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Evaluation of performance and perceived utility of mental health care indicators in routine health information systems in five low- and middle-income countries

Research output: Contribution to journalArticle

Mark Joris Jordans, Maya Hazel Semrau, Dan Chisholm, Dristy Gurung, Jibril Abdumalik, Shalini Ahuja, James Mugisha, Ntokozo Mntambo, Fred Kigozi, Inge Petersen, Rahul Shidhaye, Nawaraj Upadhyaya, Christopher Alan Lund, Graham John Thornicroft, Oye Gureje

Original languageEnglish
JournalBJPsych Open
Publication statusAccepted/In press - 2019

King's Authors


Background: In most low- and middle-income countries (LMIC), routine mental health information is unavailable or unreliable, making monitoring of mental health care coverage difficult. This study aims to evaluate a new set of mental health indicators introduced in primary health care settings in five LMIC.

Method: A survey was conducted among primary health care workers (n=272) to assess acceptability and feasibility of eight new indicators monitoring mental health care needs, utilization, quality and payments. Also, primary health facility case records (n=583) were reviewed by trained research assistants to assess the level of completion (yes/no) for each of the indicators and subsequently the level correctness of completion (correct/incorrect – with incorrect defined as illogical, missing, illegible information) of the indicators used by health workers. Assessments were conducted within one month after the introduction of the indicators, as well as 6-9 months afterwards.

Results: Across both time points and across all indicators 78% of the measurements of completion were correct. Among the best performing indicators (diagnosis, severity and treatment), this was significantly higher. With regards to correctness, 87% of all completed indicators were correctly completed. There was a trend towards improvement over time. Health workers’ perceptions on feasibility and utility, across sites and over time, reported a positive attitude in 81% of all measurements.

Conclusion: This study demonstrates high levels of performance and perceived utility for a set of indicators designed that can ultimately be used to monitor coverage of mental health care in primary health care settings in LMIC. We recommend for these indicators to be incorporated into existing health information systems; and adopted within the WHO Mental Health Gap Action Programme (mhGAP) implementation strategy

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