HAI and our partners at Mozambique’s Ministry of Health and Eduardo Mondlane University are working together to build the evidence for mental health integration into primary health care delivery in Mozambique. Today, we are proud to announce the publication of new evidence that small, provider-led adaptations in health systems can have demonstrable effects on mental health adherence and function improvement.

HAI-Mozambique Research Coordinator, Alberto Muanido, led the implementation of HAI’s SAIA-MH pilot project and is a co-author of Optimizing treatment cascades for task-shared mental healthcare in Mozambique: preliminary effectiveness of the Systems Analysis and Improvement Approach for Mental Health (SAIA-MH),  published today in the journal Health Policy & Planning.

“The primary takeaway is that even without a lot of funds it is possible to identify solutions that help patients return to their appointments, remain adherent [to care], and, consequently, improve their health, which is the ultimate goal of the Health System.”

Among the study’s highlights were a 53% increase in the odds of patients returning adherent to medication and a 3.7 fold increase in patients returning adherent with function improvement when providers actively used the SAIA toolkit to propose and implement discrete modifications in mental health care delivery.

“One modification that caught my attention” Muanido shares, “and which is in use and highly regarded to this day is the creation of a mental health ‘one stop.’ […] It was the team from the health center who put it into practice, spoke with hospital leadership, outlined how they would like the model to work, and started to implement it.”

Despite pointing to a personal favorite, Muanido went on to point out that “all the micro-interventions were very good and positive” and offers as proof that all the participant facilities are continuing to implement micro-interventions developed and tools adapted during the study period.

Katrin Fabian, is a PhD candidate in the University of Washington’s Department of Global Health Implementation Science Program and a Scholar-in-Residence at HAI’s headquarters office in Seattle.  Working under the guidance of study principal and HAI Technical Advisor, Dr. Brad Wagenaar, and Sofala Province’s Mental Health Coordinator and study collaborator, Dr. Vasco Cumbe, Fabian contributed to data analysis and documentation of study findings. Fabian described the project as a concrete example of taking a big, nebulous term like “systems improvement” and providing real, tangible means for measurement and demonstrating effectiveness:

“Sometimes when you first here about systems-level interventions, such as SAIA, they can feel nebulous and abstract. […] That was the challenge of this paper and this whole project, to characterize all the things we did in a way that was easily translatable as gains in clinical outcomes, like adherence to medication or returning to visits.”

That particular challenge was achieved through the elaboration and use of a two-part mental health care cascade, pictured above. The first, focused on initial patient diagnosis/engagement in care; and a second which measured follow-up chronic care.

“There’s more and more of a recognition that things are based on systems. Being able to translate these nebulous, complex concepts into real, tangible things that demonstrate effectiveness is really important, not just in the context of mental health in Mozambique, but everywhere.”