This extract from "Challenges and Opportunities for Implementing Integrated Mental Health Care: A District Level Situation Analysis from Five Low- and Middle-Income Countries" by Charlotte Hanlon, et al. (2014) explains the genesis and reasoning behind PRIME's situation analysis tool:
For the purposes of the PRIME project, we developed a new situation analysis tool. Existing methods and tools for appraising mental health systems and services in LMICs did not meet the needs of PRIME either due to reliance on primary research, or because they were not applicable to small population units, such as districts and sub-districts.
The situation analysis was orientated around those factors required for implementation of the WHO's mhGAP-IG in the PHC setting. A small number of items overlapped conceptually with items from the WHO-Assessment Instrument for Mental Health Systems (WHO-AIMS). Where duplication occurred, the WHO-AIMS item was included in preference. Methodology for in-depth case studies of mental health services in LMICs was also reviewed to identify further domains. The draft situation analysis tool was circulated within the PRIME Research Programme Consortium, which includes expertise in health service evaluation, planning and implementation of mental health care services, and both multi-sectoral and community engagement in mental health care. To ensure a comprehensive approach feedback was also solicited from other experts in the field.The situation analysis tool comprised six sections:
- Section I (Relevant context; 39 items) covered environmental, population, economic, health (including reproductive health and HIV) and social indicators.
- Section II (Mental health politics, policies and plans; 15 items): national and local political support for mental health care, including budgets, policies, plans, legislation and welfare benefits, and details of the specialist mental health workforce at national level.
- Section III (Mental health treatment coverage; 19 items): prevalence of MNS disorders, numbers receiving care and estimated treatment coverage.
- Section IV (District level health services; 62 items): general health services, including the available cadres of health professionals at each level in the system, specialist mental health services, with particular reference to elements of specialist mental health care needed to support PHC-based mental health care and delivery of the mhGAP packages, the extent and nature of mental health care delivered in primary care and health systems structures to support integration of mental health care into PHC.
- Section V (Community; 17 items): sociocultural aspects, relevant non-health sector organisations and awareness-raising activities.
- Section VI (Monitoring and evaluation; 4 items): health information systems, and monitoring and evaluation of services.
For sections I-III, information was collected for both the national and district level to be cognisant of national programs even if these were absent in the district selected for the PRIME project. A section was also included for a narrative description of the district.
The situation analysis tools were completed by project co-ordinators and research staff from the PRIME countries between October and December 2011 and then reviewed by CH and MDS for completeness and comprehensibility. Discrepancies between data sources were noted, prompting cross-checking by project co-ordinators where possible. Concerns about the veracity of the data obtained from a particular data source were noted. Sources of information contributing to the situation analysis were documented, together with the date of data collection, thus allowing the document to be updated when new information became available.
Challenges and Opportunities for Implementing Integrated Mental Health Care: A District Level Situation Analysis from Five Low- and Middle-Income Countries
Hanlon C, Luitel NP, Kathree T, Murhar V, Shrivasta S, et al. (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(2): e88437. doi: 10.1371/journal.pone.0088437
PRIME's Situational Analysis Tool by PRIME is licensed under a Creative Commons Attribution 4.0 International License.