Browsing by Subject "Developing countries"

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    Implementation strategy in collaboration with people with lived experience of mental illness to reduce stigma among primary care providers in Nepal (RESHAPE): protocol for a type 3 hybrid implementation effectiveness cluster randomized controlled trial
    (2022-06-16) Kohrt, Brandon A; Turner, Elizabeth L; Gurung, Dristy; Wang, Xueqi; Neupane, Mani; Luitel, Nagendra P; Kartha, Muralikrishnan R; Poudyal, Anubhuti; Singh, Ritika; Rai, Sauharda; Baral, Phanindra P; McCutchan, Sabrina; Gronholm, Petra C; Hanlon, Charlotte; Lempp, Heidi; Lund, Crick; Thornicroft, Graham; Gautam, Kamal; Jordans, Mark J D
    Background There are increasing efforts for the integration of mental health services into primary care settings in low- and middle-income countries. However, commonly used approaches to train primary care providers (PCPs) may not achieve the expected outcomes for improved service delivery, as evidenced by low detection rates of mental illnesses after training. One contributor to this shortcoming is the stigma among PCPs. Implementation strategies for training PCPs that reduce stigma have the potential to improve the quality of services. Design In Nepal, a type 3 hybrid implementation-effectiveness cluster randomized controlled trial will evaluate the implementation-as-usual training for PCPs compared to an alternative implementation strategy to train PCPs, entitled Reducing Stigma among Healthcare Providers (RESHAPE). In implementation-as-usual, PCPs are trained on the World Health Organization Mental Health Gap Action Program Intervention Guide (mhGAP-IG) with trainings conducted by mental health specialists. In RESHAPE, mhGAP-IG training includes the added component of facilitation by people with lived experience of mental illness (PWLE) and their caregivers using PhotoVoice, as well as aspirational figures. The duration of PCP training is the same in both arms. Co-primary outcomes of the study are stigma among PCPs, as measured with the Social Distance Scale at 6 months post-training, and reach, a domain from the RE-AIM implementation science framework. Reach is operationalized as the accuracy of detection of mental illness in primary care facilities and will be determined by psychiatrists at 3 months after PCPs diagnose the patients. Stigma will be evaluated as a mediator of reach. Cost-effectiveness and other RE-AIM outcomes will be assessed. Twenty-four municipalities, the unit of clustering, will be randomized to either mhGAP-IG implementation-as-usual or RESHAPE arms, with approximately 76 health facilities and 216 PCPs divided equally between arms. An estimated 1100 patients will be enrolled for the evaluation of accurate diagnosis of depression, generalized anxiety disorder, psychosis, or alcohol use disorder. Masking will include PCPs, patients, and psychiatrists. Discussion This study will advance the knowledge of stigma reduction for training PCPs in partnership with PWLE. This collaborative approach to training has the potential to improve diagnostic competencies. If successful, this implementation strategy could be scaled up throughout low-resource settings to reduce the global treatment gap for mental illness. Trial registration ClinicalTrials.gov, NCT04282915 . Date of registration: February 25, 2020.
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    Maternal mental health in primary care in five low- and middle-income countries: a situational analysis
    (BioMed Central, 2016-02-16) Baron, Emily C; Hanlon, Charlotte; Mall, Sumaya; Honikman, Simone; Breuer, Erica; Kathree, Tasneem; Luitel, Nagendra P; Nakku, Juliet; Lund, Crick; Medhin, Girmay; Patel, Vikram; Petersen, Inge; Shrivastava, Sanjay; Tomlinson, Mark
    Background: The integration of maternal mental health into primary health care has been advocated to reduce the mental health treatment gap in low- and middle-income countries (LMICs). This study reports findings of a cross-country situation analysis on maternal mental health and services available in five LMICs, to inform the development of integrated maternal mental health services integrated into primary health care. Methods: The situation analysis was conducted in five districts in Ethiopia, India, Nepal, South Africa and Uganda, as part of the Programme for Improving Mental Health Care (PRIME). The analysis reports secondary data on the prevalence and impact of priority maternal mental disorders (perinatal depression, alcohol use disorders during pregnancy and puerperal psychosis), existing policies, plans and services for maternal mental health, and other relevant contextual factors, such as explanatory models for mental illness. Results: Limited data were available at the district level, although generalizable data from other sites was identified in most cases. Community and facility-based prevalences ranged widely across PRIME countries for perinatal depression (3–50 %) and alcohol consumption during pregnancy (5–51 %). Maternal mental health was included in mental health policies in South Africa, India and Ethiopia, and a mental health care plan was in the process of being implemented in South Africa. No district reported dedicated maternal mental health services, but referrals to specialised care in psychiatric units or general hospitals were possible. No information was available on coverage for maternal mental health care. Challenges to the provision of maternal mental health care included; limited evidence on feasible detection and treatment strategies for maternal mental disorders, lack of mental health specialists in the public health sector, lack of prescribing guidelines for pregnant and breastfeeding women, and stigmatising attitudes among primary health care staff and the community. Conclusions: It is difficult to anticipate demand for mental health care at district level in the five countries, given the lack of evidence on the prevalence and treatment coverage of women with maternal mental disorders. Limited evidence on effective psychosocial interventions was also noted, and must be addressed for mental health programmes, such as PRIME, to implement feasible and effective services.
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    Pension fund Investment and infrastructure development in Namibia
    (2020) Mingeli, Benedictus; Alhassan, Abdul Latif
    Developing countries, such as Namibia, need to bridge the existing infrastructure gap to improve the country's comparative advantage, economic growth and competitiveness, quality of life and the welfare of its citizens. As traditional sources of finance dwindle, Pension Fund savings need to be pooled to complement traditional sources of funding, such as government budgetary allocations, borrowing and user fees. Although infrastructure's economic and financial characteristics are a match to Pension Fund liabilities, Namibia's Pension Fund investment in infrastructure lags behind world-class benchmarks. This study investigated the factors that hinder Pension Fund investment in infrastructure in Namibia. The study employed a mixed-method research method and convergent parallel data collection processes. The study obtained a representative sample to participate in the survey from a population of NAMFISA registered Pension Fund and investment managers using a combination of the stratified random and simple random sampling techniques as part of primary data collection. The financial characteristics that make infrastructure assets attractive such as; long term, low sensitivity to economic swings, a low correlation with other assets and long term and inflation hedged returns makes them suitable for Pension Fund investments. The study confirms findings of previous studies by Beeferman, (2008); Ehlers, (2014); Inderst & Della Croce, (2013); Sy, (2017) and Thierie & Moor (2016), amongst others, revealed factors such as; a lack of a project pipeline, a lack of expertise by Pension Funds in infrastructure investments, Pension Fund regulation and a lack of financial instruments and assets that match Pension Funds are barriers to Pension Fund investment in infrastructure. The lack of a project pipeline is further attributable to issues such as infrastructure projects that are not sufficiently developed or viable on their own without some form of government support, inefficiencies in public procurement and public-private partnership policies and a lack of project preparation funding. The study recommends the following initiatives by policymakers and key stakeholders towards increasing Pension Fund investment in infrastructure: firstly, government and state-owned institutions responsible for public services should implement policies that will increase the pipeline of bankable and implementable projects. The National Development Plans (NDP5), the Harambee Prosperity plans and the Vision 2030 already identify projects; however, institutionstasked with infrastructure development need to develop implementation modelsthat are viable and bankable. The development plans need to be coordinated across the various levels iii of government and state-owned enterprises for effective implementation. Secondly, it is recommended that policymakers create the necessary conditions for Public Procurement and Public Private Partnership Policies to gain confidence amongst investors. Rooting out corruption and ensuring processes are transparent and fair to all stakeholders can have the effect of creating investor confidence in the two policies. The financial institutions, especially with a developmental angle, should support the public institutions with project preparation funding and technical assistance during project planning/development. Thirdly, the government, through the regulators, NAMFISA, are advised to continue with the implementation of policies aimed at increasing the limit on assets held with unlisted investment managers to allow increased Pension Fund investment in infrastructure without compromising the performance (return) and risk exposure. The financial regulators, NAMFISA and the Bank of Namibia should encourage the growth of the local financial sector to increase the quality and quantity of financial instruments available to investors and increase the depth of the financial sector to absorb local funding capacity. Lastly, the government is recommended to explore the options of partial listing infrastructure SOEs,such as NamPower, NamWater, Road Fund Administrator (RFA), NamPort, TransNamib, among others, to facilitate Pension Fund investment into infrastructure and reduce transaction cost and risks. The study identifies the need for future research opportunities with the aim of understanding issues that affect the project pipeline in the Namibian context in greater detail.
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    The (political) economics of antiretroviral treatment in developing countries
    (Elsevier, 2008) Nattrass, Nicoli
    Despite unprecedented international mobilisation to support universal provision of highly active antiretroviral therapy (HAART), national governments continue to play the key role in determining access to treatment. Whereas some AIDS-affected countries have performed as well as or better than expected given their level of development, institutional characteristics and demographic challenges (e.g. Thailand and Brazil), others (notably South Africa) have not. This article argues that the 'economics' of antiretroviral drug delivery is at heart a political-economy of access to treatment. It depends on commitment on the part of national governments to negotiate with pharmaceutical companies over patented antiretroviral drug prices, on their policy towards compulsory licensing, and on the approach they adopt to delivering HAART. Civil society has an important role to play in encouraging governments to become, and remain, committed to taking action to ensure sustainable and widespread access to HAART.
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    Psychological treatments for depression and anxiety disorders in low- and middle- income countries: a meta-analysis
    (2011) van't Hof, E; Stein, Dan J; Cuijpers, Pim; Waheed, W
    Objective: The objective of this meta-analysis was to determine the efficacy of psychological treatments for depression and anxiety disorders in low- and middle- income countries (LAMIC). Method: Meta-analysis of randomized controlled trials on psychological treatment of depression and anxiety disorders in low-and middle income countries using an existing database (www.evidencebasedpsychotherapies.org), PubMed, Embase, Psychinfo, Dissertation Abstracts International and the Cochrane Central Register of Controlled Trials were searched for studies published in all languages. Additional studies were identified from reference lists of found studies. Randomized controlled trials in which a psychological intervention for anxiety or depression was compared to a control condition (care-as-usual, waiting list, placebo, or another control group) were included. The randomized controlled trials needed to be conducted in a LAMI country (classification of LAMI countries according to the World Bank’s list of economies) to be eligible for inclusion in the meta-analysis. Psychological treatments were defined as interventions in which the core element of treatment consisted of verbal communication between a therapist and a patient. Results: Seventeen studies met our inclusion criteria, with a total of 3,010 participants. The mean standardized difference between the treatment and control groups at post-test was 1.02 (95% CI: 0.76~1.28) which corresponds well with the effects found in high-income countries. Conclusion: These results indicate that psychological treatments of depression and anxiety disorders are also effective in LAMI countries, and may encourage global dissemination of these interventions.
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    The rise of assertive community interventions in South Africa: a randomized control trial assessing the impact of a modified assertive intervention on readmission rates; a three year follow-up
    (2014-02-27) Botha, Ulla A; Koen, Liezl; Galal, Ushma; Jordaan, Esme; Niehaus, Daniel J
    Abstract Background Many countries have over the last few years incorporated mental health assertive interventions in an attempt to address the repercussions of deinstitutionalization. Recent publications have failed to duplicate the positive outcomes reported initially which has cast doubt on the future of these interventions. We previously reported on 29 patients from a developing country who completed 12 months in an assertive intervention which was a modified version of the international assertive community treatment model. We demonstrated reduction in readmission rates as well as improvements in social functioning compared to patients from the control group. The obvious question was, however, if these outcomes could be sustained for longer periods of time. This study aims to determine if modified assertive interventions in an under-resourced setting can successfully maintain reductions in hospitalizations. Methods Patients suffering from schizophrenia who met a modified version of Weidens’ high frequency criteria were randomized into two groups. One group received a modified assertive intervention based on the international assertive community treatment model. The other group received standard care according to the model of service delivery in this region. Data was collected after 36 months, comparing readmissions and days spent in hospital. Results The results demonstrated significant differences between the groups. Patients in the intervention group had significantly less readmissions (p = 0.007) and spent less days in hospital compared to the patients in the control group (p = 0.013). Conclusion Modified assertive interventions may be successful in reducing readmissions and days spent in hospital in developing countries where standard care services are less comprehensive. These interventions can be tailored in such a way to meet service needs and still remain affordable and feasible within the context of an under-resourced setting.