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. 2020 Jul 28;6(4):e77. doi: 10.1192/bjo.2020.60

Table 3.

Achievements against theory of change (ToC) indicators

MHCP component, ToC indicators Indicators achieved Supporting evidence
Health organisation level
Engagement and advocacy
Mental health is integrated in the district health plan Fully achieveda MoH has allocated separate budget for scaling up of mental health services
Mental health programme coordinator in post Fully achieved

  1. MoH appointed a focal person to coordinate PRIME activities in the beginning of the project

  2. DPHO appointed a focal person to coordinate MH activities in the field

  3. Mental health focal unit has been established under NCD by MoHa
Policy for provision of psychotropic medication Fully achieveda 6 new psychotropic medicines are included in the essential list
DPHO has allocated required budget for psychotropic medicine Fully achieved Municipalities/village municipalities have allocated budget for psychotropic medicines
Referral for specialist's consultation
Referral system established with the district hospital Partly achieved Referral system from PHCs to psychiatrist department at district hospital was established
Cases referred to psychiatrist from the PHC facilities Partly achieved 24 people referred by PHC workers for specialised care
Health facility level
Service providers awareness and anti-stigma
Training conducted Fully achieved 4 training courses conducted (2 for prescribers and 2 for non-prescribers)
Health workers trained Fully achieved 35 prescribers, and 41 non-prescribers were trained (all health workers from 10 primary healthcare facilities)
Improvement knowledge and attitude of primary care workers Partly achieved Knowledge and attitude changed significantly after the training (see Table 4)
Screening and assessment
Adequate numbers of human are available at the health facility levels Partly achieved

  1. 43 prescribers and 41 non-prescribers.

  2. No psychosocial workers in the existing health system so hired counsellors externally
Staff gained knowledge and skills to diagnose and treat mental health problems Partly achieved

  1. Knowledge and attitude changed significantly after the training (see Table 4)

  2. Correct diagnosis and initiation of treatment changed significantly25
Physical/confidential space is available Not achieved No confidential place in most of health facilities
Protocols and guidelines are in place Fully achieved

  1. mhGAP Intervention Guide translated and adapted for Nepal

  2. Standard treatment protocol

  3. Trainers and facilitators manual (for both prescribers and non-prescribers)

  4. HAP and CAP manuals

  5. OPD registers/OPD card
Increased number and proportion of people identified/diagnosed Full achieved 0.15% to 3.24% (see Fig. 1)
Basic psychosocial support
Non-prescribers trained on basic psychosocial support Fully achieved All 41 non-prescriber were trained
People initiating treatment in primary care Fully achieved 1122 (379 depression; 292 alcohol use disorder, 206 psychosis, 111 epilepsy and 134 others)
Increased number of people receiving evidence-based treatment Fully achieved See Fig. 2
Psychotropic treatment
Medications were available at all clinics 95% of time Partially achieved Out of 6 medicines, 5 medicines were always available in all health facilities
Stock-outs in past 30 days for essential psychotropic medications outlined in the MHCP Partially achieved Trihexyphenidyl was not available at 4 out of the 10 facilities
Continue care
Functioning supervision and quality control system is in place Fully achieved

  1. 1 individual supervision

  2. 8 monthly/quarterly supervisions

  3. 2 three-days refresher training
Treatment outcomes
Improved health, social and economic outcomes for people living with priority mental disorders Fully achieved Changes in treatment outcomes – small-to-moderate effect sizes (9.7 – points reduction (d = 0.34) in AUD symptoms, 6.4-points reduction (0.43) in psychosis symptoms and 7.2-points reduction (d = 0.58) in depression symptoms) at 12-months post-treatment25
Community level
Mass community sensitisation
Community sensitisation programme conducted Fully achieved 139 community sensitisation programmes conducted
People oriented on mental health Fully achieved 5628 key community members oriented on mental health
Improved mental health literacy and decreased stigma Partly achieved

  1. Mental health literacy increased from 22.2% to 30.4% among general community members

  2. Stigma associated with mental health decreased but the change was not significant6
Improvement in treatment coverage Partially achieved

  1. Depression, 0% to 12.2%

  2. Alcohol use disorder, 0% to 7.5%

  3. Psychosis, 3.2% to 53.4%,

  4. Epilepsy, 1.3% to 13.0%
Community detection
FCHV trained on CIDT Fully achieved All 103 FCHVs were trained on CIDT
People referred through CIDT Fully achieved 685 people were referred to health facilities through CIDT
People visited health facilities because of CIDT Fully achieved 67%26
Advanced psychosocial counselling
Psychosocial counsellors trained Fully achieved 14
People received service from psychosocial counselling Fully achieved 152 (see Jordans et al 2019 for details)25
Home-based care (HBC)
FCHVs trained on HBC Fully achieved All 103 FCHVs trained on HBC
Home visits by FCHVs Partially achieved FCHVs made 1803 visits

MHCP, mental healthcare plan; MoH, Ministry of Health; PRIME, PRogramme for Improving Mental Health carE; DPHO, district public health office; NCD, non-communicable disease; PHC, primary healthcare; mhGAP, Mental Health Gap Action Programme; HAP, healthy activity programme; CAP, counselling for alcohol problems; OPD, out-patient department; FCHV, female community health volunteers; CIDT, Community Informant Detection Tool.

a.

Achieved by the end of the project period.