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Key influences in the design and implementation of mental health information systems in Ghana and South Africa

  • S. Ahuja (a1), T. Mirzoev (a2), C. Lund (a3), A. Ofori-Atta (a4), S. Skeen (a3) and A. Kufuor (a4)...

Abstract

Introduction

Strengthening of mental health information systems (MHIS) is essential to monitor and evaluate mental health services in low and middle-income countries. While research exists assessing wider health management information systems, there is limited published evidence exploring the design and implementation of MHIS in these settings. This paper aims to identify and assess the key factors affecting the design and implementation of MHIS, as perceived by the key stakeholders in Ghana and South Africa.

Methods

We report findings from the Mental Health and Poverty Project, a 5-year research programme implemented within four African countries. The MHIS strengthening in South Africa and Ghana included two related components: intervention and research. The intervention component aimed to strengthen MHIS in the two countries, and the research component aimed to document interventions in each country, including the key influences. Data were collected using semi structured interviews with key stakeholders and reviews of key documents and secondary data from the improved MHIS. We analyzed the qualitative data using a framework approach.

Results

Key components of the MHIS intervention involved the introduction of a redesigned patient registration form, entry into computers for analysis every 2 months by clinical managerial staff, and utilization of data in hospital management meetings in three psychiatric hospitals in Ghana; and the introduction of a new set of mental health indicators and related forms and tally sheets at primary care clinics and district hospitals in five districts in the KwaZulu-Natal and Northern Cape provinces in South Africa. Overall, the key stakeholders perceived the MHIS strengthening as an effective intervention in both countries with an enhanced set of indicators in South Africa and introduction of a computerized system in Ghana.

Discussion

Influences on the design and implementation of MHIS interventions in Ghana and South Africa relate to resources, working approaches (including degree of consultations during the design stage and communication during implementation stage) and the low priority of mental health. Although the influencing factors represent similar categories, more influences were identified on MHIS implementation, compared with the design stage. Different influences appear to be related within, and across, the MHIS design and implementation and may reinforce or negate each other thus leading to the multiplier or minimization effects. The wider context, similar to other studies, is important in ensuring the success of such interventions.

Conclusion

Future MHIS strengthening interventions can consider three policy implications which emerged from our analysis and experience: enhancing consultations during the intervention design, better consideration of implementation challenges during design, and better recognition of relations between different influences.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

*Address for correspondence: S. Ahuja, Public Health Foundation of India, New Delhi, India. (Email: shalini.ahuja@phfi.org)

References

Hide All
AbouZahr, C, Boerma, T (2005). Health information systems: the foundations of public health. Bulletin of the World Health Organization 83, 578583.
Bird, P, Omar, M, Doku, V, Lund, C, Nsereko, JR, Mwanza, J (2011). Increasing the priority of mental health in Africa: findings from qualitative research in Ghana, South Africa, Uganda and Zambia. Health Policy and Planning 26, 357365.
Bloom, D, Cafiero, ET, Jané-Llopis, E, Abrahams-Gessel, S, Bloom, LR, Fathima, S, Feigl, AB, Gaziano, T, Mowafi, M, Pandya, A, Prettner, K, Rosenberg, L, Seligman, B, Stein, AZ, Weinstein, C (2012). “The Global Economic Burden of Non communicable Diseases,” PGDA Working Papers 8712, Program on the Global Demography of Aging.
Brender, J, de Keizer, N, Nykänen, P, Rigby, M, Ammenwerth, E (2013). STARE-HI – statement on reporting of evaluation studies in health informatics. Explanation and elaboration. Applied Clinical Informatics 4, 331358.
Chaulagai, CN, Moyo, C, Koot, J, Moyo, H, Sambakunsi, T, Khunga, F, Naphini, P (2005). Design and implementation of a health management information system in Malawi: issues, innovations and results. Health Policy and Planning 20, 375384.
Doku, V, Ofori-Atta, A, Akpalu, B, Read, U, Osei, A, Ae-Ngibise, K, Awenva, D, Lund, C, Flisher, AJ, Petersen, I, Bhana, A, Bird, P, Drew, N, Faydi, E, Funk, M, Green, A, Omar, M (2008). The Mental Health and Poverty Project: Phase 1. Country Report: A Situation Analysis of Mental Health Policy Development and Implementation in Ghana. p. 345.
Flisher, AJ, Lund, C, Funk, M, Banda, M, Bhana, A, Doku, V, Drew, N, Kigozi, FN, Knapp, M, Omar, M, Petersen, I, Green, A (2007). Mental health policy development and implementation in four African countries. Journal of Health Psychology 12, 505516.
Garrib, A, Stoops, N, McKenzie, A, Dlamini, L, Govender, T, Rohde, J (2008). An evaluation of the district health information system in rural South Africa. South African Medical Journal 98, 549552.
Gladwin, J, Dixon, RA, Wilson, TD (2003). Implementing a new health management information system in Uganda. Health Policy and Planning 18, 214224.
Health Metrics Network (2008). Framework and Standards for Country Health Information Systems. 2nd edn. Health Metrics Network, World Health Organization: Geneva.
Henderson, L, Tulloch, J (2008). Incentives for retaining and motivating health workers in Pacific and Asian countries. Human Resources for Health 6, 18.
Krishnan, A, Nongkynrih, B, Yadav, K, Singh, S, Gupta, V (2010). Evaluation of computerized health management information system for primary health care in rural India. BMC Health Services Research 10, 310.
LaFond, A, Brown, L, Macintyre, K (2002). Mapping capacity in the health sector: a conceptual framework. International Journal of Health Planning and Management 17, 322.
Lund, C, Kleintjes, S, Campbell-Hall, V, Mjadu, S, Petersen, I, Bhana, A, Kakuma, R, Mlanjeni, B, Bird, P, Drew, N, Faydi, E, Funk, M, Green, A, Omar, M, Flisher, AJ (2008). Mental Health Policy Development and Implementation in South Africa: a Situation Analysis. Phase 1 Country Report. Mental Health and Poverty Project: Cape Town, South Africa.
Lund, C, Kleintjes, S, Kakuma, R, Flisher, AJ (2009) Public sector mental health systems in South Africa: inter-provincial comparisons and policy implications. Social Psychiatry and Psychiatric Epidemiology 45, 393404.
Lund, C, Flisher, AJ (2003). Community/hospital indicators in South African public sector mental health services. Journal of Mental Health Policy and Economics 6, 181187.
MHaPP (2010). Mental Health Information System Pilot Project Report: KwaZulu-Natal. Mental Health and Poverty Project. University of Cape Town: Cape Town, South Africa.
MHaPP (2010 a). Mental health policy development and implementation in four African countries. Final Report. MHaPP Research Programme Consortium: Cape Town.
Miles, M, Huberman, M (1994). Qualitative Data Analysis: A Sourcebook of New Methods, 2nd edn. Sage Publications: Beverly Hills, CA.
Mirzoev, T, Omar, M, Green, A, Bird, P, Lund, C, Ofori-Atta, A, Doku, V (2012). Research-policy partnerships – experiences of the mental health and poverty project in Ghana, South Africa, Uganda and Zambia. Health Research Policy and Systems 10, 30.
Murray, CJ et al. (2012). Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the global burden of disease study 2010. Lancet 380, 21972223.
Nykänen, P, Brender, J, Talmonc, J, Keizer, N, Rigbye, M, Beuscart-Zephir, MC, Ammenwerth, E (2011). Guideline for good evaluation practice in health informatics (GEP-HI). International Journal of Medical Informatics 80, 815827.
Odhiambo-Otieno, GW (2005). Evaluation criteria for district health management information systems: lessons from the Ministry of Health, Kenya. International Journal of Medical Informatics 74, 3138.
Ofori-Atta, A, Mirzoev, T, Mensah-Kufuor, A, Osei, A, Dzadey, A, Armah-Aloo, K, Atweam, KD (2012). Experience of strengthening the mental health information system in Ghana's three psychiatric hospitals. reader in psychiatry. In Changing Trends in Mental Health Care and Research in Ghana (ed. Ofori-Atta, A. and Ohene, S.), p. 22. University of Ghana 60th Anniversary Series: Accra, Ghana, 22.
Ofori-Atta, A, Read, UM, Lund, C (2010). A situation analysis of mental health services and legislation in Ghana: challenges for transformation. African Journal of Psychiatry 13, 99108.
Omar, MA, Green, AT, Bird, PK, Mirzoev, T, Flisher, AJ, Kigozi, F, Lund, C, Mwanza, J, Ofori-Atta, AL (2010). Mental health policy process: a comparative study of Ghana, South Africa, Uganda and Zambia. International Journal of Mental Health Systems 4, 24.
Ritchie, J, Spencer, L (1994). Qualitative data analysis for applied policy research. In Analyzing Qualitative Data (ed. Bryman, A. and Burgess, R.), p. 9. Routledge: New York, 9.
Smith, M, Shirin, M, Adebusoye, A, Mwele, LM, Edwin, M (2008). Integrating health information system in Tanzania: experience and challenges. Electronic Journal of Information System in Developing Countries 33, 121.
Trafton, JA, Greenberg, G, Harris, AH, Tavakoli, S, Kearney, L, McCarthy, J, Blow, F, Hoff, R, Schohn, M (2013). VHA mental health information system: applying health information technology to monitor and facilitate implementation of VHA Uniform Mental Health Services Handbook requirements. Medical Care 51(3 Suppl. 1), S29S36.
WHO (2004). Developing Health Management Information Systems. A Practical Guide For Developing Countries. World Health Organization. Regional Office for the Western Pacific: Manila, Philippines.
WHO (2005). Mental Health Policy and Service Guidance Package. Mental Health Information Systems. World Health Organisation: Geneva.
WHO (2010). Mental Health and Development: Targeting People with Mental Health Conditions as a Vulnerable Group. World Health Organization: Geneva.

Keywords

Key influences in the design and implementation of mental health information systems in Ghana and South Africa

  • S. Ahuja (a1), T. Mirzoev (a2), C. Lund (a3), A. Ofori-Atta (a4), S. Skeen (a3) and A. Kufuor (a4)...

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