Country contextualization of the mental health gap action programme intervention guide: a case study from Nigeria
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The mhGAP-IG has been contextualized and piloted in Nigeria and utilized in programme implementation in some states.
“The World Health Organization’s Mental Health Gap Action Programme-Intervention Guide (mhGAP-IG), which supports this approach to scale-up treatment and services for MNS disorders in LMICs (Keynejad et al., 2021), has been contextualized and piloted in Nigeria and utilized in programme implementation in these states (WHO, 2010; Abdulmalik et al., 2013; Keynejad et al., 2018).”
From Integrating mental health into primary care in Nigeria: Implementation outcomes and clinical impact of the <i>HAPPINESS</i> intervention (2024) · cites this paper as Abdulmalik et al., 2013
The Nigerian Context reports successful contextualization and pilot implementation of the mhGAP-IG, and Process and Observations describes its use to train primary care providers. However, Limitations says the programme could be piloted in only one state, Osun; this paper does not establish implementation in multiple states. No page numbers are available in our copy. (LLM, conf=0.89)
Experimental — accuracy not yet measuredOver 75% of Nigerians reside in rural and peri-urban areas and face barriers including pervasive stigma, limited mental health awareness and inadequate integration of mental health services into PHC.
“The majority of Nigerians, over 75% of whom reside in rural and peri-urban areas, face additional barriers, including pervasive stigma, limited mental health awareness and inadequate integration of mental health services into primary health care (PHC) systems (Abdulmalik et al., 2013).”
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 Abdulmalik et al., 2013
The Nigerian Context (page unavailable) describes poor access to mental health services for most Nigerians and proposes integration into primary care to address disparities. Process and Observations (page unavailable) reports limited mental health knowledge among primary-care workers in Osun state, while Box 1 names stigma as a target of national policy. The copy does not substantiate the figure that over 75% of Nigerians live in rural and peri-urban areas, or establish pervasive stigma and limited awareness as barriers faced by Nigerians generally. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe contextualization of the mhGAP-IG for Nigeria has already been successfully completed.
“This step has already been successfully completed in Nigeria [21].”
From Integrating mental health into primary care in Nigeria: report of a demonstration project using the mental health gap action programme intervention guide (2015) · cites this paper as [21]
Mental health is often a low priority for governments and donors, and there is often a lack of political will to prioritize this area.
“Mental health is often a low priority for governments and donors, and too often there is a lack of political will to prioritize this area [8].”
From World Health Organization guidelines for management of acute stress, PTSD, and bereavement: key challenges on the road ahead (2014) · cites this paper as [8]
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“packages of care through task-shifting [10]”
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Research works printed but not linked: 1
- [24]National Primary Health Care Development Agency (2012) National guidleines for development of primary health care system in Nigeria. 4th edition. NPHCDA, Abuja.
Cited by
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“This step has already been successfully completed in Nigeria [21].”
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“Specific details of the country integration packages are summarized in table one below and have been published elsewhere (4, 8).”
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“Ministries of health and non-governmental organizations alike have adopted and adapted the materials and used them in over 50 countries (Abdulmalik et al., 2013; Abera et al., 2014; Budosan et al., 2014; Hijazi et al., 2011; Rose et al., 2011).”
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“It incorporated the treatment specifications of the WHO Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) as adapted for the health system of Nigeria [34].”
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“The MHGAP-IG has already been contextualized and adapted for Nigeria (Abdulmalik et al. 2013) and the National Primary Health Care Development Agency (NPHCDA) is currently exploring its introduction into the curriculum for training primary health care workers (NR6).”
BackgroundSelf-citationFactors for success in mental health advocacy
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“Stakeholders at all levels should have a central role in both advocating for reform and in participating in the processes of reform (13).”
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“In regard to the provision of evidence-based care for psychosis, the manual also includes (and the PHCPs are trained in the use of) the psychosis module of the MH Gap Action Programme intervention guide (mhGAPIG), as contextualised to the Nigerian health system (World Health Organization, 2010; Abdulmalik et al., 2013…”
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“Various studies have been conducted in Asia, Africa and other parts of the world, with mhGAP IG utilized as central part of training interventions for primary or community health care workers [2, 16, 20, 21].”
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“…studies, the lifetime prevalence of mental disorders in Nigeria ranges from 12.1 to 26.2 percent (Wang et al., 2007), and only 20% of people with serious common mental disorders in Nigeria received treatment in the previous 12 months, with therapy being largely inadequate (Abdulmalik et al., 2013).”
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“This is an issue which hopefully will be addressed by the new emphasis on treatment at primary healthcare facilities through the implementation of the Mental Health Gap Action Program(mhGAP) being advocated by the World Health Organization (Abdulmalik et al., 2013).”
BackgroundGlobal Mental Health Reforms: Mental Health Care in Anglophone West Africa
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Facilitators and barriers to effective primary health care in Nigeria
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Built for expansion': The 'social life' of the WHO's mental health GAP Intervention Guide
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“One approach to realise that is by task-shifting [5, 14], which relies on training non-mental health workers in depression screening and treatment while supervised by mental health specialists.”
BackgroundOgunyemi, A. O., Balogun, M. R., Ojo, A. E., Welch, S. B., Onasanya, O. O., Yesufu, V. O., Omotayo, A. T., & Hirschhorn, L. R. (2023) · PLOS Global Public Health · doi:10.1371/journal.pgph.0001411 · Cited by 24 · see citing works
“Nigeria’s PHC system is run through a 5-tier system consisting of medical officers of health who supervise the centres, nurse practitioners and community health officers who serve as the head of the PHCs and supervise community health extension workers (CHEWS) [24].”
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“This has been previously adapted for the Nigerian context [43], and provides practical, evidence-based guidance for treatment of 8 priority conditions.”
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“The mhGAP has already been contextualized and tested in Nigeria [49, 50].”
MethodRagheb, W., Azé, J., Bringay, S., & Servajean, M. (2021) · IEEE Transactions on Knowledge and Data Engineering · doi:10.1109/tkde.2021.3078898 · Cited by 22 · see citing works
“There are always ongoing trials to close this gap by the integration of mental health services into primary care [8] or by task sharing and capacity building [9].”
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“Within these countries, however, lie di ff erences in the conception of mental health conditions and mental healthcare organization, factors that encourage varying socio-cultural contexts (Abdulmalik et al. 2013; Thornicroft & Patel, 2014).”
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Discussion of the updated WHO recommendations for mental, neurological, and substance use disorders
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“The mhGap has seen successful integration, for instance, in a pilot implementation programme in eight selected local government areas in Nigeria (Abdulmalik et al., 2013; Gureje et al., 2015a).”
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“…is a growing literature documenting the development of country-specific versions of mhGAP-IG, where the guidelines are seen as a “generic template that requires adaptation and contextualization to suit the particular needs of the health system in a given country” (Abdulmalik et al., 2013, p. 1).”
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“22,23 Large, community-based, stakeholder-driven, ‘ bottom-up ’ approaches to developing and testing interventions that are community-owned and community-delivered are lacking across LMICs.”
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“…(designated as Master Trainers) trained non-specialist physicians and senior nurses (Trainers or Facilitators) to further train other frontline primary care providers to recognize and care for mental disorders using the WHO Mental Health Gap Action Programme -Intervention Guide (mhGAP-IG) [14].”
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Mental health in low- and middle-income countries
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Nigeria mental health law: Challenges and implications for mental health services
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“Gureje O, et al. Integrating mental health into primary care in Nigeria: report of a demonstration project using the mental health gap action programme intervention guide.”
MethodInfluentialSelf-citationAdewuya, 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
“Nigeria ’ s engagement with mhGAP implementation has evolved significantly over the past decade, with early initiatives providing foundational evidence for task-sharing in PHC (Abdulmalik et al., 2013; Gureje et al., 2015; Eaton et al., 2018; Adewuya et al., 2019; Chu et al., 2022).”
Searle, K., Blashki, G. A., Kakuma, R., Yang, H. M., Lu, S., Li, B., Xiao, J., & Minas, H. (2022) · International Journal of Mental Health Systems · doi:10.1186/s13033-022-00523-0 · Cited by 7 · see citing works
“Whilst a universal approach to the adaptation of mhGAP-IG is still evolving [43], it is generally agreed upon that the consultation of end-users is integral for the appropriate adaptation and enhancement of future implementation [38, 44, 45].”
BackgroundResultInfluentialBitta, M. A., Kariuki, S. M., Abubakar, A. A., & Newton, C. R. J. C. (2018) · Wellcome Open Research · doi:10.12688/wellcomeopenres.13540.2 · Cited by 7 · see citing works
Salehi, M., Hormozi, F., Marvi, A., Seddigh, B., & Zakeri, A. (2025) · BMC Health Services Research · doi:10.1186/s12913-025-13702-9 · Cited by 6 · see citing works
“These include the absence of stable and coordinated mental health policies, a shortage of trained human resources, insufficient funding, weak health information systems, social stigma, limited intersectoral collaboration, and cultural and linguistic challenges [16–19].”
Raghuram, H., Rajguru, A. J., Pathiyil, M. M., Brahmbhatt, A., Bhan, A., Spagnolo, J., & Naslund, J. A. (2025) · International Journal of Mental Health Systems · doi:10.1186/s13033-025-00671-z · Cited by 8 · see citing works
“…the modification (e.g., improving fit, cultural adaptation, cost reduction) educational institutes [60], government ministries and departments [40, 42, 44, 46, 49–51, 58, 60–68], programme leaders [43, 69], health care professionals [41, 64, 66, 67] including mental healthcare professionals [57],…”
InfluentialFlooding in Nigeria, towards prioritizing mental health and psychosocial support
Malachy, E., Dossen, S. B., & Ebuenyi, I. D. (2022) · Pan African Medical Journal · doi:10.11604/pamj.2022.43.199.38251 · Cited by 6 · see citing works
“impact on account of implementation challenges [11], and there was no mention of MHPSS in it [10].”
BackgroundObindo, T. J., Eaton, J., Tsaku, P. A., Nwefoh, E. C., Ode, P., Baird, T., Sunday, P. O., & Afolaranmi, T. (2023) · International Health · doi:10.1093/inthealth/ihad073 · Cited by 5 · see citing works
“11 In Nigeria, the mhGAP Intervention Guide was adapted for lo-cal use in 2015 13 and is specifically recommended as normative guidance in the Nigeria National Policy for Mental Health Service Delivery.”
MethodDuke, A. E. E., Harri, B. I., Iyamu, I. O., Obi‐Jeff, C., Dahiru, A. M. C., Ojo, T. M.-F., Musami, U. B., Said, J. M., Agyapong, V. I. O., Orji, R., et al. (2025) · Journal of Primary Care & Community Health · doi:10.1177/21501319251406840 · Cited by 5 · see citing works
“…have enabled non-specialist primary care workers in Osun State to recognize and manage priority mental, neurological and substance use conditions, 46 large scale mhGAP training under the Mental Health in Primary Care (MeHPriC) program in Lagos State improved primary care workers’ knowledge,…”
Addressing the challenges of integrating care for perinatal depression in primary care in Nigeria
Oladeji, B. D., Ayinde, O. O., Bello, T., Kola, L., Faregh, N., Abdulmalik, J. O., Zelkowitz, P., Seedat, S., & Gureje, O. (2024) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-024-02611-7 · Cited by 6 · see citing works
“However, an important challenge in using these approaches to provide care for women with perinatal depression is overcoming human resource constraints [33].”
Self-citationThe WHO mhGAP Intervention Guide for people with intellectual disability: the Sri Lankan experience
Gumber, R., Gangavati, S., Bhaumik, S., Cooray, S. E., Purandare, K. N., Mendis, J., & Abeywickrema, C. (2015) · BJPsych International · doi:10.1192/s2056474000000805 · Cited by 4 · see citing works
Development of a psychiatric liaison service in Rawalpindi, Pakistan
Minhas, A., Bender, K. G., & Minhas, F. A. (2015) · BJPsych International · doi:10.1192/s205647400000074x · Cited by 4 · see citing works
Akinsulore, A., Esimai, O. A., Afolabi, O. T., Aloba, O. O., & Mapayi, B. M. (2015) · Journal of Behavioral Health · doi:10.5455/jbh.20150407103425 · Cited by 4 · see citing works
“Mental disorders are very common worldwide, but there is a wide treatment gap between developed and developing countries [1].”
BackgroundIheanacho, T., Chu, C., Aguocha, C. M., Nwefoh, E., & Dike, C. (2024) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2024.4 · Cited by 3 · see citing works
Nwedu, A. B., & Ominyi, J. (2025) · Mental Illness · doi:10.1155/mij/5522798 · Cited by 6 · see citing works
Mkubwa, B., Angwenyi, V., Pacione, L. R., Nzioka, B. M., John, M., Kibirige, N., Gichuki, J., Newton, C. R. J. C., Sijbrandij, M., & Abubakar, A. A. (2025) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2025.10049 · Cited by 2 · see citing works
“Building on these international examples, the contextualization process in Nairobi and Kilifi acknowledged the significant role of traditional and spiritual beliefs in shaping help-seeking behaviour in mental health conditions.”
InfluentialEntangled pathways: navigating mental healthcare dynamics in Abeokuta
Alabi, T. O. (2025) · Discover Mental Health · doi:10.1007/s44192-025-00264-9 · Cited by 2 · see citing works
“The burden of mental illness in Sub-Saharan Africa is significant, yet mental healthcare resources are extremely limited and underutilised, creating a substantial ‘treatment gap’ [28–33].”
Effects of Listening to Music on Mental Health of Nigerian Undergraduate Students
Omole, O. R. (2023) · International Neuropsychiatric Disease Journal · doi:10.9734/indj/2023/v20i2390 · Cited by 2 · see citing works
A Study of Machine Learning Models for Predicting Mental Health Through Text Analysis
Kadam, D., & Reddy, K. T. V. (2023) · DMIHER International Conference on Artificial Intelligence in Healthcare, Education and Industry (IDICAIHEI) · doi:10.1109/idicaiei58380.2023.10406845 · Cited by 2 · see citing works
“Through the strategies of task sharing and capacity building, endeavors are made to address this gap [15].”
BackgroundGajida, A. U., Ibrahim, U. M., Jalo, R. I., Tukur, J., Takai, I. U., Jaafar, J. S., Borodo, A. M., Abubakar, N., & Gwarzo, D. H. (2020) · Pyramid Journal of Medicine · doi:10.4081/pjm.2019.39 · Cited by 2 · see citing works
Aderibigbe, O. O., & Perlman, C. M. (2019) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/763045 · Cited by 2 · see citing works
Gureje, O., Ojagbemi, A., & Esan, O. (2023) · doi:10.1093/med/9780198735588.003.0012 · Cited by 1 · see citing works
Self-citationAdewuya, A. O., Abdulmalik, J. O., Abímbọ́lá, Ṣ., Oladipo, O. E., Dahiru, A., Shettima, F., Fasawe, A. A., Fahim, C., Marten, R., Yangchen, S., et al. (2026) · Health Research Policy and Systems · doi:10.1186/s12961-026-01463-8 · Cited by 1 · see citing works
“The mhGAP intervention guide (mhGAP-IG) had been contextualized and adapted for the Nigerian setting [9].”
Self-citationMental Health of Prison Inmates in the Nigerian Criminal Justice System
Eseadi, C. (2021) · Springer eBooks · doi:10.1007/978-3-030-71024-8_10 · Cited by 1 · see citing works
Owoeye, A. B. (2024) · International Journal For Multidisciplinary Research · doi:10.36948/ijfmr.2024.v06i01.13084 · Cited by 1 · see citing works
Sodeinde, K. J., Ogunsilu, E., Imishue, O. T., Adebisi, O., Omotosho, A., Adefala, N., & Gbadebo, A. (2024) · Tanzania journal of health research/Tanzania Journal of Health Research · doi:10.4314/thrb.v25i2.10 · Cited by 1 · see citing works
Mobile Health monitoring systems model for chronic diseases patients in developing countries
Kalema, B. M., & Musoma, R. M. (2019) · IEEE Annual Information Technology, Electronics and Mobile Communication Conference (IEMCON) · doi:10.1109/iemcon.2019.8936181 · Cited by 1 · see citing works
An evaluation of mhGAP training for primary healthcare workers in Mulanje, Malawi
Kokota, D. (2015) · Open University of Cape Town (University of Cape Town) · Cited by 1 · see citing works
Adoption of ICT4D frameworks to support screening for depression in Nigerian universities
Ojeme, B. (2018) · Open University of Cape Town (University of Cape Town) · Cited by 1 · see citing works
Affective behavior modeling on social networks
Ragheb, W. (2020) · doi:10.70675/bce319edz6f07z4ee2za880z8da9302d2585 · Cited by 1 · see citing works
Family Stress and Care in South Africa
Venter, I., van Rhyn, L., & Oruche, U. M. (2016) · doi:10.4324/9781315780344.ch24
MEN’S RECOVERY FROM SCHIZOPHRENIA IN NORTHERN NIGERIA
Utoblo, B. (2017) · Leeds Beckett Repository (Leeds Beckett University)
Hellandendu, M. M.-A. (2019) · Open Access Institutional Repository at Robert Gordon University (Robert Gordon University)
Searle, K., Blashki, G. A., Kakuma, R., Yang, H. M., & Minas, H. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19052570
“[61,62] It is freely available in seven languages (Arabic, English, French, Italian, Marathi, Russian, Spanish (not officially available in Mandarin Chinese)) and has been used in over 90 countries as a framework to review mental health policy, for health curriculum development and training, and an assessment aid at t…”
BackgroundFamily stress and care in South Africa
Venter, I., van Rhyn, L., & Oruche, U. M. (2016) · Routledge eBooks · doi:10.4324/9781315780344-35
Primary Mental Health Care in Low- and Middle-Income Countries
Isaac, M., Gureje, O., & Sumathipala, A. (2018) · Cambridge University Press eBooks · doi:10.1017/9781911623038.006
Self-citationPoursaadati, M. Z., Maarefvand, M., Bolhari, J., Hosseinzadeh, S., & Khubchandani, J. (2022) · International Journal of Social Psychiatry · doi:10.1177/00207640221124438
“…Couture & Penn, 2003; Price et al., 2016), poor insurance coverage (Fortney et al., 2009; Mansouri et al., 2013; Price et al., 2016), lack of access to professional care (Keynejad et al., 2018; Lund et al., 2012), and weak policies in mental health (Abdulmalik et al., 2013; Rebello et al., 2014).”
BackgroundIheanacho, T. (2023) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2024.4.pr4
Iheanacho, T., Chu, C., Aguocha, C. M., et al. (2023) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2024.4.pr2
Iheanacho, T., Chu, C., Aguocha, C. M., et al. (2023) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2024.4.pr5
Iheanacho, T., Chu, C., Aguocha, C. M., et al. (2023) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2024.4.pr9
Iheanacho, T. (2023) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2024.4.pr1
Iheanacho, T., Chu, C., Aguocha, C. M., et al. (2023) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2024.4.pr3
Iheanacho, T., Chu, C., Aguocha, C. M., et al. (2023) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2024.4.pr11
Iheanacho, T. (2023) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2024.4.pr7
Iheanacho, T., Chu, C., Aguocha, C. M., et al. (2023) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2024.4.pr6
Iheanacho, T., Chu, C., Aguocha, C. M., et al. (2023) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2024.4.pr8
Ojagbemi, A., Mediavilla, R., Daley, S., Oyedapo-Ishola, H., Olojugba, T., Olowoyo, C., Feeney, Y., Ayuso‐Mateos, J. L., & Gureje, O. (2024) · Wellcome Open Research · doi:10.12688/wellcomeopenres.22445.1
Self-citationFaija, C., Bee, P., Pedley, R., Bennion, M., Susanti, H., Fausiah, F., Idaiani, S., Susilo, D., Hussen, M., & Brooks, H. L. (2025) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2025.10059
Iheanacho, T., Chu, C., Aguocha, C., Nwefoh, E., & Dike, C. C. (2023) · Research Square · doi:10.21203/rs.3.rs-3148682/v1
- Authors
- Abdulmalik, J., Kola, L., Fadahunsi, W., Adebayo, K., Yasamy, M. T., Musa, E., & Gureje, O.
- Affiliations
- University of Ibadan (NG)
- World Health Organization - Nigeria (NG)
- Ladoke Akintola University of Technology (NG)
- World Health Organization (CH)
- Corresponding author
- Gureje, Oye
- Venue
- PLoS Medicine
- Publisher
- Public Library of Science (PLoS)
- Published
- 2013-08-20
- Volume
- 10
- Issue
- 8
- Pages
- e1001501
- ISSN
- 1549-1277 (ISSN-L)
- 1549-1676
- PMC
- PMC3747990
- OpenAlex
- W1987795635
- Cited by
- 104
- References
- 21
- Citations by year
- 2026: 5 · 2025: 8 · 2024: 7 · 2023: 17 · 2022: 7 · 2021: 6 · 2020: 6 · 2019: 10 · 2018: 11 · 2017: 5 · 2016: 9 · 2015: 9 · 2014: 4
- FWCI
- 11.01
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS Medicine (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)
- Figshare (submittedVersion, cc-by)
- Greater South Information System
- Funders
- World Health Organization
- European Commission
- Bundesministerium für Gesundheit
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Global Health and Surgery
- Keywords
- Mental Health Gap Action Programme, intervention guide, mental health services, Nigeria, mental health policy
- MeSH terms
- Developing Countries, Humans, Mental Health, Nigeria
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