SAIA-Mental Health: Systematically improving the mental health treatment cascade 

HAI is adapting and implementing the evidence-based Systems Analysis and Improvement Approach (SAIA) to improve screening and treatment for common mental health disorders in Central Mozambique.

Mental disorders are the leading cause of disability in Mozambique, yet only 7.2% of health facilities offer mental health services.  In Beira, Central Mozambique’s largest provincial capital (population: 530,000+), only 1% of depressive symptoms are detected in outpatient settings, and primary care facilities have few procedures in place to screen for mental health symptoms.

In the SAIA-Mental Health project, HAI is working with the Sofala Provincial Health System to adapt the SAIA toolkit  to improve screening and treatment for Mozambicans suffering from depression, epilepsy, and schizophrenia among other common mental health conditions.  The Systems Analysis and Improvement Approach (SAIA) is an evidence-based multi-step implementation strategy that systematically identifies barriers and facility-level solutions to health care delivery and patient flow using a systems engineering approach.  Health providers use an adapted mental health cascade analysis tool (MHCAT) to identify patient retention stress points and then develop workflow modifications (micro-interventions) in response. 

As part of the SAIA-Mental Health project, HAI worked in partnership with Mozambique’s Ministry of Health to enhance patient data collection tools and provide support to providers in the use of data to support mental health diagnosis and treatment.


Health providers use the SAIA toolkit to identify and test micro-interventions that respond to the unique challenges faced at their own facilities:

“We are thinking about developing a support group for patients with Epilepsy. We wanted to do it but we haven’t been able to […] because it has been difficult to get the group together because their consult dates are different. Our idea was to schedule their appointments at the same time so we can develop the group and start having the activity regularly.”

– Psychologist, Munhava

The study found that after just six months of implementing such micro-interventions, along with the rest of the SAIA toolkit, function improvement among patients increased from 4.2% to 13.1%.  And, the odds of a patient returning on time and adherent to prescribed medicines increased by a factor of 1.53 when exposed to a health facility implementing SAIA-MH.

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[2019-2024] Systems Analysis and Improvement to Optimize the Hypertension Diagnosis and Care Cascade for HIV-infected Individuals (SAIA-HTN).

This project receives funding support from the National Heart, Lung, and Blood Institute of the National Institutes of Health under award number R01HL142412, via a subagreement from the University of Washington.

[2012-2015] Systems Analysis and Improvement to Optimize pMTCT: A Cluster Randomized Trial.

This project received funding support from the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under award number R01HD075057, via a subagreement from the University of Washington.


For additional SAIA project funding information, visit the SAIA main page.


Explore how SAIA is transforming service delivery




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