Experience of strengthening the mental health information system in Ghana's three psychiatric hospitals

Abstract

•255• Chapter 20 Experience of Strengthening the Mental Health Information System in Ghana’s Three Psychiatric Hospitals A.Ofori-Atta, T. Mirzoev, A. Mensah-Kufuor, A. Osei, A. Dzadey, K. Armah-Aloo, K.D.Atweam Introduction The World Health Organization defines a Mental Health Information System (MHIS) as ‘a system for collecting, processing, analysing, disseminating and using information about a mental health service and the mental health needs of the population it serves (WHO, (2005). Developing MHIS may be considered a costly intervention, and yet the ultimate aim in establishing MHIS in low-income countries is for a more equitable distribution of resources in the context of scarcity (Husein, Adeyi, Bryant et al., 1993) . This is particularly pertinent for mental health care in Ghana, where there is inequitable distribution of mental health services (Doku, Ofori-Atta, Akpalu, et al., 2008). A situation analysis of mental health policy implementation in Ghana was conducted as the first phase of the Mental Health and Poverty Project (MHAPP). The MHAPP was a 5-year (research consortium project funded by the Department for International Development of the United Kingdom (DfID) and it ended in December 2010. The situation analysis revealed numerous challenges faced by the existing Mental Health Information System (MHIS) in Ghana (Doku et al., 2008). There was limited information on mental health collected routinely at the three psychiatric hospitals, and the district and regional hospitals. The information also focused on four disease categories only (psychotic disorders, epilepsy, substance use disorders and neurosis). The definitions of the categories were not standardized across the different data-gathering institutions, results were poorly analysed, rarely disseminated and the output was not useful to policy makers or for mental health advocacy. In response to the above •256• Chapter 20 challenges, an intervention to strengthen the MHIS in Ghana was implemented with support from the MHAPP and in collaboration with the Ghana Health Service. MHIS is owned by the Ministry of Health and the Ghana Health Service (GHS). This intervention was therefore a collaboration between the Ghana Health Service and the Mental Health and Poverty Project (MHAPP). A basic understanding to work conjointly towards the strengthening of the MHIS was agreed upon, with the MHAPP acting as collaborator and catalyst, and the Ministry of Health and its institutions as the implementers. The GHS provided the human resources, with the MHAPP contributing specialist and financial resources. The objective of this paper is to report on the design and implementation of the MHIS, and to deliberate on the factors which influenced these processes and the key intervention effects. General principles on health management information systems which were considered in the design of the MHIS Our design for the development of the MHIS was informed by general principles deduced from literature. The literature showed that challenges when developing health information systems generally in developing countries include insufficient training for staff responsible for implementation, lack of understanding of the changes introduced, inadequate supervision for staff involved, and lack of the skills and abilities necessary to undertake additional responsibilities required by the HMIS (Gladwin, Dixon, and Wilson, 2003) . Furthermore, systems must be ‘user friendly’ (WHO 2005) in order to have the best chance of consistent and accurate collection of data by health care workers (Husein et al., 1993). There is the need to focus on a broad spectrum of mental disorders, not only those for which treatment is available in order to illustrate unmet need so as to lobby for greater resources. One must also decide whether data collected should be population or facility-based depending on how comprehensive the data need to be ( Kustner, Varo, and Gonzales, 2002). An MHIS that collects data only from mental health services is likely to exclude many cases. Finally, process issues such as consultation with stake-holders, and the need •257• Experience of Strengthening the Mental Health Information System for monitoring and evaluation, are worth planning for (OdhiamboOtieno , 2005a; Odhiambo-Otieno, 2005b). Intervention design and implementation Intervention design. The intervention was aimed to strengthen and expand MHIS at the psychiatric hospitals, focusing on the functions of collection, processing, analysis, and use of information. The MHIS was designed to include a combination of paper-based and computerized elements. Patients were given a registration form on each visit, which was filled in as they contacted professionals in each department of the hospital. On exit, the form was retained and sent to the records department, where it was entered into the database. Sites: The intervention was...