Abstract
BackgroundThere has been a growing global movement championed by the World Health Organization (WHO) to integrate mental health into primary health care as the most effective way of reducing the mental health treatment gap. This study aimed to investigate the impact of WHO Mental Health Gap Action Programme (mhGAP) training and supervision on primary health workers’ knowledge, confidence, attitudes and detection rate of major mental disorders in Mulanje, Malawi.MethodThe study used a quasi-experimental method (single cohort pre- and post-measures) with an interrupted time-series design. A 2 day mhGAP training was delivered to 43 primary healthcare workers (PHWs) working in 18 primary care clinics serving the entire population of Mulanje, Malawi (population 684,107). Modules covered were psychosis, moderate-severe depression, and alcohol & substance use disorders. The PHWs completed pre and post-tests to assess knowledge, confidence and attitudes. Number of diagnosed cases was obtained from clinic registers for 5 months prior to and 7 months following training. Data was analyzed using mean scores, t-test, one-way analysis of variance and linear regression.ResultsThe mean knowledge score increased significantly from 11.8 (SD: 0.33) before training to 15.1 (SD: 0.38) immediately after training; t (42) = 7.79, p < 0.01. Similarly, mean knowledge score was significantly higher 6 months post training at 13.9 (SD: 2.52) compared to before; t (42) = 4.57, p < 0.01. The mean confidence score also increased significantly from 39.9 (SD: 7.68) before training to 49.6 (SD: 06.14) immediately after training; t (84) = 8.43, p < 0.01. It was also significantly higher 6 months post training 46.8, (SD: 6.03) compared to before; t (84) = 6.60, p < 0.01. One-way analysis of variance showed no significant difference in mean scores on all four components of the scale used to measure attitudes. A significant positive change in the trend in mental health service utilization after the intervention was demonstrated using a segmented linear regression (β = 2.43 (95% CI 1.02; 3.83) as compared to before (β = − 0.22 (95% CI − 2.67; 2.23) and immediately after (β = 1.63 (95% CI − 7.31; 10.57).ConclusionThe findings of this study add to the growing evidence for policy makers of the effectiveness of mhGAP training and supervision in a resource-constrained country.
Highlights
There has been a growing global movement championed by the World Health Organization (WHO) to integrate mental health into primary health care as the most effective way of reducing the mental health treatment gap
The findings of this study add to the growing evidence for policy makers of the effectiveness of Mental Health Gap Action Programme (mhGAP) training and supervision in a resource-constrained country
The current study evaluates a mhGAP training and supervision programme by assessing knowledge, attitudes, confidence, and number of new mental health cases detected by primary healthcare worker (PHW) in Mulanje district, Malawi
Summary
There has been a growing global movement championed by the World Health Organization (WHO) to integrate mental health into primary health care as the most effective way of reducing the mental health treatment gap. The treatment gap for mental and substance use disorders in Africa and other low-income countries (LICs) is between 70 and 90% [1]. This is despite growing evidence that it is possible to provide cost effective interventions for many mental disorders in low-income settings [2]. One of the reasons for the high treatment gap in LICs is the lack of human resources for mental health. According to the World Health Organization’s Mental Health Atlas 2017, there are 11.9 psychiatrists per 100,000 population in high-income countries (HICs) compared to less than 0.1 per 100,000 population in LICs countries [3]. Task-shifting to non-specialists is one of the potential solutions to overcome this human resource problem [4]
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