Identifying the health systems changes necessary to sustain and scale up the integration of mental health services into primary care in Lagos, Nigeria

问题说明：尽管心理健康问题负担巨大，但撒哈拉以南非洲（SSA）约85%的严重精神疾病患者没有接受任何形式的治疗。将精神卫生服务纳入初级卫生保健被认为是缩小这一治疗差距的最可行手段。干预措施的制定、功效测试和实施的线性模式导致了随着时间的推移和在真实的世界环境中的可持续性问题。由于制定没有可持续性和扩大规模的有效卫生方案会产生政策和道德影响，因此需要了解影响循证干预措施可持续性和扩大规模的因素和过程，以便进行积极规划。这项可行性研究旨在确定战略，以促进卫生系统的必要变革，以维持和扩大初级保健中的精神卫生服务，尼日利亚的拉各斯。项目要解决的具体问题1）MeHPriC项目的实施情况如何，目前实施的基础因素是什么？2)方案的不同组成部分在背景（内部和外部）、执行进程、执行行为者和干预产出和成果方面有哪些动态互动？3)这些组成部分如何影响方案的可持续性;以及4）可能需要哪些战略来促进可持续性和扩大规模所需的变化。1.在第一阶段，我们将审查政策文件，并与选定的政策制定者进行深入访谈，以制定假设，评估项目的目标指标是否达到，确定如何达到，确定关键的背景促进因素和限制因素以及它们影响结果的方式。2.在第二阶段，我们将在包括决策者和行政人员、方案管理人员、初级保健保健工作者和护理接受者在内的利益攸关方中进行定量调查。他们将完成量表，以评估组织准备改变，可持续性和感知干预的可接受性和可行性3。在第三阶段，我们将对实施情况进行简要评估，并通过深入访谈，研究利益攸关方对卫生系统在提供、扩大和维持干预措施方面的制约因素的看法。我们还将观察选定的初级保健设施，使我们能够了解的因素，作为促进者或障碍，以维持干预交付。4.在第四阶段，我们将举办一个变革理论研讨会，主要利用早期阶段的分析结果，结合科学知识和方案经验，确定卫生系统的变革，以提高干预措施的可持续性。在第5阶段，我们将分析并向资助者和利益相关者提交项目报告。个别护理接受者将受益于持续水平的循证干预措施，导致更好的结果和改善生活质量。2.这项研究将提高卫生工作者的知识，动机和态度，以可持续的方式提供有效的心理健康干预。3.方案执行者将能够确定并将可持续性组成部分纳入其复杂干预措施的设计和执行。4.本研究中产生的证据将与世卫组织团队分享，为中低收入国家心理健康干预措施的可持续性和可扩展性提供潜在战略信息。5.该项目将使决策者了解维持有益干预的方法，从而最大限度地明智地使用资金

STATEMENT OF THE PROBLEM: Despite the huge burden of mental health problems, about 85% of people with severe mental illness in sub-Saharan Africa (SSA) do not receive any form of treatment. Integrating mental health services into primary health care (PHC) has been advocated as the most viable means of closing this treatment gap. The linear model of intervention development, efficacy testing and implementation led to problems with sustainability over time and in real world setting. As there are policy and ethical implications of developing effective heath programmes without sustainability and scale-up, an understanding of the factors and processes that influences sustainability and scale up of an evidence-based intervention is needed for proactive planning OVERALL AIM: This feasibility study aims to identify the strategies to facilitate the health system changes necessary to sustain and scale up mental health services in primary care in Lagos, Nigeria. SPECIFIC QUESTIONS TO BE ADRESSED BY THE PROJECT 1) what is the state of implementation of the MeHPriC Project and what are the factors that are currently underlying its implementation?; 2) What are the dynamic interactions between the different components of the programme as regards contexts (inner and outer), implementation processes, implementation actors and intervention outputs and outcomes?; 3) How do these components influence the sustainability of the programme; and 4) What strategies may be required to facilitate the changes necessary for sustainability and scale-upMETHODOLOGY There are 5 phases of the study. 1. In Phase 1, We will review policy documents and conduct in-depth interviews with selected policy makers to develop hypotheses, assess whether the target indicators for the project are met, identify how they are met, identify the key contextual facilitators and constraints and the way they affect the outcome. 2. In Phase 2, we will conduct a quantitative survey amongst the stakeholders including policy makers and administrators, programme managers, PHC health workers and recipients of care. They will complete scales to assess organisational readiness to change, sustainability and perceived intervention acceptability and feasibility 3. In Phase 3, we will conduct a brief evaluation of the implementation and through in-depth interviews, we will examine the stakeholders' perception about the health systems constraints to delivering, scaling up and sustaining the intervention. We will also observe selected PHC facilities to enable us to understand the factors that act as facilitators or barriers to sustenance of the intervention delivery. 4. In Phase 4, we will conduct a Theory of Change (ToC) workshop that will draw mainly on the results from the analysis of the earlier phases in combination with scientific knowledge and programme experience to identify health system changes that will improve sustainability in the delivery of the intervention.5. In Phase 5, we will analysis and present the project report to the funders and the stakeholders RESEARCH IMPACT:1. The individual care recipients will benefit from sustained level of evidence-based interventions leading to better outcomes and improved quality of life. 2. This study will enhance the health workers knowledge, motivation and attitude in providing effective mental health interventions in a sustainable way. 3. The programme implementers will be able to identify and include sustainability components to their design and implementation of complex interventions. 4. Evidence generated in this study will be shared with the WHO team to inform potential strategies for a sustainability and scalability of mental health interventions in LMICs. 5. The project will inform Policy makers on methods of sustaining beneficial interventions thereby maximizing the judicious use of funds