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Strengthening System and Implementation Research Capacity for Child Mental Health and Family Well-being in Sub-Saharan Africa

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Abstract

Background

Children in Sub-Saharan Africa (SSA) experience high rates of mental health problems, and the region has limited access to mental health resources and research capacity to address the needs. Despite the success of numerous evidence-based interventions (EBIs) and emerging methodology from the field of implementation science for addressing child mental health needs, most EBIs and implementation science methodology have not been applied in SSA contexts. The SMART-Africa Center aims to address these child welfare, mental health, services, and EBI implementation research gaps by establishing a regional trans-disciplinary collaborative center and studying strategies to strengthening mental health system and implementation research capacity. Our paper describes the overall framework and strategies that SMART-Africa team developed to strengthen capacity in three SSA countries (Ghana, Kenya, and Uganda) while focusing on its contextualization for the Kenyan school-community mental health settings. Methods to document the progress and impacts are also described.

Methods

The design of the system and research strengthening activities is guided by a SMART-Africa Capacity Building framework. Two areas of capacity are focused. Mental health system capacity focuses on building political wills, leadership, transdisciplinary partnership, and stakeholders’ global competency in evidence child mental health policy, intervention, and service implementation research. Implementation research capacity building focuses on building researchers’ implementation research competency by carrying out an EBI implementation research (using a Hybrid Type II effectiveness-implementation). For illustration purpose, we describe how the system strengthening strategies has been applied in Kenya and how the mixed methods design applied to assess the value and impacts of the capacity building activities. Feedback data and evaluation data collection using qualitative and quantitative methods for both areas of capacity building are still ongoing. Data will be analyzed and compared across countries in 2020–2021.

Conclusion

Our work has shown some feasibility of applying the theory-guided system strengthening model in improving child mental health service system and research capacity in one of the three SMART-Africa partnering countries. Our mental health landscape and resource mapping in Kenya also illustrated that capacity building in SSA countries involved complex dynamic, history, and some overlap efforts with multiple partnerships, and these are critical to consider in training activity and evaluation design.

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Data Availability

The evaluation data collection is ongoing and not yet complete.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIMH or the National Institutes of Health.

Abbreviations

SSA:

Sub-Saharan Africa

EBI:

Evidence-based interventions

RE-AIM:

Reach, Effectiveness, Adoption, Implementation, and Maintenance

MNS:

Mental, neurological, and substance use

WHO:

World Health Organization

MFG:

Multiple Family Groups

DBD:

Disruptive behavioral disorders

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Acknowledgments

We would like to thank the collaborative partners from Kenya Ministry of Health, Ministry of Education, NGOs, community health workers, and school staff and families from three primary schools. We are grateful to the parents, teachers, and community health workers who have contributed to the adaptation of the MFG. We also thank the cross-country partners from SMART-African in supporting and providing input for our paper.

Funding

The study outlined in this paper is supported by the National institutes of Mental Health (NIMH) under Award Number U19 MH110001 (MPIs: Fred Ssewamala, PhD; Mary McKay, PhD; Kimberly Hoagwood, PhD).

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Authors and Affiliations

  1. Department of Psychiatry, University of Nairobi, Nairobi, Kenya

    Anne Mbwayo, Manasi Kumar, Muthoni Mathai & Teresia Mutavi

  2. BasicNeedsBasicRights, Nairobi, Kenya

    Jane Nungari & Rosemary Gathara

  3. Washington University in St. Louis, St. Louis, USA

    Mary McKay & Fred Ssewamala

  4. NYU School of Medicine, New York, NY, USA

    Kimberly Hoagwood & Keng-Yen Huang

  5. University of KwaZulu-Natal, Durban, South Africa

    Inge Petersen

  6. South African Medical Research Council, Cape Town, South Africa

    Arvin Bhana

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  1. Anne Mbwayo
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Contributions

The proposal was jointly written by AM, MK, MM, KYH, and MMcK and reviewed by TM, JN, RG, FS, KH, IP, and AB. All authors read and approved the manuscript.

Corresponding author

Correspondence to Anne Mbwayo.

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Conflicts of Interest

The authors declare that they have no competing interests.

Ethics Approval and Consent to Participate

The study was approved by the Ethics and Research Committee of Kenyatta National and University of Nairobi (P216/03/2016). All participants who were approached gave verbal and written consent to participate.

Study Status

The study is ongoing. Participant recruitment has completed, but the data collection is not yet completed. We anticipate evaluation data collection will be completed in February 2021. The available data have not yet been cleaned or finalized for evaluation analysis.

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Mbwayo, A., Kumar, M., Mathai, M. et al. Strengthening System and Implementation Research Capacity for Child Mental Health and Family Well-being in Sub-Saharan Africa. Glob Soc Welf 9, 37–53 (2022). https://doi.org/10.1007/s40609-021-00204-9

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