Table 2 Implementation framework and activities across the two country sites
Interventions | South Africa | Uganda |
|---|---|---|
Reorientation of district management. | Regular sensitization and feedback meetings were held with district management throughout the duration of the project. | Regular sensitization workshops and feedback meetings with district management throughout the project. |
Establish a community collaborative multi-sectoral forum. | Established - met 3-4 times a year. | Established - met twice a year. |
Establish an expert mental health consultancy liaison team to provide support and supervision of primary healthcare personnel, | 1. Two additional Psychiatric Nurses dedicated to providing support to nurses at the PHC clinics were deployed by the sub-district health authority. 2. A permanent position for a Psychologist was created by the sub-district health authority. 3. Consolidation of services of a consultant Psychiatrist was obtained by the sub-district health authority. 4. A Mental Health Counsellor was employed by the project for the duration of the project to provide training, support and supervision to CHWs and a referral service at PHC clinic level | 1. Regular supervisory visits to the health centres by regional support supervision team was facilitated. This team- comprised a Psychiatrist and 2 Psychiatric Clinical Officers. 2. The specialist Mental Health Nurse in the district rotated through the health centres on a regular basis, providing supervision and support to general healthcare workers. |
Manualized training of general health workers and CHWs/equivalents in identification, management and referral of persons with mental health problems. | 1. Week long training of 12 PHC nurses from PHC clinics in the sub-district in identification, management and referral of mental disorders. 2. CHWs (30) servicing sub-district DSA exposed to 4 day training workshops (2) in identification of CMDs, supportive counselling and problem management skills. 3. Two additional dedicated community mental health workers (CMHWs) trained to run a specific psychological treatment for depression which was an adapted manualized version of group Interpersonal Therapy (IPT). | 1. Week long training of general health workers of various cadres (Medical Officer, Clinical Officers, Nurses, Midwives and Nursing Assistants) (150) in identification, management and referral of mental disorders, especially severe mental disorders 2. Sensitization and training workshops in identification, management and/or referral of severe and more common mental disorders for CHWs and community leaders in the 3 sub-districts were held. |
Development of community-based self-help groups | At least three self-help groups for people with CMDs formed by CHWs • Provided supportive counselling • Income generating projects | User-carer group comprising approximately 200 families of severe mental disorders formed. • Met once a month • Assisted users to access medicine • Income generating activities initiated - piggery farming, chicken rearing and rice growing • Saving bank for medication initiated |