Barriers and drivers to capacity-building in global mental health projects

Abstract

Background The global shortage of mental health workers is a significant barrier to the implementation and scale-up of mental health services. Partially as a result of this shortage, approximately 85% of people with mental, neurological and substance-use disorders in low- and middle-income countries do not receive care. Consequently, developing and implementing scalable solutions for mental health capacity-building has been identified as a priority in global mental health. There remains limited evidence to inform best practices for capacity building in global mental health. As one in a series of four papers on factors affecting the implementation of mental health projects in low- and middle-income countries, this paper reflects on the experiences of global mental health grantees funded by Grand Challenges Canada, focusing on the barriers to and drivers of capacity-building. Methods Between June 2014 and May 2017, current or former Grand Challenges Canada Global Mental Health grantees were recruited using purposive sampling. N = 29 grantees participated in semi-structured qualitative interviews, representing projects in Central America and the Caribbean (n = 4), South America (n = 1), West Africa (n = 4), East Africa (n = 6), South Asia (n = 11) and Southeast Asia (n = 3). Based on the results of a quantitative analysis of project outcomes using a portfolio-level Theory of Change framework, six key themes were identified as important to implementation success. As part of a larger multi-method study, this paper utilized a framework analysis to explore the themes related to capacity-building. Results Study participants described barriers and facilitators to capacity building within three broad themes: (1) training, (2) supervision, and (3) quality assurance. Running throughout these thematic areas were the crosscutting themes of contextual understanding, human resources, and sustainability. Additionally, participants described approaches and mechanisms for successful capacity building. Conclusions This study demonstrates the importance of capacity building to global mental health research and implementation, its relationship to stakeholder engagement and service delivery, and the implications for funders, implementers, and researchers alike. Investment in formative research, contextual understanding, stakeholder engagement, policy influence, and integration into existing systems of education and service delivery is crucial for the success of capacity building efforts.

Barriers and drivers to service delivery in global mental health projects

“…The framework was populated separately and discussed, using an iterative process, to arrive at consensus about predominant themes. This paper presents findings for the Service Delivery cluster, with results from the other two clusters published elsewhere in this volume [13,14].…”

“…A major challenge in the implementation of mental health detection was the lack of appropriate human resources. As described further by Endale et al [13] in an accompanying paper, this was related to barriers in retaining providers, stigma associated with working in mental health services, and the absence of specialists needed to conduct diagnostic evaluations.…”

“…This paper describes results of a qualitative analysis of barriers and drivers to the implementation of service delivery in projects across GCC's GMH funding portfolio [13,14,15]. For the purpose of this study, "barriers" and "drivers" refer to key factors that either positively or negatively affected a project's ability to deliver an intervention as described in its initial funding proposal.…”

Barriers and drivers to stakeholder engagement in global mental health projects

“…This paper describes results of a qualitative analysis of barriers and drivers to stakeholder engagement in GMH as part of a multi-methods study examining barriers and drivers to implementation across a portfolio of GCC-funded projects [ 21 – 23 ]. Based on the results of a quantitative analysis of GCC-funded project outcomes using a portfolio-level Theory of Change framework [ 24 ], six key themes emerged as important to implementation success: (1) stakeholder engagement; (2) training providers; (3) supervision of providers; (4); detection of mental illness; (5) treatment of mental illness, and; (6) mental health promotion and awareness.…”

“…Each of three members of the study team (JM, OQ and TE) initially identified themes, and subsequently discussed and refined them until consensus was achieved. This paper presents findings for the stakeholder engagement cluster, with results from the other two clusters published as part of this series [ 22 , 23 ].…”