WP05 - Improved coverage and goal attainment in mental health (health system outputs)


This work package aims to identify, develop and test the utility of indicators that help to monitor the output of the mental health service. The subsequent integration into routine use, of such assessment tools and procedures should provide objective evaluation of improved coverage and rate of goal attainment in mental health care:

  • Conduct a review of existing information systems to identify current gaps and strengths (Task 1)
  • Develop reliable indicators that measure improvement in mental health service coverage and performance and are applicable across participating countries (Task 2)
  • Ensure that consortium members consistently use reliable and appropriate indicators to assess mental health coverage and service performance (Task 3)
  • Conduct routine monitoring and evaluation of the performance of the indicators for their identified uses and develop a process for the revision and modification of indicators to meet the objectives of user friendliness, appropriateness, and applicability (Task 4)
Nepal: TPO Nepal's children program
Nepal: TPO Nepal's children program, Copyright: TPO Nepal

Work package Description

The current state of mental health services in both developed and developing countries indicate that a significant proportion of individuals do not receive adequate care and treatment for mental health conditions. These raise a number of important policy issues:

  1. Coverage: What proportion of the population that requires mental health services gain access to adequate care and treatment? How equitable is the mental health system in ensuring that vulnerable populations gain access to services?
  2. Performance: How are the available mental health resources in each participating country optimally utilized? What is the level of responsiveness of the service to population need? What is the quality of the mental health services provided?
  3. Information: What is the profile of the extant information and reporting system for mental health service in the participating countries? Are there uniform indicators that can be utilized for comparisons of mental health systems within and across countries? What is the right mix of indicators for each country setting that meets its specific health system setup, including its human, technical and administrative resources? 

Work Package 5 sets out to address these health systems evaluation and monitoring questions through the identification and development of an acceptable, comparable and fit-for-use set of performance indicators. Specific highlights include:

  1. Efficiency: We appreciate that the provision of health services is an expensive undertaking. We would therefore be focusing on the generation and use of evidence in resource-constrained settings to monitor the extent to which scarce resources are being put to the best possible use. This should help to identify the best mix of actions that address population health needs within available resources.
  2. Performance evaluation: Performance assessment requires valid, reliable and comparable data which can only be obtained through a robust health information system. The overall aim of a health information system is to monitor and improve the effectiveness, efficiency and equity of health services by enabling managers and service providers to make more informed decisions for improving access to and quality of care. We propose to develop a set of indicators that allow for better estimation of the treatment gap within a specific setting, and which will assist in monitoring the scaling up of care and the reduction of the treatment gap. We will follow the steps outlined by the WHO in the development of a Mental Health Information System by (i) conducting an assessment about what information is needed and what information is already available in consortium countries (ii) identifying the essential MHIS sub-systems and indicators, which include mapping the information flow, capacity building and piloting, and (iii) evaluating the MHIS, including comparisons with baseline. Evaluation will include a number of criteria, including validity, reliability, feasibility, cost, relevance, specificity, sensitivity, data capture, and simplicity of administration
  3. Indicators: Following successful mapping of the existing information system in member countries and the recognition of the information gaps, we will identify, develop and introduce reliable indicators that are acceptable across member countries. This will entail a systematic literature review of existing indicators and a selection of the best fit-for-purpose set of indicators that will be uniformly acceptable and useful across participating countries. They may require adaptation and modifications, in consultation with other member countries.
  4. Effective coverage: This concept refers to the use of an intervention conditional on someone needing it and adjusted for the quality of the intervention delivered. In this workpackage, we shall use reliable and valid indicators, to test the concept of effective coverage in the context of scaled-up mental health care in the participating countries. Our program of work will provide us with the information required to develop and test this concept since we will have data on utilisation, need, as well as quality of services. By developing and empirically testing this concept in low- and middle-income country settings, we will be making an important contribution to the evaluation of health systems not only in the countries of our work and in the field of mental health, but providing potentially useful methodology for similar work in other country settings as well as in other areas of health.