Table 1.

Summary of capacity-building interventions

Capacity-building intervention	Summary
Capacity-building for substance misuse system change in Russia [22]	As part of a larger program of mental health service enhancement, a project was implemented in St Petersburg, to support a shift from a universally medical model of drug and alcohol services to one which incorporates psychosocial aspects of care. Through a program of exchange between Russia and England, staff from the University of Portsmouth and St Petersburg paid learning visits to each country’s services and shadowed peers, supplemented by seminars and workshops on different therapies and clinical skills, such as patient assessment and motivational interviewing, followed by supervision sessions. Training participants included staff with responsibilities for policy-making and implementation.
Scaling up harm reduction for opioid injecting in India [23]	Project ORCHID (organized response for comprehensive HIV interventions in selected high-prevalence districts) aimed to establish and scale-up a harm reduction package for people injection opioid drugs in two states of north-eastern India, through capacity-building of community participation and a network of 24 local non-government organizations (NGOs). They created a program management team comprising injecting opioid users, which gradually took responsibility for supporting local advocacy work. Through its emphasis on project management and support, ORCHID fostered data-driven decision-making, development of guidelines and training manuals to standardize care and widespread, robust monitoring procedures. NGO-led strategies such as task-shifting, harm reduction methods, opioid agonist treatment, mobile outreach and peer education were introduced, which later influenced national policy.
Mental health system strengthening in Russia [24]	In a partnership between the Institute of Psychiatry, London and the Russian Federal Government, WHO, local municipalities and universities led the implementation of a multifaceted intervention in urban, semi-urban and rural areas of Sverdlovsk oblast. Following a context-specific literature review and situational assessment, interventions implemented over two years incorporated local and government-level policy dialogues, creation of Inter-sectoral Steering Committees (ISCs) to facilitate patients’ access to health care and other services, mental health training for social workers and general medical doctors. In addition, training and technical support were provided to build the capacity of non-government organizations in the fields of advocacy, service provision, and management.
Mental health system strengthening in Kenya and Tanzania [25–28]	Two diverse mental health system strengthening programs were implemented in Kenya and Tanzania, each comprising initial country-level situation analysis, local and national multidisciplinary policy dialogue, a system to coordinate mental health services and mental health training and supervision, establishment of clinical guidelines, inter-sectoral partnerships from local to national levels, awareness-raising activities and work to incorporate mental health into general health systems. In Kenya, alongside training of primary care workers, capacity-building courses were delivered to provincial, district, and sub-district general hospitals, to promote the incorporation of mental health into local annual operational plans (which feed into the national annual operational plan), and to foster supervision and coordination of primary mental health care by secondary care psychiatric and public health nurses.
Mental health capacity-building in Nicaragua [29]	In a four year collaboration between the National Autonomous University of Nicaragua in León and the Centre for Addiction and Mental Health in Canada, a needs assessment was conducted for mental health capacity-building. Two international workshops on mental health and addictions focusing on primary care were delivered to clinical staff, academics, and NGO members, after which diploma and masters-level courses were developed, to enhance inter-professional leadership, knowledge exchange, networking, and education.
De-institutionalization of children’s services in Russia [30]	From 2009 to 2012, a two-tier educational program was implemented in the Nizhny Novgorod region of Russia, to establish a model of children’s community services to reduce institutionalization. In the first tier, five week-long seminars delivered a course introducing principles of managing children’s community services with a focus on early intervention and family support to experienced clinical staff motivated to take on roles in service planning. In the second tier, a mentorship and training program was delivered over two years to staff at eight pilot sites and additional staff from five ‘participant sites’, covering the knowledge and skills to lead family support and early intervention programs in children’s services. During this period, four week-long supervisory seminars created opportunities for staff to assess progress, receive service user feedback, and discuss challenges faced.
The International Mental Health Leadership Program (iMHLP) [31–33]	Founded in 2001, the capacity-building intervention of iMHLP is embedded within a broader program of mental health system strengthening housed at the University of Melbourne’s Centre for International Mental Health. A collaboration with the University’s Department of Global Health and Social Medicine and Harvard Medical School, iMHLP’s goal is “to contribute to the development of effective mental health systems by providing training and mentoring in leadership”. The program focuses on training future leaders of mental health systems in LMICs. It comprises a four week intensive workshop, complemented with subsequent provision of mentoring and supervision to participants at home. The program encompasses skills in leadership, policy, mental health budgeting, community service design, human resources, advocacy, human rights, and research aspects. Course attendees undertake a research or service development project, with support from staff at the University of Melbourne and seniors in their home country. Examples of previous participants include key stakeholders in the development of community mental health systems in both Sri Lanka and the Indonesian province of Aceh, whose health and social care services were severely affected by the 2004 Indian Ocean earthquake and tsunami.
The mental health Leadership and Advocacy Program (mhLAP) [34]	mhLAP represents a collaboration between the Department of Psychiatry, University of Ibadan, Nigeria, the international development organization, CBM International, and the Center for International Health, University of Melbourne. Commencing in 2010, the program’s objectives are “capacity-building for mental health leadership and advocacy” and “development of stakeholder groups with the ability to identify and pursue country-specific mental health service development needs and targets”. The program comprises an annual two week interactive training course, whose curriculum was influenced by that of the iMHLAP, including research developments in public health and health system development, and stakeholder needs in LMICs. The course covers the “burden of mental, neurological, and substance use disorders, organization of mental health services, evaluation of services, mental health financing, mental health policy and legislation, social determinants of mental health, principles and practice of health promotion, the art of communication, stigma of mental illness, and mental health system reform and strengthening. The course also aims to inform the trainees about the strong reciprocal links that exist, at both personal and national levels, between poverty, social determinants, and mental health.” In addition, a country facilitator is appointed in each of the participating countries in West Africa. Their role includes performing a baseline assessment of local mental health services, to inform later program evaluations. The role additionally entails building connections between mental health stakeholders and supporting activities identified as their priorities. This proceeds through creation of a National Stakeholders Council (NSC) or support for existing local networks. An annual three day workshop is held in Nigeria for NSC representatives, to facilitate regular monitoring and review, and sharing of experiences from each country’s activities.
The Consortium for NCD prevention and control in sub-Saharan African (CNCD-Africa) [35]	At an international meeting of stakeholders, including representatives from the United States Centers for Disease Control and Prevention (CDC), the Department of Health of England, the International Union for Health Promotion and Education, and World Health Organization, CNCD-Africa was established. Its objectives were to provide a framework for dialogue about NCDs in sub-Saharan Africa, to bring together regional activities in NCD prevention and control, to develop policies, standards, guidelines, and protocols, and mobilize regional resources, to foster networking, partnership, and evaluation of NCD interventions, and identify causative factors and communicate results worldwide. Mental health was included among NCDs and regional capacity-building took place through convening of symposia and meetings, representation of CNCD-Africa at external meetings, creation of two open-access documents on NCD policies in the region, local and international promotion, and awareness raising and networking through social media.