Alonge Olakunle, Chiumento Anna, Hamoda Hesham M, Gaber Eman, Huma Zill-E-, Abbasinejad Maryam, Hosny Walaa, Shakiba Alia, Minhas Ayesha, Saeed Khalid, Wissow Lawrence, Rahman Atif
Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, E8140, Baltimore, MD 21205, USA.
Department of Psychological Sciences, Institute of Population Health Sciences, The University of Liverpool, Block B, Waterhouse Buildings, 1-5 Brownlow Street, Liverpool L69 3GL, UK.
Health Policy Plan. 2020 Nov 1;35(Supplement_2):ii112-ii123. doi: 10.1093/heapol/czaa124.
Globally there is a substantial burden of mental health problems among children and adolescents. Task-shifting/task-sharing mental health services to non-specialists, e.g. teachers in school settings, provide a unique opportunity for the implementation of mental health interventions at scale in low- and middle-income countries (LMICs). There is scant information to guide the large-scale implementation of school-based mental health programme in LMICs. This article describes pathways for large-scale implementation of a School Mental Health Program (SMHP) in the Eastern Mediterranean Region (EMR). A collaborative learning group (CLG) comprising stakeholders involved in implementing the SMHP including policymakers, programme managers and researchers from EMR countries was established. Participants in the CLG applied the theory of change (ToC) methodology to identify sets of preconditions, assumptions and hypothesized pathways for improving the mental health outcomes of school-aged children in public schools through implementation of the SMHP. The proposed pathways were then validated through multiple regional and national ToC workshops held between January 2017 and September 2019, as the SMHP was being rolled out in three EMR countries: Egypt, Pakistan and Iran. Preconditions, strategies and programmatic/contextual adaptations that apply across these three countries were drawn from qualitative narrative summaries of programme implementation processes and facilitated discussions during biannual CLG meetings. The ToC for large-scale implementation of the SMHP in the EMR suggests that identifying national champions, formulating dedicated cross-sectoral (including the health and education sector) implementation teams, sustained policy advocacy and stakeholders engagement across multiple levels, and effective co-ordination among education and health systems especially at the local level are among the critical factors for large-scale programme implementation. The pathways described in this paper are useful for facilitating effective implementation of the SMHP at scale and provide a theory-based framework for evaluating the SMHP and similar programmes in the EMR and other LMICs.
全球范围内，儿童和青少年面临着沉重的心理健康问题负担。将心理健康服务任务转移/分担给非专业人员，例如学校环境中的教师，为在低收入和中等收入国家（LMICs）大规模实施心理健康干预措施提供了独特机会。在低收入和中等收入国家，几乎没有信息可指导大规模实施基于学校的心理健康项目。本文描述了在地中海东部地区（EMR）大规模实施学校心理健康项目（SMHP）的途径。成立了一个协作学习小组（CLG），其成员包括参与实施SMHP的利益相关者，如来自EMR国家的政策制定者、项目管理人员和研究人员。CLG的参与者应用变革理论（ToC）方法，确定通过实施SMHP改善公立学校学龄儿童心理健康结果的一系列先决条件、假设和假定途径。随着SMHP在埃及、巴基斯坦和伊朗这三个EMR国家逐步推行，在2017年1月至2019年9月期间通过多次区域和国家ToC研讨会对所提出的途径进行了验证。这三个国家通用的先决条件、策略以及项目/背景适应性调整是从项目实施过程的定性叙述性总结以及CLG半年一次会议期间的促进讨论中得出的。EMR地区大规模实施SMHP的ToC表明，确定国家倡导者、组建专门的跨部门（包括卫生和教育部门）实施团队、持续进行政策宣传以及各级利益相关者的参与，以及教育和卫生系统之间尤其是地方层面的有效协调，是大规模项目实施的关键因素。本文所述途径有助于大规模有效实施SMHP，并为评估EMR地区及其他低收入和中等收入国家的SMHP及类似项目提供了一个基于理论的框架。
