IntroductionEvidence-based low-intensity psychological interventions such as Problem Management Plus (PM+) have the potential to expand treatment access for depression and anxiety, yet these interventions are not yet effectively implemented in rural, public health systems in resource-limited settings. In 2017, Partners In Health adapted PM+ for delivery by primary care nurses in rural Rwanda and began integrating PM+ into health centres in collaboration with the Rwandan Ministry of Health, using established implementation strategies for mental health integration into primary care (Mentoring and Enhanced Supervision at Health Centers for Mental Health (MESH MH)). A gap in the evidence regarding whether low-intensity psychological interventions can be successfully integrated into real-world primary care settings and improve outcomes for common mental disorders remains. In this study, we will rigorously evaluate the delivery of PM+ by primary care nurses, supported by MESH MH, as it is scaled across one rural district in Rwanda.Methods and analysisWe will conduct a hybrid type 1 effectiveness-implementation study to test the clinical outcomes of routinely delivered PM+ and to describe the implementation of PM+ at health centres. To study the clinical effectiveness of PM+, we will use a pragmatic, randomised multiple baseline design to determine whether participants experience improvement in depression symptoms (measured by the Patient Health Questionnaire-9) and functioning (measured by the WHO-Disability Assessment Scale Brief 2.0) after receiving PM+. We will employ quantitative and qualitative methods to describe and evaluate PM+ implementation outcomes using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework, using routinely collected programme data and semistructured interviews.Ethics and disseminationThis evaluation was approved by the Rwanda National Ethics Committee (Protocol #196/RNEC/2019) and deemed exempt by the Harvard University Institutional Review Board. The results from this evaluation will be useful for health systems planners and policy-makers working to translate the evidence base for low-intensity psychological interventions into practice.
Introduction: Globally mental health disorders have become the leading cause of disability adjusted life where 183.9% millions of people are affected by mental health disorders and substance use. In Rwanda mental health disorder has increased and been classified among the top 10 causes of YLDs. To cope with it, since 2012 Partners In Health (PIH) in collaboration with Rwandan Ministry of Health implemented mentorship initiative namely MESH at Health Centers level in Burera District. The intervention started with pharmacotherapy and completed with Problem Management Plus in 2017 as all patients did not respond to it. However, there is no study done and published on knowledge, attitude and practice of PM+ since its implementation despite the increasing number of mental health disorders.Methods A cross-sectional study design with mixed approach was conducted in July 2022. The sample was 205 participants (HCPs) from Burera District health facilities. The interviews were conducted and structured questionnaires were filled for quantitative and an interview guide for qualitative approach to collect data before entering and analyzing data into SPSS. Descriptive statistics analysis was used to determine percentages and frequencies while multivariate seconded the bivariate regression analysis to determine the factors associated with PM + practices.Results the majority of respondents 118(60.5%) were females and their age is between 19 and 50, 136 (69.7%). Majority of them have bachelor’s degree 98(50.3%). (57.4%) of HCPs have low level of knowledge on PM + intervention, (48.2%) of them have negative attitudes and (82.1%) of HCPs have poor practices towards PM+. The male respondents were three times more likely to have good practice of PM + intervention compared to females (AOR = 3.277; 95% CI: [1.358–7.665], p = 0.008). The odds of practicing PM + intervention among respondents who did not know it than those who knew it were 1.771 times (AOR = 1.771; 95%CI: [0.534–5.872], p = 0.041). The odds of applying PM + were 12.749 times (AOR = 12.749; 95%CI: 0.751-216.377, p = 0.028) among HCPs who did not know how to use the screening tool compared to those who said that they knew how to use it.Conclusion The knowledge, attitudes and practices among HCPs have great impact on mental health project implementation and training of health care providers on PM + will be crucial.
Uganda attracts the highest number of migrants, refugees, and asylum-seekers in the East and Horn of Africa sub-region. Factors including an ‘open door’ policy, relative political stability, and a central geographical location have contributed to Uganda becoming an attractive hub for human rights defenders. The right to freedom of movement is enshrined in all significant human rights treaties and many regional and sub-regional economic treaties, including the one establishing the East African Community. However, in practice many exiled human rights defenders and refugees face various obstacles to move freely. This article explores the scope and meaning of freedom of movement into, within, and out of Uganda. Uganda remains one of, if not the most open country in the region for asylum-seekers, where everyone, including refugees and exiled human rights defenders, may move and settle wherever they choose. However, the majority of human rights defenders struggle to leave Uganda as they usually do not possess a national passport. While Convention Travel Documents, or refugee passports, are provided for under Ugandan and international refugee law, they are elusive in the refugee community and the majority of those interviewed face overwhelming challenges in obtaining one. This leaves many feeling hopeless and not in control of their own future or opportunities, as they are unable to travel within the East African Community, or beyond, for any reason. In particular, women human rights defenders and those who identified as, or advocated for the LGBTIQ (lesbian, gay, bisexual, transgender, intersex and queer) community, face compounded difficulties when moving within and out of Uganda, including arbitrary restrictions by authorities, violations by private actors, and protection concerns when moving.
The general objective was to examine the effect of project risk management on performance of construction of rehabilitation house construction in Kigali, Rwanda. The specific objectives were; to determine effect of project risk assessment, project risk base decision and project contingency decision on performance of commercial rehabilitation in Kigali. Working on that topic would provide a better way to large-scale construction projects. Other scholars who would be interested to work in the same field. The study used relevant theories such as risk management and risk assessment theories. This research used a descriptive study variables, indicators and measurement. A correlation study design was used to establish the association between variables and regression effect size for each specific objectives. The study targeted 180 staffs of Horizon Construction. A sample of 125 respondents determined using Yamane formula participated in the study process. The sample size was chosen using simple random and purposive sampling techniques. The study collected data using questionnaire and interview guide. The researcher study data using a computer based software known statistical product and service solutions to 26.0 to generate descriptive and inferential statistics. Qualitative data was analyzed using content analysis through themes and subthemes. Findings show that 57.3% show a disagreement with the analysis of risk was the focus at rehabilitation houses construction. Estimating risk given to respondents where 68.3% a positive agreement with the statement. Review technique was agreed by 85.5%. The study discovered that after having an interview with the rehabilitation houses construction. The study results show that 59.3 at a mean of 3.63 and standard deviation of 1.135 demonstrated an agreement that Horizon Construction applied managing change orders, 66.7% evidence that Horizon Construction has poorly written contact. Moreover, 63.4% accepted that the statement that Horizon Construction felt that all customers were given a time of allocation of decision and 65.4 agreed that the Horizon Construction prepared how they are managing decision with a mean of 4.18 and standard deviation of 1.14. Findings reiterate that 56.8% accepted that program management, 57.8% indicated that
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