Strengthening South Africa's health system through integrating treatment for mental illness into chronic disease care (Project MIND)
Lead Research Organisation:
South African Medical Research Council
Department Name: Mental Health, Alcohol, Substance Use an
Abstract
Integrating mental health care into primary health care services could reduce the impact of both chronic communicable and non-communicable diseases (NCDs). Like many low- and middle-income countries (LMICs), South Africa (SA) faces the challenge of how to reduce the high prevalence and impact of communicable diseases and NCDs, including mental disorders where limited services are available. Mental disorders are important to address among patients with chronic diseases as these problems are associated with poor adherence to treatment, more rapid disease progression and treatment failure. As treatment failure increases the use of health services and health service costs, chronic disease care in LMICs must be expanded to include mental health care. The integrated delivery of mental health services and chronic disease care has been shown to not only improve access to mental health care but also the mental health of patients living with a chronic disease. .
Yet, limited knowledge of how mental health care can be integrated into chronic disease services in ways that are acceptable to patients and providers and feasible to implement with few resources has delayed the integration of services in SA. The provision of integrated mental health and chronic disease services has also been delayed by questions about whether services should be vertically or horizontally integrated. Vertically integrated services are delivered at the same location, but mental health and chronic disease services are provided by separate cadres of health workers. Horizontally integrated services are delivered at the same location by the same staff are responsible for mental health and chronic disease care. The goal of this project is to answer these questions by assessing current capacity and barriers to integrating mental health services into chronic disease care and by comparing the effectiveness and cost-effectiveness of a vertically and horizontally integrated model of service integration among patients receiving treatment for HIV or diabetes and who are at risk for treatment failure in Cape Town, SA. Through this project we hope to identify a feasible, acceptable and effective model for integrating mental health services into chronic disease care that is applicable to other LMICs. Findings from this study are likely to be highly relevant for use in other LMICs given similarities between the burden of disease, treatment populations, and treatment systems in SA and other LMICs.
The study will comprise two phases. In the first phase, we will conduct in-depth interviews with a range of healthcare providers in HIV and diabetes services to assess barriers to integration and the feasibility and acceptability of our proposed models of service integration (Aim 1). Findings from this phase will be used to adapt our evidence-based mental health service package for optimal integration into chronic disease services. In phase two, a clustered randomised controlled trial will be conducted. We will select 24 HIV and 24 diabetes clinics to randomise to a vertically integrated arm, horizontally integrated arm, or treatment as usual (no integration). We will recruit 25 patients at risk for treatment failure from each of these clinics (total 1200 patients). After study enrollment, a baseline assessment will be completed by a fieldworker. Participants recruited from clinics randomised to either the vertically integrated or horizontally integrated arm will then receive their intervention sessions. All participants, irrespective of their intervention arm, will be tracked for 6- and 12-month follow-up interviews. At these interviews, fieldworkers blinded to their intervention arm will re-administer the baseline assessment and biological specimens will be collected to assess for chronic disease outcomes. Findings from this phase will be used to evaluate the relative effectiveness and cost-effectiveness of our proposed models of service integration (Aims 2-3).
Yet, limited knowledge of how mental health care can be integrated into chronic disease services in ways that are acceptable to patients and providers and feasible to implement with few resources has delayed the integration of services in SA. The provision of integrated mental health and chronic disease services has also been delayed by questions about whether services should be vertically or horizontally integrated. Vertically integrated services are delivered at the same location, but mental health and chronic disease services are provided by separate cadres of health workers. Horizontally integrated services are delivered at the same location by the same staff are responsible for mental health and chronic disease care. The goal of this project is to answer these questions by assessing current capacity and barriers to integrating mental health services into chronic disease care and by comparing the effectiveness and cost-effectiveness of a vertically and horizontally integrated model of service integration among patients receiving treatment for HIV or diabetes and who are at risk for treatment failure in Cape Town, SA. Through this project we hope to identify a feasible, acceptable and effective model for integrating mental health services into chronic disease care that is applicable to other LMICs. Findings from this study are likely to be highly relevant for use in other LMICs given similarities between the burden of disease, treatment populations, and treatment systems in SA and other LMICs.
The study will comprise two phases. In the first phase, we will conduct in-depth interviews with a range of healthcare providers in HIV and diabetes services to assess barriers to integration and the feasibility and acceptability of our proposed models of service integration (Aim 1). Findings from this phase will be used to adapt our evidence-based mental health service package for optimal integration into chronic disease services. In phase two, a clustered randomised controlled trial will be conducted. We will select 24 HIV and 24 diabetes clinics to randomise to a vertically integrated arm, horizontally integrated arm, or treatment as usual (no integration). We will recruit 25 patients at risk for treatment failure from each of these clinics (total 1200 patients). After study enrollment, a baseline assessment will be completed by a fieldworker. Participants recruited from clinics randomised to either the vertically integrated or horizontally integrated arm will then receive their intervention sessions. All participants, irrespective of their intervention arm, will be tracked for 6- and 12-month follow-up interviews. At these interviews, fieldworkers blinded to their intervention arm will re-administer the baseline assessment and biological specimens will be collected to assess for chronic disease outcomes. Findings from this phase will be used to evaluate the relative effectiveness and cost-effectiveness of our proposed models of service integration (Aims 2-3).
Technical Summary
Background: The integrated delivery of chronic disease and mental health services has been shown to improve access to mental health care and patient disease outcomes in low and middle income countries, such as South Africa. Yet integration has been slow due to limited knowledge of feasible, acceptable and effective collaborative care models. We propose addressing this knowledge gap by testing collaborative care models for patients at risk of treatment failure in Cape Town.
Objectives:
1. To assess the feasibility and acceptability of a vertical and horizontal model for integrating mental health care into HIV and diabetes services.
2. To compare the effectiveness of a vertical model of service integration relative to a horizontal model relative to treatment as usual (TAU), with depression and risky alcohol use as primary outcomes and HIV1 RNA viral load and HbA1c as secondary outcomes.
3. To determine the cost-effectiveness of a vertical model of service integration relative to a horizontal model relative to TAU.
Methods:
Interviews will be conducted with HIV and diabetes service providers to assess barriers to integration and the feasibility and acceptability of our proposed models of service integration (Aim 1). Findings will be used to adapt our mental health package for optimal integration. Next we will conduct a clustered randomised controlled trial in which 24 HIV and 24 diabetes clinics will be allocated to a vertically integrated, horizontally integrated, or treatment as usual (no integration) arm. We will recruit 25 patients at risk for treatment failure from each clinic (total 1200) and administer a baseline assessment. Participants in the vertically integrated and horizontally integrated arms will receive their intervention sessions. Participants will return to the clinic for 6- and 12-month follow-ups. Findings will be used to evaluate the relative effectiveness and cost-effectiveness of the proposed models of service integration (Aims 2-3).
Objectives:
1. To assess the feasibility and acceptability of a vertical and horizontal model for integrating mental health care into HIV and diabetes services.
2. To compare the effectiveness of a vertical model of service integration relative to a horizontal model relative to treatment as usual (TAU), with depression and risky alcohol use as primary outcomes and HIV1 RNA viral load and HbA1c as secondary outcomes.
3. To determine the cost-effectiveness of a vertical model of service integration relative to a horizontal model relative to TAU.
Methods:
Interviews will be conducted with HIV and diabetes service providers to assess barriers to integration and the feasibility and acceptability of our proposed models of service integration (Aim 1). Findings will be used to adapt our mental health package for optimal integration. Next we will conduct a clustered randomised controlled trial in which 24 HIV and 24 diabetes clinics will be allocated to a vertically integrated, horizontally integrated, or treatment as usual (no integration) arm. We will recruit 25 patients at risk for treatment failure from each clinic (total 1200) and administer a baseline assessment. Participants in the vertically integrated and horizontally integrated arms will receive their intervention sessions. Participants will return to the clinic for 6- and 12-month follow-ups. Findings will be used to evaluate the relative effectiveness and cost-effectiveness of the proposed models of service integration (Aims 2-3).
Planned Impact
This study will provide new, internationally relevant knowledge of how to better integrate mental health services into chronic disease care within resource-limited health systems. The existing knowledge base is insufficient for guiding evidence-based service design as there are questions about whether services should be vertically or horizontally integrated. Vertically integrated services are co-located to allow for referral between condition-specific services. However, each service is delivered by its own dedicated work force (12-13). In contrast, horizontally integrated services are functionally merged with some chronic disease staff designated to provide mental health care alongside chronic disease care (12-13). Both models require staff to be trained and supervised by mental health specialists. While the merits of each model have been outlined (12-13), the relative effectiveness and cost-effectiveness of these models for mental health and chronic disease outcomes has not been examined. We propose a developmental study, effectiveness trial, and cost-effectiveness analysis to identify the most feasible, acceptable and efficient model for integrating a novel, generic mental health care package into communicable disease and NCD services. If positive outcomes are achieved in both service settings, we would have identified an approach to mental health service delivery with potential applicability across a range of chronic disease services. Findings may aid efforts to improve the delivery of integrated mental health and chronic disease services in SA. Further, the lessons learned could benefit other LMICs. As SA faces a quadruple burden of communicable diseases, NCDs, injury and mental disorders (1), it provides a laboratory for health system interventions that are potentially useful for other LMICs engaging in epidemiological transitions.
Second, this study will have an economic and societal impact. Healthcare personnel will benefit by learning how to address mental disorders among chronic disease patients and will be able to help enhance their patients' health and quality of life. This study will empower healthcare personnel to identify and address mental disorders that contribute to treatment failure by providing staff with evidence-based screening and intervention tools. Implementing either of these two models of integrated service delivery may increase the availability of mental health care within the public health system. Providing mental health services within chronic disease care could benefit the health system by reducing the burden placed on these services by patients with poor responses to treatment, who often require more expensive and intensive treatments (10). Also, study participants in both intervention arms are likely to benefit from these mental health services, which may improve the quality of their own and their family's lives. Finally, the knowledge generated by this study will be of direct relevance to current efforts to reform the public health system in SA and many other LMICs where there is a focus on expanding access to mental health care. The WCDOH also is likely to benefit from this study. The WCDOH has prioritised the provision of mental health care to chronic disease patients in its service delivery plans. Should the study find that one model of integrated care is more cost-effective than another; the WCDOH is likely to adopt this model of care and conduct a wider, pragmatic evaluation of its effects on health service delivery. In addition, the WCDOH will use these findings to influence regional and national health policies and legislation, with a view to strengthening the provision of mental health care within SA's public health system. We will also try and influence international health guidelines through disseminating findings to our World Health Organisation contacts and other international networks. As such, results could have a far-reaching impact on public health for similar LMICs.
Second, this study will have an economic and societal impact. Healthcare personnel will benefit by learning how to address mental disorders among chronic disease patients and will be able to help enhance their patients' health and quality of life. This study will empower healthcare personnel to identify and address mental disorders that contribute to treatment failure by providing staff with evidence-based screening and intervention tools. Implementing either of these two models of integrated service delivery may increase the availability of mental health care within the public health system. Providing mental health services within chronic disease care could benefit the health system by reducing the burden placed on these services by patients with poor responses to treatment, who often require more expensive and intensive treatments (10). Also, study participants in both intervention arms are likely to benefit from these mental health services, which may improve the quality of their own and their family's lives. Finally, the knowledge generated by this study will be of direct relevance to current efforts to reform the public health system in SA and many other LMICs where there is a focus on expanding access to mental health care. The WCDOH also is likely to benefit from this study. The WCDOH has prioritised the provision of mental health care to chronic disease patients in its service delivery plans. Should the study find that one model of integrated care is more cost-effective than another; the WCDOH is likely to adopt this model of care and conduct a wider, pragmatic evaluation of its effects on health service delivery. In addition, the WCDOH will use these findings to influence regional and national health policies and legislation, with a view to strengthening the provision of mental health care within SA's public health system. We will also try and influence international health guidelines through disseminating findings to our World Health Organisation contacts and other international networks. As such, results could have a far-reaching impact on public health for similar LMICs.
Publications
Bitew T
(2020)
Stakeholder perspectives on antenatal depression and the potential for psychological intervention in rural Ethiopia: a qualitative study.
in BMC pregnancy and childbirth
Bitew T
(2022)
Adapting an intervention of brief problem-solving therapy to improve the health of women with antenatal depressive symptoms in primary healthcare in rural Ethiopia.
in Pilot and feasibility studies
Bitew T
(2021)
Brief problem-solving therapy for antenatal depressive symptoms in primary care in rural Ethiopia: protocol for a randomised, controlled feasibility trial.
in Pilot and feasibility studies
Brooke-Sumner C
(2019)
'Doing more with less': a qualitative investigation of perceptions of South African health service managers on implementation of health innovations
in Health Policy and Planning
Jack H
(2019)
Mutual Capacity Building to Reduce the Behavioral Health Treatment Gap Globally
in Administration and Policy in Mental Health and Mental Health Services Research
Jacobs Y
(2021)
Task Sharing or Task Dumping: Counsellors Experiences of Delivering a Psychosocial Intervention for Mental Health Problems in South Africa.
in Community mental health journal
| Description | This award let to an indepth analysis of health system capacity to implement task-shared mental health counselling within chronic disease services offered on the primary care platform in the Western Cape, the design of two approaches to resourcing community health worker delivered counselling and the testing of these two approaches against treatment as usual in a cluster trial conducted at 24 facilities. 1. We discovered that there is system capacity, but preparedness to implement this new services varies from facility to facility as a function of leadership, resources, facility climate, and staff understanding and attitudes. Organisational interventions to build readiness for implementing mental health services are needed to support the introduction and sustained delivery of this new service. 2. We developed two approaches to delivering CHW counselling- as well as a training and supervision package. The training package can be brought to scale and should be accompanied by weekly supervision delivered by a registered psychological counsellor and monthly peer supervision. 3. CHWs trained and supported to deliver the intervention experience it as personally and professionally beneficial. They noted it helped them work more effectively with their current patients. They do however require more system-level support to enable them to deliver the service (notably reviewing the scope of their other work activities to ensure equitable distribution of tasks). 4. Key findings from the trial: We recruited 1340 participants of whom 804 were being treated for HIV and 622 were being treated for diabetes. Most of the sample (76%) were female. Among MIND participants, 83% scored above the CES-D scale's cut-off for depression and 49% scored above the AUDIT cut-off for hazardous/harmful alcohol use. We retained 87% of participants in the study at 12 month follow up. The psychological intervention significantly reduced depression scores, regardless of whether it was delivered by dedicated or designated CHWs. • Participants in both the dedicated counselling arm AND the designated counselling arm had significantly lower scores on the CES-D at the 12-month follow up compared to participants who received treatment as usual. Lower scores indicate fewer symptoms of depression. • On average, participants in the dedicated arm reduced their depression scores by 5.5 points (95% CI: -7.4; -3.7, p<0.001) more than those in treatment as usual (TAU). Participants in the designated arm reduced their CES-D scores by 6.5 points more than those in TAU (95% CI: -8.3; -4.7; p<0.001). • Participants in the dedicated and designated counselling arms had similar outcomes for depression. Our findings suggest that designated counsellors can provide psychological interventions just as effectively as dedicated counsellors, given appropriate training, supervision and support. The psychological intervention significantly reduced AUDIT scores if it was delivered by dedicated CHWs. • Only participants in the dedicated counselling arm had significantly lower scores on the AUDIT at the 12-month follow up compared to participants who received treatment as usual. Lower scores indicate less risk of hazardous/harmful drinking. • On average, participants in the dedicated arm reduced their AUDIT scores by 2 points more than those in TAU at the 12 month follow up (95% CI: -3.4; -0.1, p=0.038). • Participants in the designated and TAU groups had similar outcomes for alcohol consumption. • Our findings suggest that dedicated counsellors may be better placed to provide psychological interventions targeting alcohol reduction than designated counsellors. Participants may be less willing to engage with their usual care provider on alcohol issues, due to concerns about stigma. Summary • Our findings highlight the large unmet need for mental health interventions among patients presenting for chronic disease services. • Project MIND demonstrated that it is feasible to train CHWs to deliver structured psychological interventions effectively. • Our findings show that when CHWs are trained and supported to deliver evidence-based psychological interventions, these interventions can significantly reduce patients' mental health symptoms, and that the effects of these interventions can still be seen 12 months later. • We demonstrated that primary care facilities can utilise their existing human resources to deliver psychological interventions for depression but may need additional, dedicated CHWs to effectively reduce risk of alcohol harms. The cost effectiveness of these approaches is ongoing. |
| Exploitation Route | The intervention and training package is adaptable for a range of other conditions and contexts. It is being adapted for use in Ethiopia (for antenatal depression and IPV). We are in discussions with the Department of Health who are committed to including the MIND training package into their current training curricula and will be testing the scale up in rural health districts in 2021-2022.We have already trained 40 community health workers to deliver the intervention in one health district and are planning for training in a second district When the outcomes of the trial are finalised and published, we plan to package the training materials and intervention materials to make these publicly available for broader use (under a creative commons license). |
| Sectors | Healthcare |
| URL | http://projectmind.mrc.ac.za/resources.html |
| Description | We have used our findings to advocate the scaling up of community health worker delivered mental health counselling in primary care services in South Africa. THis has influenced/ resulted in commitment to 1) incorporate training in the MIND intervention package into standard training for community health workers provided by the Department of Health 2) expanding the scope of work of CHWs to include behavioural health care and 3) broader implementation of the MIND intervention package in rural health districts in the Western Cape province. In December 2021, we developed and finalised a training package (including manual) for the DoH based on the MIND trial and conducted training in the intervention with the first cohort of community health workers who are now using the intervention materials |
| First Year Of Impact | 2021 |
| Sector | Healthcare |
| Impact Types | Societal,Policy & public services |
| Description | Academy of Science of South Africa- panel on mental, neurological and substance use disorders |
| Geographic Reach | National |
| Policy Influence Type | Participation in a guidance/advisory committee |
| Description | Citation in systematic review of Programmes that bring mental health services to primary care populations in the international setting |
| Geographic Reach | Multiple continents/international |
| Policy Influence Type | Citation in systematic reviews |
| Impact | n/a |
| URL | https://www.tandfonline.com/doi/abs/10.1080/09540261.2018.1564648 |
| Description | Inputs into Provincial strategy to reduce the impact of alcohol on society |
| Geographic Reach | Local/Municipal/Regional |
| Policy Influence Type | Participation in a guidance/advisory committee |
| Description | Inputs into review of National Department of Health drug master plan |
| Geographic Reach | National |
| Policy Influence Type | Contribution to a national consultation/review |
| Description | Membership of Academy of Science of South Africa panel on developing core competencies for mental, neurological and substance use disorders |
| Geographic Reach | National |
| Policy Influence Type | Participation in a guidance/advisory committee |
| Description | Membership of Academy of Science of South Africa panel on developing core competencies for mental, neurological and substance use disorders (2016) |
| Geographic Reach | National |
| Policy Influence Type | Participation in a guidance/advisory committee |
| Description | Technical advice to UNODC/WHO joint initiative for substance use treatment system strengthening in LMICs |
| Geographic Reach | Multiple continents/international |
| Policy Influence Type | Participation in a guidance/advisory committee |
| Description | Training of community health workers in screening brief interventions and referral to treatment |
| Geographic Reach | National |
| Policy Influence Type | Influenced training of practitioners or researchers |
| URL | https://attcnetwork.org/centers/south-africa-hiv-attc/meet-south-africa-hiv-attc-team |
| Description | Joint Global Health Trials |
| Amount | £149,166 (GBP) |
| Funding ID | MR/R018464/1 |
| Organisation | Medical Research Council (MRC) |
| Sector | Public |
| Country | United Kingdom |
| Start | 08/2018 |
| End | 08/2020 |
| Description | MIND-ECON: The longer term, average & distributional effects of mental health interventions & the causal impact of mental illness on economic outcomes |
| Amount | £623,522 (GBP) |
| Funding ID | MR/S007946/1 |
| Organisation | Newton Fund |
| Sector | Public |
| Country | United Kingdom |
| Start | 03/2019 |
| End | 04/2022 |
| Description | South African Medical Research Council's Intramural career development award |
| Amount | R1,350,000 (ZAR) |
| Organisation | Medical Research Council of South Africa (MRC) |
| Sector | Public |
| Country | South Africa |
| Start | 01/2017 |
| End | 12/2020 |
| Title | Developed a short version of the organisational readiness to change questionnaire |
| Description | Developed a short version of the organisational readiness to change questionnaire (ORC-S) that can be used as part of a process to assess organisational readiness to implement new practices. Shorter versions of validated questionnaires can enhance the feasibility of their utilisation in busy health facilities. |
| Type Of Material | Physiological assessment or outcome measure |
| Year Produced | 2020 |
| Provided To Others? | Yes |
| Impact | No impacts as yet |
| Description | Collaboration with AMARI fellowship |
| Organisation | University of Cape Town |
| Department | Centre for Public Mental Health |
| Country | South Africa |
| Sector | Academic/University |
| PI Contribution | Directly through this grant, we have collaborated and contributed to the success of the African Mental Health Research (AMARI) initiative which seeks to develop postgraduate skills in mental health research in Africa. Several of the project MIND staff have been involved in the student selection process, have reviewed protocols and are acting as supervisors for students. project MIND is providing data for one Masters-level student (Yuche Jacobs) to use for his dissertation- he is being supervised by Prof Myers and Prof. Sorsdahl. The MIND counselling programme is also being adapted for use in Ethiopia- an AMARI postdoctoral fellow (Tesera Bitew) is adapting the intervention for perinatal mental health. He is being supervised by Prof Charlotte Hanlon, Prof Sorsdahl and Prof Myers. It has also been adapted for use in IPV settings in Ethiopia by Dr Rebecca Keynjed. |
| Collaborator Contribution | They are providing funding for students to work on project MIND. In so doing we have strengthened the counsellor supervision and assessments of treatment fidelity for the project MIND interventions. We are also generating useful detailed information on how much training and support it takes to develop core counselling competencies in community health workers who are tasked with delivering basic mental health counselling. This has provided funding for Tesera Bitew to adapt for the Ethiopian context which will enable us to extend the potential generalizability of the counselling programme through adapting it for another cultural context. |
| Impact | One student (Yuche Jacobs) funded and using MIND data for his thesis which has been published. Another postdoctoral fellow is adapting the intervention for the Ethiopian context. A key note address given at the AMARI Annual Scientific meeting in Malawi in 2018 by Prof Myers that relates to lessons learned from project MIND. Three papers have been published from the Ethiopian adaptations |
| Start Year | 2016 |
| Description | Collaboration with Academy of Science of South Africa (ASSAF) |
| Organisation | Academy of Science of South Africa |
| Country | South Africa |
| Sector | Academic/University |
| PI Contribution | As PI for project MIND, I am part of a panel of experts that is developing core competencies for providers of mental, neurological and substance use disorders in South Africa. I am contributing specifically to core competencies for nonspecialist nonprescribing providers, including all levels of community health workers, as utilized in project MIND. Using experiences and lessons from project MIND as well as other community-health worker delivered interventions, we are identifying gaps in knowledge, training needs and recommendations for developing this cadre of mental health providers. |
| Collaborator Contribution | ASSAf are providing all financial support for this initiative as well as science-writing support. They have funded a survey of mental health providers to assess needs and training gaps. |
| Impact | A final report is available at https://protect-za.mimecast.com/s/RTuRCJZKVAIBAD7xfVkNxg. Yes it is multidisciplinary and includes psychiatrists, psychologists, social workers, occupational therapists and nursing disciplines among other health professionals. |
| Start Year | 2015 |
| Description | Collaboration with the Industrial engineering department, University of Stellenbosch |
| Organisation | University of Stellenbosch |
| Country | South Africa |
| Sector | Academic/University |
| PI Contribution | Co-supervision of students developing a prototype for tools for trial planning and management, using project MIND to validate the tool. |
| Collaborator Contribution | Two industrial engineering students have used project MIND data and experiences to guide the development of a trial planning tool prototype and trial management tool prototype as part of their course work. One of the students won an interdepartmental award for his work and has been accepted into a postgraduate programme to further develop this work. We are consulting with potential funders to see whether we can refine the prototype and transform it into an open source app. |
| Impact | A prototype tool is available that will have potential to enhance trial planning and implementation. Yes, the collaboration is multidisciplinary -involves psychology, medicine and industrial engineers |
| Start Year | 2017 |
| Description | Collaboration with the South African Addiction Technology Transfer Centre (SA-ATTC) |
| Organisation | University of Cape Town |
| Department | Department of Psychiatry and Mental Health |
| Country | South Africa |
| Sector | Academic/University |
| PI Contribution | Provide training to HIV service providers in mental screening and the mental health counselling intervention used by project MIND. Providers need to complete the SA-ATTC training evaluation sheets. Prof Myers, Prof Sorsdahl ( co-I on MIND) and Prof Stein (co-I on MIND) are part of the SA-HIV ATTC team. In this role Prof Myers and Sorsdahl have provided training to health providers in screening and brief mental health interventions (used in MIND) for the ATTC and have also c-facilitated a national policy workshop for the National Department of Health where we provided inputs into the strategic policy framework that directly emanated from our experience of the MIND counselling intervention |
| Collaborator Contribution | The SA-ATTC helps fund the ongoing training of HIV service providers in project MIND interventions. The SA-ATTC has also committed to providing funding to the dissemination of findings through workshops and presentations to HIV providers across the 24 primary care sites in which the MIND team is working. |
| Impact | Training materials for screening and brief mental health interventions SBIRT policy framework for the National Department of Health |
| Start Year | 2017 |
| Title | Blended motivational interviewing and problem solving treatment for depression and problem alcohol use among patients with HIV or diabetes |
| Description | We have adapted a previously tested intervention for use in HIV and chronic disease services. The intervention is a three session intervention (with an additional booster session) and focuses on improving readiness for change and building problem solving skills to facilitate reductions in depression and alcohol use and adherence to treatment. The intervention has been adapted. The next stage is piloting the intervention in health care settings, prior to implementation in primary health care clinics. MRC-UK is the primary source of funding for this development. |
| Type | Therapeutic Intervention - Psychological/Behavioural |
| Current Stage Of Development | Early clinical assessment |
| Year Development Stage Completed | 2016 |
| Development Status | Under active development/distribution |
| Impact | Still under development |
| Title | Blended motivational interviewing and problem-solving therapy for common mental disorders: brief intervention |
| Description | We have adapted a previously tested intervention for use in HIV and chronic disease services. The intervention is a three session intervention (with an additional booster session) and focuses on improving readiness for change and building problem solving skills to facilitate reductions in depression and alcohol use and adherence to treatment. The intervention has been adapted for use in chronic disease services, patient handbooks to support implementation have been developed and the intervention has been piloted in primary health care clinics. We are now preparing for testing in a clinical trial. MRC-UK is the primary source of funding for this development. |
| Type | Therapeutic Intervention - Psychological/Behavioural |
| Current Stage Of Development | Late clinical evaluation |
| Year Development Stage Completed | 2016 |
| Development Status | Under active development/distribution |
| Impact | Impacts include a packaged intervention that can be task-shifted to lay counsellors to deliver to chronic disease patients. We have developed a patient handbook to support implementation that is useful as a treatment guide and reference for patients. The pilot test revealed significant reductions in alcohol use and symptoms of depression and psychological distress. Patients and providers reported high levels of acceptability and appropriateness. |
| Title | Trial planning and management tool |
| Description | Together with two Industrial Engineering students, developed a trial planning and management prototype (proof of concept) tool that can be used to help plan new trials in terms of resourcing and budget requirements and manage recruitment and retention of participants. This is a beta version and is not available in the public domain. In 2018 a student refined the tool to make it more dynamic and ready for changing it to an application that can be tested and used in practical trial settings. The tool was finalised in 2019 and is ready for implementation |
| Type Of Technology | Webtool/Application |
| Year Produced | 2018 |
| Impact | A collaboration with Industrial engineering and the development of a web based application of this prototype. This application is currently being licensed. |
| Description | A formal talk or presentation- Stakeholder advisory group meeting |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | Three stakeholder advisory group meetings are held per year. The project was discussed which sparked questions and discussion- increased awareness of mental health concerns among chronic disease patients and enhanced willingness to support and engage in mental health awareness raising activities. Group members made recommendations for better monitoring of counsellors, monitoring how much training is required to make lay counsellors proficient in skills set and enhanced enthusiasm for adopting the interventions |
| Year(s) Of Engagement Activity | 2016,2017,2018,2019,2020 |
| URL | http://projectmind.mrc.ac.za |
| Description | Acadamey of Science of South Africa and Leopoldina institute Mental Health symposium: GLOBAL MENTAL HEALTH IN AN ERA OF SUSTAINABLE DEVELOPMENT: RESEARCH AND POLICY PRIORITIES |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Policymakers/politicians |
| Results and Impact | Presented on lessons learned about implementing screening and brief counselling interventions for common mental disorders. The National Department of Health and provincial departments expressed interest in the presentation and asked for further information. |
| Year(s) Of Engagement Activity | 2019 |
| URL | http://research.assaf.org.za/bitstream/handle/20.500.11911/138/2020_assaf_global_mentalhealth_sympos... |
| Description | Academy of Science of South Africa task team |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | The purpose of this meeting is to develop core standards and competencies for people working in the field of mental, neurological and substance use disorders. The experiences of project MIND training of lay counsellors was shared and is contributing to the development of training materials and standards for this group of mental health worker. Experiences frm mIND-Y have also fed into this process |
| Year(s) Of Engagement Activity | 2016,2017,2018,2019 |
| Description | Academy of Science of South Africa task team |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Policymakers/politicians |
| Results and Impact | This panel is constituted to establish core competencies for the treatment of mental, neurological and substance use disorders. I have contributed training manuals for Project MIND counsellors. There has been discussion about the integration of care- outcome has been increased awareness of how the treatment for MNS disorders can be integrated into primary health care. |
| Year(s) Of Engagement Activity | 2015,2016 |
| Description | Engagement with Khayelitsha and Eastern subdistrict mental health forum |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Professional Practitioners |
| Results and Impact | We have participated in and presented at regular meetings of this mental health forum that includes representatives from various primary care clinics in the region as well as subdistrict mental health management teams. The outcome of this engagement has been high levels of support for project MIND in this subdistrict and commitment to future involvement in the project. |
| Year(s) Of Engagement Activity | 2015,2016 |
| Description | Evaluation of mini drug master plan for National Department of Health |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Policymakers/politicians |
| Results and Impact | Engaged with representatives from the National Department of Health's mental and substance abuse directorate during the course of evaluating their strategic plan for managing illicit drugs. As part of this plan, they hope to integrate brief interventions for alcohol into HIV and chronic disease care and were interested to hear about project MIND. There was a lot of debate about feasibility and they expressed interest in the findings of the study. |
| Year(s) Of Engagement Activity | 2015 |
| Description | Impact activities: training of rural health counsellors in the project mind model |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | Trained community health workers in the mind counselling programme. They are currently implementing this as part of routine practice |
| Year(s) Of Engagement Activity | 2021,2022 |
| Description | Integrating brief interventions into common mental disorders in primary care. South African Community Epidemiology Network On Drug Use meeting 19 October |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | The SACENDU network is the largest and longest established network of alcohol and drug practitioners, policymakers and researchers in South Africa. it meets biannually. We presented at the October meeting. There was a lot of enthusiasm for the phase one findings and excitement about the implications for Phase 2 and what this may mean for improved service delivery. |
| Year(s) Of Engagement Activity | 2016 |
| Description | Meeting with DG Murray Trust, a charitable organisation to discuss investment in brief mental health counselling |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Supporters |
| Results and Impact | In presentation we discussed investment in brief mental health counselling. The trust requested support for training of community workers in mental health screening and referral. At the end, they reported increased enthusiasm and understanding for brief mental health counselling |
| Year(s) Of Engagement Activity | 2017 |
| Description | Meeting with Kendall Bryant from NIAAA |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Supporters |
| Results and Impact | Dr Kendall Bryant from NIAAA visited the SAMRC where I met with him and presented on project MIND. We discussed methods for measuring changes in alcohol use among participants. He also visited some of the health facilities where pilot activities were occurring. |
| Year(s) Of Engagement Activity | 2016 |
| Description | Meetings with HIV/TB care |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Patients, carers and/or patient groups |
| Results and Impact | On a number of occasions, we have engaged with TB/HIV care, an NGO that provides patient care and support for HIV and TB, both within communities and the primary health care system. The purpose of these engagements was to garner support for project MIND and develop a referral pathway for HIV patients identified through the study requiring further care. The outcome of this meeting was commitment for further shared activities, including HIV adherence counsellors to be trained to deliver mental health care. |
| Year(s) Of Engagement Activity | 2015 |
| Description | Mental Health round table discussion: Western Cape Department of Health Provincial Research Day |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | Led a round table discussion on integrating mental health counselling into chronic disease care. This round table included presentations on the project, the experiences of training and supervising community health workers to deliver counselling and the experiences of working in low-resourced facilities including implementation issues that need to be considered for scale up. |
| Year(s) Of Engagement Activity | 2019 |
| Description | Oral presentation at the Kettill Bruun Society (KBS) meeting on alcohol- Ultrecht 2019 |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Postgraduate students |
| Results and Impact | Presented findings on factors associated with retention in alcohol reduction counselling during the Kettil Bruun society meeting- this led to increased awareness of the alcohol reduction counselling initiatives being implemented in South Africa and requests for further collaboration |
| Year(s) Of Engagement Activity | 2019 |
| URL | https://www.kbs2019utrecht.nl/ |
| Description | Presentation at Cape Mental Health society |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Patients, carers and/or patient groups |
| Results and Impact | Cape Mental Health is a patient advocacy agency for people with mental disorders. We engaged with them in order to obtain their support for the project MIND initiative and to learn about how we could build a system for linking patients identified in the primary health care system to ongoing care and support. As a reuslt of this meeting, the agency committed to supporting the project MIND initiative and to helping us link with patient advocacy groups to ensure that the voices of patients remained represented during this project. |
| Year(s) Of Engagement Activity | 2015 |
| Description | Presentation at Centre for Public Mental Health, University of Cape Town |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Postgraduate students |
| Results and Impact | Discussed challenges of implementing task-shifting approaches to mental health counselling in a low and middle income country setting. Audience reported greater awareness of challenges and possible solutions |
| Year(s) Of Engagement Activity | 2017 |
| Description | Presentation at Family physician forum |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | Presented an overview of project MIND to approximately 15 family physicians working across primary care services in the Western Cape. They were supportive of the initiative and acknowledged the need for better access to mental health services and committed to supporting the roll out of the initiative. |
| Year(s) Of Engagement Activity | 2015 |
| Description | Presentation at National Non-communicable disease symposium |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | Presented baseline findings from project MIND related to counselling needs, uptake and demand among patients with diabetes and other multimorbidity. There were several requests for additional information and discussions revealed opportunities for collaboration and potential roll out of the MIND approach. |
| Year(s) Of Engagement Activity | 2020 |
| URL | https://www.cebhc.co.za/research-key-outputs/ncd-research-symposium/ |
| Description | Presentation at rural district health management meeting |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | Presented an overview of project MIND to rural district managers (roughly 9 managers) and answered questions about potential coverage and long term sustainability. The attendees acknowledged that the initiative was important for addressing the mental health treatment gap in the region and made a commitment to being involved and supporting the implementation of the project. we were successful in influencing their decision to support the initiative. |
| Year(s) Of Engagement Activity | 2015 |
| Description | Presentation at the Health Systems Global Symposium October 2018 |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | One poster and one oral presentation at Health Systems Global on project MIND activities- presentations sparked questions and debate. Several people from the audience have followed up and requested additional information |
| Year(s) Of Engagement Activity | 2018 |
| Description | Presentation at the College of Problems on Drug Dependence June 2017 |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | About 100 people attended a talk on the project. this led to discussion after the presentation and sharing of research experiences and future opportunities for joint collaboration |
| Year(s) Of Engagement Activity | 2017 |
| Description | Presentation at the NIDA International Forum, June 2017 |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | About 200 people attended the talk which sparked discussion. Led to requests for more information |
| Year(s) Of Engagement Activity | 2017 |
| Description | Presentation at the Psychotherapy symposium for low and middle income countries October 2017 |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Presentation at psychotherapy symposium. Participants reported increased interest in mental health counselling delivered through a task shifting framework |
| Year(s) Of Engagement Activity | 2017 |
| Description | Presentation at workshop on best buys for addressing alcohol and HIV as Pre-AIDS Impact meeting (November 2017) |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Policymakers/politicians |
| Results and Impact | Presentation on brief interventions as a best buy for addressing alcohol among people with HIV. Presentation was well received and sparked much debate about how to implement these interventions. Influenced a document emerging from the meeting that summarized the best buys. |
| Year(s) Of Engagement Activity | 2017 |
| Description | Public Health Association of South Africa Conference |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | In August 2016, we attended and presented at PHASA congress. We presented two oral presentations on findings from our qualitative phase and findings from our pilot of the intervention. Both oral presentations were very well received and lead to questions and debate. It also led to expression of interest from other provinces in the MIND intervention and continued support for project-related activities. |
| Year(s) Of Engagement Activity | 2016 |
| URL | https://www.phasa.org.za/2016-phasa-conference/ |
| Description | Stakeholder Advisory Group meetings |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | Stakeholder advisory group meetings were held in which the study was presented to the audience. This sparked questions and discussion- according to participants there was increased interest in addressing mental health issues as part of chronic disease care and also external support and awareness of the project MIND initiative. |
| Year(s) Of Engagement Activity | 2015,2016 |
| Description | Subdistrict management meetings |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | We have presented at each of the health subdistrict management meetings in the province. The purpose of these presentation was to raise awareness of the initiative and get subdistrict management support for the initiative. We also developed written promotional materials we have distributed at these meetings. The outcome has been increased awareness of the initiative and managerial support for the rollout of our collaborative care models. |
| Year(s) Of Engagement Activity | 2015,2016 |
| Description | Training workshop on brief mental health interventions with Medecins San Frontiers |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | Discussed potential collaboration and supporting them in screening and conducting brief interventions for patients with drug resistant TB who have mental health concerns. A plan for future collaboration and access to MIND materials was developed |
| Year(s) Of Engagement Activity | 2018 |
| Description | US Substance Abuse and Mental Health Services Administration Meeting |
| Form Of Engagement Activity | Participation in an open day or visit at my research institution |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Third sector organisations |
| Results and Impact | SAMHSA was visiting South Africa to scope the range of work occurring in the substance abuse and mental health space, and identify gaps and opportunities. They were excited to hear about project MIND which they described as innovative. |
| Year(s) Of Engagement Activity | 2016 |
| Description | Visit to Diabetes South Africa, anon-profit organisation |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Patients, carers and/or patient groups |
| Results and Impact | We had two engagement activities with Diabetes South Africa. We formally presented to the management team i order to obtain support for the roll out of mental health services to patients receiving diabetes care. They committed to providing support and to act as a referral agency for patients requiring ongoing psychosocial support (they conduct psychosocial education and support groups in communities). We also hosted a diabetes awareness day, during which diabetes South Africa presented information on diabetes prevention and management and we presented on the importance of mental health for diabetes patients. This reached an audience of approximately 50 people. |
| Year(s) Of Engagement Activity | 2015 |
| Description | Western Cape Department of Health "health outcomes indaba". 11-13 October 2016 |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | We attended and presented on project MIND at a three day conference facilitated by the Western Cape Department of Health. There were delegates from non-profits, health facilities and students. The presentation was very well -received with several individuals discussing findings and future plans with me afterwards. interest was expressed in terms of participating in this initiative |
| Year(s) Of Engagement Activity | 2016 |
| URL | http://sharepoint.westerncape.gov.za/depts/doh/dhsp/hp/Health%20Outcomes%20Indaba/SitePages/Home.asp... |
| Description | Western Cape Department of Health Executive committee meeting |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | This was a high level meeting with key decision makers from the Western Cape Department of Health. At this meeting, findings from Phase one of the project were presented, plans for Phase 2 were presented, and we requested approval for these activities and feedback. At this meeting, some recommendations were made for enhancing Phase 2 plans and a formal decision was made to continue to actively support the project. |
| Year(s) Of Engagement Activity | 2016 |
| Description | Western Cape Department of Health chronic disease working group meeting |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | We attended and presented findings from phase one and plans for phase 2 at this meeting in September 2016. The main purpose was to prevent overlap with other activities and to identify facilities where it would be suitable to implement project MIND. The main outcomes were increased awareness and enthusiasm for project MIND. This led to an invitation to present at a provincial conference as well as decisions to support the roll out of project MIND. |
| Year(s) Of Engagement Activity | 2016 |
| Description | Western Cape Department of Health on working with community health workers |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Policymakers/politicians |
| Results and Impact | Invited to share lessons learned from working with CHWs, their training and supervision needs, from the experience of the MIND projects with the Department of Health who are reconfiguring their CHW programmes. The department is now considering scaling up our training and support programmes |
| Year(s) Of Engagement Activity | 2018,2019,2020 |
| Description | Western Cape Department of Health- Metro district management meeting |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | At this meeting in September 2016, we presented the outcomes from Phase one and plans for phase two which sparked questions and debate. Some recommendations for facilities that could participate in phase 2 were made as well as plans for strengthening Phase 2 plans. The main outcomes of this meeting were increased awareness of project MIND among managers at these facilities which led to them approving phase 2 plans and enthusiasm and support for the implementation of the project MIND intervention. |
| Year(s) Of Engagement Activity | 2016 |
| Description | presentation for the Western Cape Department of Health planning committee for lay counsellors |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Policymakers/politicians |
| Results and Impact | Presented "Using lay counsellors to deliver behaviour change counselling : Lessons from local research" to officials from the Western Cape Department of Health in a workshop consultation to outline principles for task sharing behavior change counselling to community health workers and lay counsellors. Findings guided the development of a lay counsellor policy framework. |
| Year(s) Of Engagement Activity | 2019,2020,2021 |
| Description | primary health care facilities (Western Cape) |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | We have presented orally at 22 primary care facilities (22 HIV teams and 22 diabetes care teams) and we have distributed written materials about the project and put up posters about project MIND in each of these facilities. Through these activities, we have spoken with 140 health care providers and 30 patients. These formal and informal discussions have increased awareness of the need for greater integration of mental health, HIV and chronic disease services and the facilities reported increased interest in participating in project MIND. More recently we have provided individual feedback to each facility that participated in the trial. |
| Year(s) Of Engagement Activity | 2015,2016,2019,2020 |
| Description | project MIND twitter account |
| Form Of Engagement Activity | Engagement focused website, blog or social media channel |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Public/other audiences |
| Results and Impact | Has sparked public awareness and interests and requests for more information |
| Year(s) Of Engagement Activity | 2018,2019,2020 |
| Description | project MIND website |
| Form Of Engagement Activity | Engagement focused website, blog or social media channel |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Public/other audiences |
| Results and Impact | We've developed an engagement website that includes links to all our activities and updates on project activities. |
| Year(s) Of Engagement Activity | 2017,2018,2019 |
| URL | http://projectmind.mrc.ac.za/index.html |
| Description | rural district health executive committee meeting |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | Presented an update of phase one activities to the Rural district health management meeting in May 2016. Also discussed plans for Phase 2 to identify suitable facilities and obtain support and buy-in for these activities. The main outcomes included confirmation of findings from Phase one (they validated them), identification of 9 facilities in which Phase 2 would occur and ongoing support and enthusiasm for project MIND related activities. This was also a good networking opportunity. At this meeting, a decision was made to continue to be involved and actively supporting the roll out of project MIND. |
| Year(s) Of Engagement Activity | 2016 |