Esponda G Miguel, Ryan G K, Estrin G Lockwood, Usmani S, Lee L, Murphy J, Qureshi O, Endale T, Regan M, Eaton J, De Silva M
Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, Camberwell, London, SE5 8AB, UK.
ESRC Centre for Society and Mental Health, King's College London, London, UK.
Int J Ment Health Syst. 2021 Feb 27;15(1):18. doi: 10.1186/s13033-021-00442-6.
Given the underinvestment in global mental health to-date, it is important to consider how best to maximize the impact of existing investments. Theory of Change (ToC) is increasingly attracting the interest of funders seeking to evaluate their own impact. This is one of four papers investigating Grand Challenges Canada's (GCC's) first global mental health research funding portfolio (2012-2016) using a ToC-driven approach.
A portfolio-level ToC map was developed through a collaborative process involving GCC grantees and other key stakeholders. Proposed ToC indicators were harmonised with GCC's pre-existing Results-based Management and Accountability Framework to produce a "Core Metrics Framework" of 23 indicators linked to 17 outcomes of the ToC map. For each indicator relevant to their project, the grantee was asked to set a target prior to the start of implementation, then report results at six-month intervals. We used the latest available dataset from all 56 projects in GCC's global mental health funding portfolio to produce a descriptive analysis of projects' characteristics and outcomes related to delivery.
12,999 people were trained to provide services, the majority of whom were lay or other non-specialist health workers. Most projects exceeded their training targets for capacity-building, except for those training lay health workers. Of the 321,933 people screened by GCC-funded projects, 162,915 received treatment. Most projects focused on more than one disorder and exceeded all their targets for screening, diagnosis and treatment. Fewer people than intended were screened for common mental disorders and epilepsy (60% and 54%, respectively), but many more were diagnosed and treated than originally proposed (148% and 174%, respectively). In contrast, the three projects that focused on perinatal depression exceeded screening and diagnosis targets, but only treated 43% of their intended target.
Under- or over-achievement of targets may reflect operational challenges such as high staff turnover, or challenges in setting appropriate targets, for example due to insufficient epidemiological evidence. Differences in delivery outcomes when disaggregated by disorder suggest that these challenges are not universal. We caution implementers, funders and evaluators from taking a one-size-fits all approach and make several recommendations for how to facilitate more in-depth, multi-method evaluation of impact using portfolio-level ToC.
鉴于迄今为止全球精神卫生领域投资不足，考虑如何最大限度地提高现有投资的影响力至关重要。变革理论（ToC）越来越吸引寻求评估自身影响力的资助者的关注。本文是采用ToC驱动方法对加拿大全球挑战组织（GCC）首个全球精神卫生研究资助项目组合（2012 - 2016年）进行调查的四篇论文之一。
通过一个涉及GCC受资助者和其他关键利益相关者的协作过程，制定了一个项目组合层面的ToC地图。将拟议的ToC指标与GCC预先存在的基于结果的管理和问责框架进行协调，以生成一个由23个指标组成的“核心指标框架”，这些指标与ToC地图的17个成果相关联。对于与其项目相关的每个指标，要求受资助者在实施开始前设定一个目标，然后每六个月报告一次结果。我们使用了GCC全球精神卫生资助项目组合中所有56个项目的最新可用数据集，对项目的特征以及与交付相关的成果进行了描述性分析。
共有12,999人接受了服务提供培训，其中大多数是外行人或其他非专业卫生工作者。除了培训外行人卫生工作者的项目外，大多数项目在能力建设方面超过了培训目标。在GCC资助项目筛查的321,933人中，有162,915人接受了治疗。大多数项目关注不止一种疾病，并且在筛查、诊断和治疗方面均超过了所有目标。对常见精神障碍和癫痫进行筛查的人数低于预期（分别为60%和54%），但被诊断和治疗的人数比最初提议的要多得多（分别为148%和174%）。相比之下，专注于围产期抑郁症的三个项目超过了筛查和诊断目标，但仅治疗了其预期目标的43%。
目标的未达成或超额达成可能反映了诸如员工流动率高之类的运营挑战，或者设定适当目标方面的挑战，例如由于流行病学证据不足。按疾病分类时交付成果的差异表明这些挑战并非普遍存在。我们提醒实施者、资助者和评估者不要采取一刀切的方法，并就如何利用项目组合层面的ToC促进对影响力进行更深入、多方法的评估提出了若干建议。
