The Emerald Project

Health systems the world over are facing ever greater demands and challenges. The health systems of low- and middle-income countries (LAMICs) are particularly strained due to the lower availability of resources and the higher overall burden of disease in these populations (compared to high-income countries).

Many LAMICs are facing an epidemiological transition or 'double burden' of disease, as declining, but still disconcertingly high, levels of mortality due to communicable, maternal, perinatal and nutritional conditions are being replaced or matched by increasing rates of chronic non-communicable disease, including mental disorders.

Health systems in LAMICs are currently failing to meet the mental health needs of the populations they seek to serve. Starting from the premise that there can be 'no health without mental health' , a health system cannot be considered to be functioning properly if it is unable to protect and take care of the basic health rights and needs of the sick and the vulnerable – including the mentally ill.

In the large majority of LAMICs, resources and services for mental health are extremely meagre, with low-income countries allocating 0.5% and lower-middle income countries 1.9% of their health budget to the treatment and prevention of these disorders, even though they represent over 10% of the overall disease burden. In low-income countries, there is on average only one psychiatrist per 1.7 million people and one psychiatric inpatient bed per 42,000 people. The result of this is a substantial treatment gap.

A large multicountry survey supported by WHO showed that 76–85% of people with severe mental disorders in low-income countries did not receive any treatment in the previous year, often with devastating consequences. The knowledge base for what to do about the escalating burden of mental disorders is now largely in place. Landmark developments include:

  • the World Health Report in 2001
  • Lancet series on mental health in 2007 and 2011
  • the establishment of a Global Movement for Mental Health
  • the development of WHO's mhGAP programme for scaling up services for mental disorders
  • the Grand Challenges in Global Mental Health review
  • the establishment of ‘Collaborative Hubs for International Research in Mental Health’ by the National Institute of Mental Health (NIMH)
  • the WHO Executive Board resolution in 2012 addressing the global burden of mental disorders as well as
  • the on-going PRogramme for Improving MEntal health care (PRIME)

What is still missing is how to translate this knowledge into practice. It is these health system issues which the Emerald Project addresses.

Specifically, the EmeraldProject aims to identify key health system barriers to, and solutions for, the scaled-up delivery of mental health services in LAMICs, and by doing so improve mental health outcomes in a fair and efficient way. It does so by pursuing the following objectives:

Objective 1: Adequate, fair and sustainable resourcing (health system inputs): To identify health system resources, financing mechanisms and information needed to scale-up mental health services and move towards universal coverage.

Objective 2: Integrated service provision (health system processes): To evaluate the context, process, experience and health system implications of mental health service implementation.

Objective 3: Improved coverage and goal attainment (health system outputs): To develop, use and monitor indicators of mental health service coverage and system performance.

Underlying all of these health system objectives, there is a further fundamental need: To enhance local capacities and skills to plan, implement, evaluate and sustain system improvements. The Emerald Project is committed to taking the mental health system strengthening steps necessary to address these objectives in Ethiopia, India, Nepal, Nigeria, South Africa and Uganda through a consortium of 12 partners in Africa, Asia and Europe.

Emerald work packages and their interrelations

To facilitate the organisation and management, Emerald is structured in six work packages (WPs), which together comprise the project. Each WP has an academic lead who is responsible for the management and the results of their WP.

The figure below shows the structure of the different WPs and their interdependencies.

By clicking on the different WPs you can find out more about their tasks and objectives.

Work packages

emerald_workpackage Project Management and Co-ordination Capacity building in health systems research Adequtae, fair and sustainable resourcing for mental health (health system inputs) Integrated provision of mental health services (health system processes) Improved coverage and goal attainment in mental health (health system outputs) Dissemination