Evaluation of performance and perceived utility of mental healthcare indicators in routine health information systems in five low- and middle-income countries
Reader, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
Dan Chisholm
Programme Manager for Mental Health, Regional Office for Europe, World Health Organization, Switzerland
Maya Semrau
Research Fellow, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London; and Global Health and Infection Department, Brighton & Sussex Medical School, Brighton, UK
Research Coordinator, Transcultural Psychosocial Organization, Nepal
Jibril Abdulmalik
Senior Lecturer, Department of Psychiatry, University of Ibadan, Nigeria
Shalini Ahuja
Researcher, Public Health Foundation of India & Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
James Mugisha
Senior Lecturer, Kyambogo University, Kampala, Uganda & Butabika National Referral and Teaching Mental Hospital, Uganda
Ntokozo Mntambo
Researcher, University of Kwazulu-Natal, South Africa
Fred Kigozi
Senior Consultant Psychiatrist and Researcher, Butabika National Referral and Teaching Mental Hospital, Uganda
Inge Petersen
Research Professor and Director, Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, South Africa
Rahul Shidhaye
Clinical Psychiatrist, Public Health Foundation of India, India; and CAPHRI School for Public Health and Primary Care, Maastricht University, the Netherlands
Professor of Public Mental Health and Professor of Global Mental Health and Development, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa, and Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
Graham Thornicroft
Professor of Community Psychiatry, Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
Oye Gureje
Professor of Psychiatry and Director, WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Substance Abuse, Department of Psychiatry, University of Ibadan, Nigeria; and Professor Extraordinary, Department of Psychiatry, Stellenbosch University, South Africa
BackgroundIn most low- and middle-income countries (LMIC), routine mental health information is unavailable or unreliable, making monitoring of mental healthcare coverage difficult. This study aims to evaluate a new set of mental health indicators introduced in primary healthcare settings in five LMIC.MethodA survey was conducted among primary healthcare workers (n = 272) to assess the acceptability and feasibility of eight new indicators monitoring mental healthcare needs, utilisation, quality and payments. Also, primary health facility case records (n = 583) were reviewed by trained research assistants to assess the level of completion (yes/no) for each of the indicators and subsequently the level of correctness of completion (correct/incorrect – with incorrect defined as illogical, missing or illegible information) of the indicators used by health workers. Assessments were conducted within 1 month of the introduction of the indicators, as well as 6–9 months afterwards.ResultsAcross both time points and across all indicators, 78% of the measurements of indicators were complete. Among the best performing indicators (diagnosis, severity and treatment), this was significantly higher. With regards to correctness, 87% of all completed indicators were correctly completed. There was a trend towards improvement over time. Health workers' perceptions on feasibility and utility, across sites and over time, indicated a positive attitude in 81% of all measurements.ConclusionThis study demonstrates high levels of performance and perceived utility for a set of indicators that could ultimately be used to monitor coverage of mental healthcare in primary healthcare settings in LMIC. We recommend that these indicators are incorporated into existing health information systems and adopted within the World Health Organization Mental Health Gap Action Programme implementation strategy.Declaration of interestNone.
