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Monitoring, Evaluation, Quality Improvement and Targeted Research to Support Site Goals

Elements of monitoring, evaluation, quality improvement, and research cut across every phase of the implementation matrix and value chain. This component offers guidance and useful insights for data collection for mental health programming and how to use this data to improve program processes. Below is a Monitoring and Evaluation  (M&E) Process Map that outlines how site teams have used M&E techniques throughout implementation of mental health programming.

Mental Health Monitoring and Evaluation Process Map

assess
1. Assess

Assess existing MH data collection processes and tools

define
2. Define

Define the population, indicators, targets, and analysis plan, including how results will be communicated with stakeholders

design
3. Designe & Set Up

Create a template or database for data collection, determine a plan for data collection, including a plan to supervise and train people using the data system

implement
4. Implement

Train providers and data clerks, pilot data collection, and revise processes if needed for quality improvement

evaluation
5. Evaluate & Follow Up

Measure indicators against targets, conduct data quality checks, implement quality improvement projects, and disseminate results

Key Performance Indicators

This component suggests useful indicators for integrated mental health program planning and assessing the quality of mental health care. The indicators highlighted here can assist implementers to assess mental health burdens during pre-implementation or monitor the impact of mental health programs or quality improvement projects.

Sample indicators

Routine Health Information Systems

Determining essential data collection tools is a core component of M&E strategies. Below are examples of tools and forms PIH mental health teams use.  

Mental Health Mastercards

The “Mastercard” approach has been designed and utilized by the Malawi Ministry of Health – NCD Unit,  APZU, PIH Sierra Leone and PIH Liberia. This concise form provides a more consolidated approach for clinics looking to establish routine data collection for each visit.

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Mental Health Registers

Daily registration of patient visits is a critical first step in monitoring patient volume and demographics and in understanding what types of treatments are provided at health facilities and communities. Below is a sample register from Sierra Leone's outpatient mental health clinic. 

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Electronic Information Systems

The establishment of Electronic Medical Records Systems (EMRs) and digital technologies can improve the data collection capacity and its value in applications to patient care, M&E, and research. OpenMRS is a collaborative open-source project to develop software to support the delivery of health care in developing countries and is used across PIH care delivery sites.
 

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Quality Improvement

Quality improvement is a structured approach to evaluating the performance of systems and processes, and then determining needed improvements in both functional and operational areas. Mental health teams across care delivery sites have used quality improvement methods to improve mental health care delivery systems. Teams have done quality improvement projects focused on increasing case detection and referral of people with mental health conditions, decreasing lost to follow-up rates for patients in outpatient mental health clinics and reducing the need for referrals to the national psychiatric referral hospitals.  

Below are quality improvement training materials and resources to help implementers assess program gaps or challenges and track QI projects. 

PIH Resources 

Global Resources

 

Targeted Research

Haiti

Providing targeted research support to answer critical questions related to locally determined service delivery goals is a core pillar of PIH’s Cross-Site Mental Health Program. We have aligned mental health service delivery, training and research, and optimizing academic opportunities with partner institutions. A primary example is the Harvard University Global Health Delivery Partnership, linked through the Program in Global Mental Health and Social Change at Harvard Medical School (HMS) and now through GlobalMentalHealth@Harvard. The linkage of high-quality services for the poor with an academic mission is what makes PIH unique.

PIH Research Articles

Adapting Problem Management Plus for Implementation

Problem Management Plus (PM+) is a low-intensity psychological intervention that can be delivered by non-specialists to address common mental health conditions. This paper describes the process of contextually adapting PM+ for implementation in Rwanda, Peru, Mexico, and Malawi undertaken by PIH. 

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Development of a Comprehensive, Sustained Community Mental Health System in Haiti

Between 2010 and 2019 PIH and its sister organization Zanmi Lasante (ZL) mounted a long-term response to the 2010 Haiti earthquake, focused on mental health. Over that time, the organization successfully developed a comprehensive, sustained community mental health system in Haiti’s Central Plateau and Artibonite departments.

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Outcomes of a Primary Care Mental Health Implementation Program in Rural Rwanda

To address the know-do gap in the integration of mental health care into primary care in resource-limited settings, a multi-faceted implementation program initially designed to integrate HIV/AIDS care into primary care was adapted for severe mental disorders and epilepsy in Burera District, Rwanda.

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