Implementation of mhGAP in Mozambique: integrating epilepsy care into the primary health care system
Open accessAbstract
BACKGROUND: " was launched in 16 districts of five provinces covering a population of over 1.9 million. Using the WHO Mental Health Gap Program (mhGAP), a pilot Program was developed to provide effective quality care and treatment for people with epilepsy at primary health care level. Implementation was against a background of a shortage of human resources trained to address epilepsy and difficulties in the availability of antiepileptic medicines. METHODS: The first step for implementation was advocacy from the Government level to relevant stakeholders in the community. mhGAP training materials were translated and adapted to the local context. Non-specialists health providers and community health workers were trained and supervised regularly. Population awareness raising and community involvement were key for acceptance of the Program. RESULTS: After 4 years of implementation, 177 health professionals and 1161 community health workers were trained and ensured services delivery for people living with epilepsy (PwE). The implementation led to 89,869 consultations, representing an increase of 67% since the Program's inception. From 2015 to 2017 a total of 13,563 new cases were attended and the treatment gap was reduced from 99 to 96%. More than 60% of the new cases are children and adolescents. Awareness actions reached more than 14,000 people per year using all available broadcast means. Preliminary positive results were used as evidence for the Ministry of Health (MoH) to increase the purchase of antiepileptic drugs and improve delivery at district level. DISCUSSION: mhGAP is an important tool for reducing the treatment gap in low-income countries. Adapting guidelines to the country context and involving community stakeholders are key for Program sustainability. As in other settings, the strategy was cost-effective resulting in an increase in new cases and follow-up consultations. CONCLUSIONS: Implementation of an adapted mhGAP strategy and the involvement of community stakeholders and commitment of the MoH resulted in significant increase in the number of PwE attending outpatient services in primary health care facilities.
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The barriers and facilitating factors demonstrated by this study are consistent with those reported in Afghanistan, Nigeria and Mozambique.
“The barriers and facilitating factors demonstrated by our study are consistent with those reported in Afghanistan, Nigeria and Mozambique.28–30”
From Process evaluation of a district mental healthcare plan in Nepal: a mixed-methods case study (2020) · cites this paper as [30]
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- Authors
- Dos Santos, P. F., Cumbe, V., Gouveia, M. L., de Fouchier, C., Teuwen, D., & Dua, T.
- Affiliations
- Ministry of Health (MZ)
- World Health Organization (CH)
- Venue
- International Journal of Mental Health Systems
- Published
- 2019-05-29
- Volume
- 13
- Issue
- 1
- Pages
- 36-36
- ISSN
- 1752-4458 (ISSN-L)
- PMC
- PMC6540570
- OpenAlex
- W2947822350
- Cited by
- 34
- References
- 17
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 3 · 2023: 4 · 2022: 10 · 2021: 3 · 2020: 8
- FWCI
- 4.18
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- International Journal of Mental Health Systems (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- UCB
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Epilepsy research and treatment
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Keywords
- epilepsy care, primary care, treatment gap, community health workers, antiepileptic drugs, health professions education, community participation, health system strengthening, Mozambique, low-income countries
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