Like my response to Simon, I will take a narrative approach to answering your questions and perhaps add some contextual materials for better understanding.
First, some background information:
To help facilitate its work in individual project countries, mhLAP established Country Offices. Each office is headed by a full-time Country Facilitator and is housed in a space provided by a country partner. Depending on the situation in specific countries, project partners include a mental health user organization (Ghana), a faith-based non-governmental organization providing care for persons with severe mental disorder (Sierra Leone), and a WHO country office (Gambia). The duties of the Country Facilitator include strengthening of links between people involved in mental health in the country, and the implementation of the programme of activities guided by these stakeholders. Depending on the local networks of stakeholders, the Facilitators either worked to strengthen existing groups (for example in Ghana and Sierra Leone) or constituted a National Stakeholders Council (NSC) [as in Gambia, Liberia, and Nigeria] where no group existed with a broad membership. The Council’s name also varies in each country. The aim was to build on local strengths rather than to replicate or create parallel or competing institutions. The reality was that in most countries, while some interest groups existed (professional, traditional, or service user/carer), there was rarely a group aiming to bring all of these diverse interests together.
In relation to the structure of NSCs:
For each participating country, the NSC comprised mental health professionals, representatives of service user and caregiver organisations, officials of relevant government departments and agencies, leaders of non-governmental organizations with interest in mental health or human rights issues, and media practitioners. Despite its mixed composition of stakeholders that cut across several sectors and/or interests, each country’s NSC was set up to serve as an active lobby group to develop and conduct mental health advocacy activities.
For Nigeria, which is a federal country; as the complexities of setting one NSC to cater for the mental health needs of such as diverse country became obvious, there was some modification in this case to set up similar sub-national bodies (State Chapters) with a view to adopting the same operational modes as the NSCs in the other countries.
The NSC meets at least two times per year to draw up program of activities reflecting identified needs. For instance, a particular NSC may decide that advocacy for a mental health policy would be its main area of action or that it would seek to organise workshops for journalists to discourage them from using derogatory terms when reporting on persons with mental illness. Once high priority activities are decided as the focus of the Council’s attention, the Country Facilitator is given the responsibility of coordinating the activities of the stakeholders in their respective spheres of influence and reporting back to the Council on the progress of implementation. Programmatically, in carrying out these functions, the Country Facilitator reports to the mhLAP Project Office in Ibadan, Nigeria from where regular supervisory visits to the country offices are often carried out.
With respect to evidence generation and use by the NSCs:
One of the first activities for the Facilitator in each country was the collection of data to inform a comprehensive situation analysis of the status of mental health services at the onset of the programmes. Published and disseminated widely, this in-country data on mental health then guides decisions about advocacy priorities, as well as serve as a baseline for subsequent programme evaluation.
Furthermore, the NSC includes graduates of the leadership and advocacy training course in Ibadan, Nigeria. The Country Facilitators, as well as these graduates, are guided by priorities set by a wide coalition of stakeholders in the country, creating a unified message, with the legitimacy that comes from such a broad-based constituency. Indeed, the expectation from the leadership course participants is that they become informed advocates for mental health service development in their respective countries. Thus, at every meeting of the NSC, further in-house capacity building is promoted by having one or two members who have attended the Ibadan training speak on selected topics as a way of informing others. In this way, members of the NSC are provided with the knowledge to enable them to inform the national agenda with respect to mental health, in a systematic and evidence-based manner.
And in reply to one of your questions on the dynamics of NSCs: though in each country, the NSC emerged as a platform for engaging with public policy on mental health and for supporting mental health advocacy activities, they soon evolved into a strong, coherent, and authoritative lobby group for mental health policy and service development. From this point, it may appear natural that the NSC become a partner with government departments/agencies in advancing the mental health agenda within each domain.
At the time of the final evaluation of the mhLAP project, the NSCs have or were transitioning to becoming indigenous national NGOs/CSOs. In describing one of them, here is a paragraph taken from the evaluation report:
Amongst them, the Mental Health Coalition of Sierra Leone is the star performer with regards to stability. This coalition, which currently operates from its own rented office premises was already in existence (2011) undertaking a similar role within the framework of an EU mental health project also associated with CBM, when the mhLAP project arrived in Sierra Leone in 2012. Registered as national NGO/CSO it has a broad range of members including individuals and organisations at different categories. At the moment there are 5 district chapters with an additional 4 being activated, so making a total of 9 out of the 16 districts in the country. However, “We also work with all the mental health nurses in all the districts until a chapter is established”. The coalition has robust organisational structure with the following arms: (i) Annual General Meeting (AGM), which takes place during the annual National Mental Health Conference of the organisation - the highest decision making body of the organisation that involves representatives of all member organisations; (ii) Executive Committee - that oversees the operations of the organisation; and (iii) Secretariat (employees, volunteers and interns) - that undertakes day-to-day project tasks and activities. In addition, the coalition has a decentralised governance arrangement, as 4 sub-committees are responsible for specific strategic tasks as follows: (a) Legislation - group working on the mental health Law; (b) Medication - access to psychotropic medicines; (c) Training and research � capacity building &aamp; research; and (d) Events - events planning, including awareness campaigns and World Mental Health Day celebration. Other than membership subscription dues it has the capacity to attract grants and provides services to other organisations - as sources of revenue. As noted, “We are an entity that is living beyond mhLAP�apart fromm grants, we also provide services that bring in income.”
The other NSCs: Ghana Mental Health Coalition (GHAMEC), Liberia Coalition for Mental Health Services (LCMHS), Mental Health Awareness, Advocacy Foundation of Nigeria, and Mental Health Leadership and Advocacy Foundation (MHLAF) for The Gambia; are making good progress in terms of functionality and stability. While this could be a legacy of the mhLAP project, the challenge is for them to maintain their status as a multisectoral, solid, and dynamic governance platform for keeping mental health on the development agenda in their respective countries.
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 Ã¯Â¿Â½ 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.
Email address: tarry AT carenet.info