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Integrated Diagnostics and Treatment for Schizophrenia, Anxiety and Depressive Disorders among youths In Northern Malawi

Contribution to reduction of mental health problems among youths in Northern Malawi through community engagement and services integration.

Photo of John Nyirenda

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What problem does your idea solve?

The project will do the following: 1. Promote mental health education and awareness 2. Increase screening and diagnostics coverage of mental health disorders 3. Increase accessibility to treatments and psychological therapies for mental health disorders. 4. Re-orient the mental health services delivery to satisfy Primary Healthcare principles and Sustainable Development Goals.

Explain your idea

In Malawi almost all patients with mental disorders are misdiagnosed in primary care settings and they are subsequently treated for physical symptoms(Malawi Ministry of Health 2013). For instance, it has also been found that 28.8% of the patients attending primary health care have common mental health problems of depression or anxiety while 19% have depression alone(F Kauye et al. 2014)(Malawi Ministry of Health 2013). In Malawi, mental health services are mainly urban based such that these services are neither decentralized nor integrated into the national Primary Health Care delivery system(Kauye et al. 2011). With inadequate services and low awareness; many patients opt for native healers and paramedics. For instance; almost 50% of mental health patients visit native healers as the first care-giver before referral(Felix Kauye et al. 2014). It is clear that major challenges to implementing Mental Health services in developing countries like Malawi are inadequate awareness and advocacy to support for services for people with mental disorders; and resistance to decentralize the services to primary care level(Saraceno et al. 2007). Therefore, substantial attention to politics, leadership, planning, advocacy, and community participation is needed for sustainable and efficient Mental Health system. This project will contribute to reduction of mental health disorders in Northern Malawi; targeting youths in Secondary schools and tertiary institutions.

Who benefits?

1. Youths in both Secondary and Tertiary Institutions in pilot sites in Northern Malawi 2. Patients with mental disorders in northern region of Malawi 3. Native healers in Northern Region of Malawi through Health Education and Capacity building 4. Health workers in hospitals for skills and knowledge for care of patients with mental disorders 5. General Public through community campaigns and health education

How is your idea unique?

Currently students are being trained in Mental health and Psychiatry in Malawi but the program is purely academic and centralized where local and poor people do not benefit. This will be an integrated and community based project where stepped-care and collaborative model will be applied. The program will be comprehensive and collaborative for effectiveness and feasibility. It will involve local people like native healers or spiritualists, hospitals and academic institutions in the region. The project will embrace principles of Primary healthcare and sustainable development. It will make all sectors to have one voice. There will be clear responsibilities and roles for each partner in the consortium. This will also embrace the spirit of Networking and collaboration amongst metal health organisations in Malawi, Africa and beyond.

Tell us more about you

This project has three partners: 1. University of Livingstonia ( - Quality assurance and information management system, consortium Coordination, implementation research and supervision of project operations. 2. St John of God College of Health Sciences - Training manuals development, facilitating of training courses 3. Ministry of Health- Northern Zone - Collecting and entry of patient data, diagnostics and treatment, Community mobilization.

What are some of your unanswered questions about the idea?

This will be the first integrated care and collaborative project in Mental health in the area, therefore; We have integrated implementation research so that we investigate the challenges and best practices that could be scaled up in order to make a significant improvements on behavior change, utilization of services and reduced stigma and discrimination. We are going to evaluate the approaches (Integrated and community engagement) and models selected ( Stepped-care and collaborative model) and the health promotion theories that we are going to use. Additionally, the synergy of the integration of mental health into the infectious diseases programs control like HIV and AIDS in health system in Malawi - Challenges and opportunities.

Where will your idea be implemented?

  • Malawi

Experience in Implementation Country(ies)

  • Yes, for more than one year.

Expertise in Sector

  • I've worked in a sector related to my idea for more than a year.

Organizational Status

  • We are a registered non-profit, charity, NGO, or community-based organization.

Idea Maturity

  • Prototyping: I have done some small tests with prospective users to continue developing my idea.

How has your idea changed based on feedback?

The feedback has enabled us to elaborate on the partners' roles and responsibilities and explanation on how the beneficiaries will access the services. These have been explained and illustrated herein. Additionally, there was an issue about sustainability of the project initiatives. We strongly believe that the project will be sustainable because we are not going to establish new systems - college is already there, hospitals are already there and our University is already there. The initiative can later on be easily adopted by the partner institutions as we have all agreed to work together.

Who will implement this idea?

This project has three partners: 1. University of Livingstonia - Quality assurance and information management system, consortium Coordination, implementation research and supervision of project operations. 2. St John of God College of Health Sciences - Training manuals development, facilitating of training courses 3. Ministry of Health- Northern Zone - Collecting and entering of patient data, diagnostics and treatment and Community mobilization.

Using a human-centered design approach, you may uncover insights that lead to small or foundational changes to your organization’s existing strategy or processes in order to unlock the potential of your idea. How would your organization go about making such changes?

The idea has been developed by managers from the three partners. The lead person is the head of department and our University is already looking for partners and collaborators in order to improve the services and grow. This is already inline with the objectives. The members had to call for short meeting to discuss this initiative. It is already a joint accepted idea in the three partners. The ideas are brought to the management and they are defended by the member who introduces them.

What is it that most attracted you to Amplify instead of a more traditional funding model?

This was call for an innovative and open idea. It was open and not very restrictive about what should be covered and how it should be implemented. This call requires people to be creative. We are asked to design a project that is effective and targeted the context on how the community and the youths, in this case, are affected by disability and mental health in our society.

What challenges do your end-users face? (1) What is the biggest challenge that your end-users face on a day-to-day, individual level? (2) What is the biggest systems-level challenge that affects your end-users?

(1) . Individually, Services on mental health for the youths are not available or not accessible such that the environment is not enabling them to access care for mental health disorders. (2). The systems are more disintegrated and services are highly centralized and that is the reason we would like to bring the services at primary care level and also integrate them.

Tell us about your vision for this project: (1) share one sentence about the impact you would like to see from this project in five years and (2) what is the biggest question you need to answer to get there?

IMPACT: By 2022, 90% of mental health disorders are correctly identified and properly treated in primary healthcare; and the proportion of mental health patients visiting traditional healers and paramedics as first contact is reduced from 50% to 10% in Malawi. QUESTION: How do we effectively apply our models and approaches to ensure that Mental Health services are integrated, adopted and culturally accepted in our health systems and communities respectively?

How long have you and your colleagues been working on this idea together?

  • Less than 6 months

How many of your team’s paid, full-time staff are currently based in the location where the beneficiaries of your proposed idea live?

  • Between 5-10 paid, full-time staff

Is your organization registered in the country you intend to implement your idea in?

  • We are registered in all countries where we plan to implement.

My organization's operational budget for 2016 was:

  • Between $500,000 and $1,000,000 USD

If your team/idea/organization has a website, please share the URL below.

We are separate organisations as above. We do not have a joint website currently but once the consortium is funded one will be developed for the project. Or we can agree to use one institution; University of Livingstonia


Join the conversation:

Photo of John Nyirenda

Thank you very much for the feedback. We are working on the concept now. We are really impressed with the constructive criticisms.

Photo of OpenIDEO

Hi John and Team! We’re excited to share with you feedback and questions from the Amplify team and an external set of experts. We encourage you to think about this feedback as you continue to improve and refine your idea. You are welcome to respond in the comments section and/or to incorporate feedback into the text of your idea. Your idea and all associated comments will all be reviewed during the final review process.

General feedback:
• This project is proposing to do very important work and the outcomes would be valuable. My concern is better understanding how it will work and how it will scale taking into account the unique needs of different communities.

Is this idea desirability, feasibility, and viability
• Desirable? Yes!
• Feasible? Yes, but it would be useful to know some more details around the practicalities of placing people from cities into regional postings - accommodation, application process, training, how communities have been consulted and feel about this.
• Viable? Potentially yes. If this proves feasible and successful, it is certainly a potentially sustainable intervention with government backing and potential training/curriculum changes meaning that it can be mainstreamed. I think the challenge will come with making sure not to over stretch your budget, capability and capacity by trying to solve too many problems.

How does this idea consider user needs?
• Yes, it does consider users, but as it is only at early research and testing phase. Can you share more on lessons learned, new iterations based on beneficiary feedback/successes/failures?

What outstanding questions do you have for this contributor? What level of training do students have? Are they being set up with more experienced healthcare professionals? Are they being trained by professionals who have specific experience of mental health issues in decentralised communities?

In case you missed it, check out this Storytelling Toolkit for inspiration for crafting strong and compelling stories: Storytelling is an incredibly useful tool to articulate an idea and make it come to life for those reading it. Don’t forget - June 4 at 11:59PM PST is your last day to make changes to your idea on the OpenIDEO platform.

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Looking forward to reading more!

Photo of Christopher Mhone

This is a beautiful project. I like its community approach for it appreciates that conditions of Malawi in which a lot of people in difficult or had to reach places are excluded from services. The community approach is the way to go! 

Photo of John Nyirenda

Thanks for an encouraging comment

Photo of Christopher Mhone

This is a great project. It is really cognizant of the realities in Malawi with mental health services under developed. I like the community approach which gives people in the hard to reach areas easy access to mental health services.   

Photo of John Nyirenda

You are welcome for collaboration or contribute in any way. This is public health.

Photo of Charles  Umeh

This is a wonderful idea .I am a medical doctor and ehealth researcher .I am working on a similar Initiative. I think we can collaborate.

Photo of Ashley Tillman

Exciting to see potential collaborations forming around very important issues Charles umeh and John Nyirenda ! 

Photo of John Nyirenda

Hie Ashley Tillman

Would you like me to describe more about myself on my profile or I can just respond through this comment. However, here is my summary. I am in Germany till December, 2017. I am a PhD Student at University of Freiburg. In Malawi, I am Head of Public Health department at University of Livingstonia where we collaboratively work with St John of God College of Health Sciences in Mental Health. I also work with Ministry of Health - North Office and other organisations in Public Health that also include mental health. Mental Health problems and addictions are prominent in our colleges and surrounding secondary schools.
I am currently away for few months but we are a strong team. My colleagues are in Malawi. This project will be piloted in selected schools in Mzuzu City and in One district in rural areas or it can be one area in city and one area in rural for piloting. This will allow for evaluation of the effectiveness, management and scaling up and comparative analysis for implementation research. This will be a learning as well as service delivery project to assess the effects of the models applied and the general health promotion approach that we shall use. I anticipate that the Government can adopt this for the country when it works well.
If you need more details, I am available. I can send you a map of Malawi through email to indicate the impact areas for pilot and graphics about how the pilot is envisaged.

Photo of John Nyirenda

You are welcome to collaborate. That will make it even more better.