Abstract
BackgroundThere is little practical guidance on how contextually relevant mental healthcare plans (MHCPs) can be developed in low-resource settings.AimsTo describe how theory of change (ToC) was used to plan the development and evaluation of MHCPs as part of the PRogramme for Improving Mental health carE (PRIME).MethodToC development occurred in three stages: (a) development of a cross-country ToC by 15 PRIME consortium members; (b) development of country-specific ToCs in 13 workshops with a median of 15 (interquartile range 13–22) stakeholders per workshop; and (c) review and refinement of the cross-country ToC by 18 PRIME consortium members.ResultsOne cross-country and five district ToCs were developed that outlined the steps required to improve outcomes for people with mental disorders in PRIME districts.ConclusionsToC is a valuable participatory method that can be used to develop MHCPs and plan their evaluation.
Highlights
There is little practical guidance on how contextually relevant mental healthcare plans (MHCPs) can be developed in lowresource settings
Using PRogramme for Improving Mental health carE (PRIME) as a case study, this article describes how theory of change (ToC) was used as a planning tool for the development and evaluation of the PRIME MHCPs and provides a framework that can be adapted for use in the development of MHCPs in low-resource settings
The first stage involved the development of an initial cross-country ToC at a workshop in India in November 2011, involving 15 key PRIME partners including psychiatrists, psychologists, epidemiologists, programme managers and at least two people who were experienced in mental health service delivery in each of the PRIME countries
Summary
The PRIME ToC process resulted in various outputs including six ToCs: one cross-country ToC and five district ToCs (Table 2). : getting political buy-in; mobilisation of programme resources; capacity building; identification of people with mental disorders; treatment and care; and long-term outcome and impact. The short-, medium- and long-term outcomes required to reach the impact are specified on the ToC map with the indicators for each outcome and how they will be measured described in Tables 3 and 4. The need for capacity building is identified by the PRIME ToC for service providers at three levels: specialist, primary healthcare and community. Environmental, policy, social and political context of the district is monitored for modification of implementation [q]
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