At the launch of the Turning the World Upside Down website earlier this year Paul Farmer, from Harvard University, spoke of the ‘fetishisation of the quantifiable’ in global health. That is not to say the quantifiable outcomes are not important, but instead to highlight that there is a lot to learn from the experience of researchers, clinicians and policy makers beyond the measurable. This is a key motivation of PLOS Medicine’s Global Mental Health Practice series, which aims to emphasize the importance of “practice-based evidence,” by placing value on the experiences and impact of interventions in real-world settings as evidence for implementation.
In this week’s PLOS Medicine we publish a new case study, as part of the series, by Oye Gureje from the University of Ibadan, Nigeria and colleagues who describe their experience of contextualizing and adapting the World Health Organization’s Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) for Nigeria. The guide is designed to help scale up the coverage of mental health services in low resource settings by providing guidance for non-specialists to provide mental health services.
Given that the under-recognition of mental health conditions in the developing world has been widely noted, it is perhaps not surprising that the authors’ preliminary situational analysis of the mental health system in Osun State, Nigeria, which has a population of ~4 million people, revealed that mental health services were sparse. They found there was no budgetary allocation for mental health, mental health services were only available at the tertiary federal teaching hospitals and primary health care workers knew very little about mental health conditions. There is a clear need to expand mental health services in this setting.
Gureje and colleagues describe the multi-step process used to adapt the mhGAP-IG for the Nigerian context, which could be a valuable guide for other countries considering adapting the mhGAP-IG for their setting. The long term impact of the guide is still to be determined but the authors note, “[m]onitoring and evaluation mechanisms are also in place to review the implementation process of the mhGAP-IG over time. Only when this is done in a systematic manner will the overall effectiveness and impact of this process become clear.”
We continue to invite submissions to this series of Health in Action articles, which is guest edited by Drs. Vikram Patel, Rachel Jenkins, and Crick Lund. Details can be found in our 2012 “call for papers” editorial: Putting Evidence into Practice: The PLOS Medicine Series on Global Mental Health Practice.
The full list of case studies published thus far in the Series, which represents an extraordinary and global look at how mental health interventions are being implemented to improve the care, well-being, and human rights of individuals around the world, is here: