SAIA Mental Health

In routine outpatient mental healthcare in the province of Sofala Mozambique, only 17% of patients may be achieving adherence to their medication, and only 26.6% may be showing improvement in activities of daily living, according to a recent pilot study. 

During a pilot study in Sofala province, Mozambique 4 outpatient clinics implemented the Systems Analysis and Improvement Approach for Mental Health (SAIA-MH) to optimize the outpatient mental health care cascade. An assessment of outcomes from 810 patients found that, during the implementation phase, there was a 40.9-point increase in the number of visits attended during which the patient demonstrated functional improvement, from 26.6% to 67.5%. This change represents functional improvement in 990 more visits than would have been otherwise expected from baseline rates. 

Mental Health in Mozambique

In Mozambique, a country of 29.5 million people, there are only about 20 psychiatrists in public-sector service. While Mozambique has been a leader in addressing this treatment gap though a Ministry of Health-led task-shifting approach, evidence suggests that due to a lack of resources, challenges in supervision, frequent stock-outs of essential medication, and other system barriers, the quality of care remains low. Healthcare systems report high rates of loss-to-follow-up, low adherence to treatment, and poor patient outcomes. There is an urgent need for evidence-based implementation strategies to optimize the performance of routine mental healthcare in Mozambique.  

The SAIA-MH implementation strategy is unique in that it builds the capacity of frontline task-shared mental health workers to visualize the performance of their own facility-level care cascade. Subsequently using that information to prioritize areas for improvement while generating facility-specific system modifications to improve patient outcomes which are calculated via measurement-based care methods.   

It is one of few (if any) evidence-based implementation strategies that exist to target continued optimization of routine mental healthcare system performance in LMICs. The continuous system analysis and improvement approach upon which SAIA-MH is built facilitates team-based care and collaborative problem solving among the healthcare workers and stakeholders who are at the forefront of outpatient care.  

Selected key findings from pilot study: 

• Five months of SAIA-MH implementation resulted in a 1.5-fold increase in medication adherence and a 3.7-fold increase in function improvement.  

• Care cascade performance was improved equally across MH diagnoses.  

• The majority, 62%, of system improvements tested by clinics targeted step F3, returning for follow-up on time and adherent to medication. 

• In-depth interviews with healthcare workers who participated indicated satisfaction with the intervention. 

Next steps: 

Building upon the evidence from the pilot study, the National Institute of Mental Health has funded a R01 cluster randomized control trial that will take place in 16 public-sector health facilities in Sofala and Manica provinces in central Mozambique. Baseline data collection is underway for this study which aims to:  

• Further evaluate the impact of SAIA-MH implementation on patient function improvement, medication adherence, and retention in mental health care across a larger study population.   

• Test causal pathway models to analyze mechanisms of action for effects of the SAIA-MH implementation strategy.  

• Estimate the cost and cost-effectiveness of scaling-up SAIA-MH in Mozambique.   

To learn more:

Review the pilot study results Optimizing treatment cascades for mental healthcare in Mozambique: preliminary effectiveness of the Systems Analysis and Improvement Approach for Mental Health (SAIA-MH)  

View additional details for the R01 RCT at Clinicaltrials.gov and/or RePORT ⟩ RePORTER (nih.gov) 

Recent Publications and Posters

SAIA-MH Study Location

The initial pilot project for SAIA-Mental Health took place in 4 public sector health facilities in Sofala province (in and around Beira City), laying the foundations for a R01 cluster RCT that will take place in 16 public-sector health facilities in Sofala and Manica provinces in central Mozambique. 

SAIA-MH Team

Thank you to our study funders and partners:

Interested in collaborating? Contact us!