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. 2018 Oct 15:12:57.
doi: 10.1186/s13033-018-0234-y. eCollection 2018.

A step-wise community engagement and capacity building model prior to implementation of mhGAP-IG in a low- and middle-income country: a case study of Makueni County, Kenya

Victoria N Mutiso  1 , Isaiah Gitonga  1 , Abednego Musau  1 , Christine W Musyimi  1 , Eric Nandoya  1 , Tahilia J Rebello  2 , Kathleen M Pike  2 , David M Ndetei  1   3
Affiliations

A step-wise community engagement and capacity building model prior to implementation of mhGAP-IG in a low- and middle-income country: a case study of Makueni County, Kenya

Victoria N Mutiso et al. Int J Ment Health Syst. .

Abstract

Background: The World Health Organization developed the Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) as guidelines for innovative utilization of available resources in low- and middle-income countries (LMICs) in order to accelerate the reduction of the mental health treatment gap. The mhGAP-IG calls for each country to contextualize the guide to their social, cultural and economic context. The objective of this paper is to describe a model for a stepwise approach for implementation of mhGAP-IG in a rural Kenyan setting using existing formal and informal community resources and health systems.

Methods: We conducted an analysis of mental health services in Makueni County, one of the 47 counties in Kenya, in order to understand the existing gaps and opportunities in a low-resource setting. We conducted stakeholder analysis and engagement through interactive dialogue in order for them to appreciate the importance of mental health to their communities. Through the process of participatory Theory of Change, the stakeholders gave their input on the process between the initiation and the end of the process for community mental health development, with the aim of achieving buy-in and collective ownership of the whole process. We adapted the mhGAP-IG to the local context and trained local human resources in skills necessary for the implementation of mhGAP-IG and for monitoring and evaluating the process using instruments with good psychometric properties that have been used in LMICs.

Results: We were able to demonstrate the feasibility of implementing the mhGAP-IG using existing and trained community human resources using a multi-stakeholder approach. We further demonstrated the feasibility to transit seamlessly from research to policy and practice uptake using our approach.

Conclusions: An inclusive model for low resource settings is feasible and has the potential to bridge the gap between research, policy and practice. A major limitation of our study is that we did not engage a health economist from the beginning in order to determine the cost-effectiveness of our proposed model, occasioned by lack of resources to hire a suitable one.

Keywords: Community; Implementation; Kenya; Mental health; Stakeholders; mhGAP-IG.

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Figures

Fig. 1
Fig. 1
It demonstrates the location of Makueni County in relation to the capital city of Nairobi and the rest of the counties. It also demonstrates the size and the administrative regions of Makueni County
Fig. 2
Fig. 2
It is the Theory of Change (ToC) developed through interactive multi-stakeholder participation. It is a summary of the activities and building blocks that link existing health system and resources and how to harness them towards a functional and integrated community mental health program that results in communities accessing mental health services
See this image and copyright information in PMC

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