Implementing an mhGAP-based training and supervision package to improve healthcare workers’ competencies and access to mental health care in Malawi
Open accessAbstract
Background: It is now well established that the integration of mental health care into primary care is one of the most effective ways of reducing the substantial treatment gap for mental disorders which exists in most low- and middle-income countries. This study set out to determine whether a Mental Health Gap Action Programme (mhGAP) training and supervision package could be contextualised and implemented within the existing health care system in five districts in Southern Malawi. In addition, the study assessed the feasibility of holding community awareness events and establishing peer support groups in each district to further improve the access of the population to evidence-based mental health care. Methods: A lead training team of experienced Malawian mental health professionals was appointed and mhGAP training materials were contextualised for use in Malawi. The lead team delivered a 4-day training package to district mental health teams in five districts covering three core conditions: psychosis, moderate-severe depression, and alcohol and substance use disorders. District mental health teams then delivered a 2-day training package and provided monthly supervision for 3 months to 500 non-specialist healthcare workers. Paired sample t-tests were used to compare knowledge, confidence and attitude scores before and immediately after training, and after 6 months in two districts. Case detection rates measured pre- and post-training in the pilot district were compared using Wilcoxon Rank Sum Test. Community awareness events were held and peer support groups were established in each of the five districts. The acceptability of the package was assessed through focus group discussions involving specialist and non-specialist healthcare workers, users and carers. Results: Non-specialist healthcare workers’ knowledge and confidence scores significantly increased immediately after training in comparison to pre-training. These scores were maintained at 6 months. However, no statistically significant change in attitude scores was detected. Case detection rates increased immediately after the training in comparison to pre-training. Responses from focus group discussion participants illustrated the programme’s acceptability. Conclusions: This study demonstrated that, with minimal additional funding and working within existing structures, an mhGAP based training at primary and secondary health care levels is feasible in Southern Malawi.
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Ahrens et al. (2020) found frequent supervisory visits in Malawi increased case detection.
“aligning with Ahrens et al. (2020), where frequent supervisory visits in Malawi increased case detection.”
From Scaling mental health care in Nigeria: Impact of WHO mhGAP training under the MeHPriC program on knowledge, attitudes, and practices of primary health care workers in Lagos State – A pre-post mixed-methods study (2025) · cites this paper as Ahrens et al. (2020)
The Results (Case detection rates) report that monthly cases detected in the pilot district rose from a median of 77 before training to 186 afterward. But Methods (Supervision) says planned supervisory visits to health centres were not feasible; staff instead attended monthly sessions at a central location. The paper does not establish that supervisory visits caused the increase. (LLM, conf=0.88)
Experimental — accuracy not yet measuredEvaluations of mhGAP training modalities demonstrate improvements in health workers' knowledge and self-efficacy, though evidence of sustained clinical behavior change remains limited.
“Evaluations of these training modalities demonstrate improvements in health workers’ knowledge and self-efficacy, though evidence of sustained clinical behavior change remains limited (Jordans et al., 2012; Ahrens et al., 2020; Al-Uzri et al., 2024; Humayun and Najmussaqib, 2024).”
From Scaling mental health care in Nigeria: Impact of WHO mhGAP training under the MeHPriC program on knowledge, attitudes, and practices of primary health care workers in Lagos State – A pre-post mixed-methods study (2025) · cites this paper as Ahrens et al., 2020
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Sorted by citations
Adewuya, A., Ola, B., Coker, O., Atilola, O., Olibamoyo, O., Oladipo, O., & Ajomale, T. (2025) · Cambridge Prisms: Global Mental Health · doi:10.1017/gmh.2025.10040 · Cited by 7 · see citing works
- Authors
- Ahrens, J., Kokota, D., Mafuta, C., Konyani, M., Chasweka, D., Mwale, O., Stewart, R. C., Osborn, M., Chikasema, B., Mcheka, M., Blackwood, D., & Gilfillan, S.
- Affiliations
- University of Malawi (MW)
- Royal Edinburgh Hospital (GB)
- Corresponding author
- Kokota, Demoubly
- ORCID
- Venue
- International Journal of Mental Health Systems
- Published
- 2020-02-27
- Volume
- 14
- Issue
- 1
- Pages
- 11-11
- ISSN
- 1752-4458 (ISSN-L)
- PMC
- PMC7045435
- OpenAlex
- W3011109773
- Cited by
- 27
- References
- 7
- Citations by year
- 2026: 4 · 2025: 11 · 2024: 3 · 2023: 3 · 2022: 3 · 2021: 3
- FWCI
- 2.32
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- International Journal of Mental Health Systems (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Scottish Government through a Malawi Development Grant entitled Enhancing Mental Health Training (SC039523)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- Mental Health Gap Action Programme, mental health workforce training, integration of mental health into primary care, psychosis, depression, alcohol and substance use disorders, case finding, peer support groups, acceptability, access to mental health care, southern Malawi
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