services; other important topics that include principles and practice of health promotion, communication arts, and prevention of stigma of mental health were covered by the Mental Health Leadership Training Course. And the course faculty comprised both national facilitators and international experts in global mental health with practical experience of working in low- and middle-income countries.
So what?
Several local leaders who were trained became arrowheads in efforts to bring mental health to prominence in their various countries. Similarly, the Stakeholder Councils that were activated in each country became effective and credible voices in all of the participating countries, as they were actively engaged in efforts to develop policy and legislation and championing community outreach programmes. For example, mhLAP was noted to have made notable contributions to the processes leading on to the adoption of the Mental Health Policy in Nigeria and the Mental Health Act in Ghana, where the project provided leadership to civil societies and other stakeholders involved. In addition, mhLAP received the attention of the WHO country offices in all the participating countries and engaged productively with the Ministers of Health in Liberia, Sierra Leone, and The Gambia. In Nigeria, the Director of Primary Care Service in Osun State, following his participation at the annual 2-week course, went back to initiate important policy changes that led to improved procurement of medication for mental health conditions in the state.
Following this level of performance, an extension phase sought to empower the Stakeholder Councils in each country to become more active in service improvement and protection of human rights. Again it was a was noted that:
* Stakeholder Councils in four of the five participating countries: Ghana, Liberia, Sierra Leone, and The Gambia empowered to a large extent to address the problem of poor quality of service and abuse of the human rights of patients in treatment by implementing the WHO QualityRights Toolkit; and
* Several anti-stigma activities aimed at addressing the problem of widespread stigma and discrimination against persons with mental illness executed by Stakeholder Councils in these four countries.
And here is a summary of outputs/outcomes following the actions of a collective of multi-disciplinary mental health leaders in each of the five project countries that led to increased policy attention in the respective countries (Taken from mhLAP Final Evaluation Report, 2020).
Chart 3: Increased Policy Attention for Mental Health in Project Countries
Project Country
Change mental health systems (policy, legislation
Ghana
* Enactment of Mental Health Act, 2012 (846)
* Development & passage of subsidiary legislation - Legislative Instrument (LI) spells out how articles of mental health law are executed
* Repeal or amendments of sections of Ghana’s statutes derogative & perpetuate stigma/ discrimination against people with mental illness
* Establishment of Mental Health Authority - to work with other service providers to ensure best care for persons with psychosocial disability
Liberia
* Establishment of Mental, Neurological & Substance Use (MNS) Programme Unit
* Development of Mental Health Policy & Strategic Plan for Liberia 2016 -2021
* Passage of Mental Health Law
* Secured budget line for mental health
Nigeria
* Establishment of mental health desk at Department of Public Health, Federal Ministry of Health
* Mental Health Policy adopted at the National Council on Health in 2013
* Mental Health Bill in the process of being passed at National Assembly awaiting final reading after public hearing in February 2020
Sierra Leone
* Establishment of Directorate for Non-Communicable Diseases (NCDs) & Mental Health
* Mental Health Policy 2012 – 2015 developed & launched by government
* Revised Mental Health Policy 2019 – 2023, along with Mental Health Strategic Plan (2019 – 2023)
* Actively engaging government & partners to institute mental health law to replace out-dated Lunacy Ordinance of 1902
The Gambia
* Establishment of Mental Health Programme Management Unit
* Revised mental health policy and strategic plan
* Draft mental health law to repeal the Lunatic Act of 1917, awaiting passage by National Assembly
1. Patel V, Araya R, Chatterjee S, Chisolm D, Cohen A, De Silva M, Hosman C, McGuire H, Rojas G, van Ommeren M. Treatment and prevention of mental disorders in low-income and middle-income countries. Lancet 2007; 370(9591):991-1005
With regards to the mhLAP End-of-Programme Evaluation Report, it is not available online. However, for the purpose of this CSO, evidence and health policy research, it may be possible to share this document with the research team after seeking permission from CBM that commissioned the evaluation.
Cheers
Tarry
HIFA Profile: Tarry Asoka is a consultant in health and development based in Nigeria. Besides assisting clients to meet their corporate objectives, Tarry is keen on searching for and implementing innovative solutions that address critical challenges that confront the world in health and development. He has experience with civil society participation in health policy processes in Anglophone West Africa (Ghana, Liberia, Nigeria, Sierra Leone, and The Gambia). In Nigeria, he has provided mentoring support and help to channel resources to the lead CSO (Health Reform Foundation of Nigeria � HERFON) both as UK DFID (now FCDDO) Health Adviser over a 5-year period and later as an Independent Consultant. Tarry is a member of the HIFA working group on SUPPORT-SYSTEMS.
https://www.hifa.org/support/members/tarry
https://www.hifa.org/projects/new-support-systems-how-can-decision-makin...
Email address: tarry AT carenet.info
