Ahuja S, Mirzoev T, Lund C, Ofori-Atta A, Skeen S, Kufuor A
Public Health Foundation of India, New Delhi, India.
Nuffield Centre for International Health and Development, University of Leeds, UK.
Glob Ment Health (Camb). 2016 Apr 8;3:e11. doi: 10.1017/gmh.2016.3. eCollection 2016.
Strengthening of mental health information systems (MHIS) is essential to monitor and evaluate mental health services in low and middle-income countries. While research exists assessing wider health management information systems, there is limited published evidence exploring the design and implementation of MHIS in these settings. This paper aims to identify and assess the key factors affecting the design and implementation of MHIS, as perceived by the key stakeholders in Ghana and South Africa.
We report findings from the Mental Health and Poverty Project, a 5-year research programme implemented within four African countries. The MHIS strengthening in South Africa and Ghana included two related components: intervention and research. The intervention component aimed to strengthen MHIS in the two countries, and the research component aimed to document interventions in each country, including the key influences. Data were collected using semi structured interviews with key stakeholders and reviews of key documents and secondary data from the improved MHIS. We analyzed the qualitative data using a framework approach.
Key components of the MHIS intervention involved the introduction of a redesigned patient registration form, entry into computers for analysis every 2 months by clinical managerial staff, and utilization of data in hospital management meetings in three psychiatric hospitals in Ghana; and the introduction of a new set of mental health indicators and related forms and tally sheets at primary care clinics and district hospitals in five districts in the KwaZulu-Natal and Northern Cape provinces in South Africa. Overall, the key stakeholders perceived the MHIS strengthening as an effective intervention in both countries with an enhanced set of indicators in South Africa and introduction of a computerized system in Ghana.
Influences on the design and implementation of MHIS interventions in Ghana and South Africa relate to resources, working approaches (including degree of consultations during the design stage and communication during implementation stage) and the low priority of mental health. Although the influencing factors represent similar categories, more influences were identified on MHIS implementation, compared with the design stage. Different influences appear to be related within, and across, the MHIS design and implementation and may reinforce or negate each other thus leading to the multiplier or minimization effects. The wider context, similar to other studies, is important in ensuring the success of such interventions.
Future MHIS strengthening interventions can consider three policy implications which emerged from our analysis and experience: enhancing consultations during the intervention design, better consideration of implementation challenges during design, and better recognition of relations between different influences.
加强心理健康信息系统（MHIS）对于监测和评估低收入和中等收入国家的心理健康服务至关重要。虽然已有研究评估更广泛的卫生管理信息系统，但在这些环境中探索MHIS设计和实施的已发表证据有限。本文旨在确定和评估加纳和南非关键利益相关者所认为的影响MHIS设计和实施的关键因素。
我们报告了心理健康与贫困项目的研究结果，该项目是在四个非洲国家实施的为期5年的研究计划。在南非和加纳加强MHIS包括两个相关组成部分：干预和研究。干预部分旨在加强两国的MHIS，研究部分旨在记录每个国家的干预措施，包括关键影响因素。通过与关键利益相关者进行半结构化访谈以及审查关键文件和来自改进后的MHIS的二手数据来收集数据。我们使用框架方法分析定性数据。
MHIS干预的关键组成部分包括在加纳的三家精神病医院引入重新设计的患者登记表，临床管理人员每两个月将其录入计算机进行分析，并在医院管理会议中使用数据；在南非夸祖鲁 - 纳塔尔省和北开普省五个地区的基层医疗诊所和地区医院引入一套新的心理健康指标以及相关表格和计数表。总体而言，关键利益相关者认为加强MHIS在两国都是有效的干预措施，在南非有一套增强的指标，在加纳引入了计算机化系统。
对加纳和南非MHIS干预设计和实施的影响涉及资源、工作方法（包括设计阶段的协商程度和实施阶段的沟通）以及心理健康的低优先级。虽然影响因素属于相似类别，但与设计阶段相比，在MHIS实施方面发现了更多影响因素。不同的影响似乎在MHIS设计和实施内部以及之间相互关联，可能相互加强或抵消，从而导致乘数效应或最小化效应。与其他研究类似，更广泛的背景对于确保此类干预措施的成功很重要。
未来加强MHIS的干预措施可以考虑我们的分析和经验中出现的三个政策含义：在干预设计期间加强协商，在设计期间更好地考虑实施挑战，以及更好地认识不同影响之间的关系。
