Decolonising global health evaluation: Synthesis from a scoping review

As decolonisation awareness and activism amplifies in the mainstream masses and within academic realms across a variety of fields, the time is right to converge parallel movements to decolonise the fields of global health and evaluation by restructuring relations of dependency and domination reified through the “foreign gaze”1 or “white gaze.” We conducted a review of relevant records with the following inclusion criteria–they define or advocate for the decolonisation of global health evaluation or explicate methods, policies or interventions to decolonise global health evaluation published by advocates of the decolonisation movement from both fields. These records were derived following a systematic article search by the lead autthor on Google, Google Scholar, NewsBank, and PubMed using the following keywords: “decolonising” and “global health,” “evaluation,” or “global health evaluation” replicating a digital search strategy utilized by scoping reviews across a variety of topics. Because the topic of interest is nascent and still emerging, the date range was not restricted. The lead author screened abstracts retrieved from the search. In total, 57 records, ranging in publication date from 1994 to 2020, were selected and charted for this review. We reviewed these records to identify socio-ecological factors that influence the decolonisation of global health evaluation, such as decolonising minds; reorienting funders and reforming funding mechanisms; and investing in sustainable capacity exchange. In doing so, we reflected on our positionality as well as our internalisation and potential reinforcement of colonial relations in the process of reporting our results. In the context of turmoil and transition due to the COVID-19 pandemic, our scoping review offers a starting point to embark on a journey first to transform and decolonise global health evaluation and then to achieve the greater goal of equity and justice

Partnerships in mental healthcare service delivery in low-resource settings: developing an innovative network in rural Nepal

Background: Mental illnesses are the largest contributors to the global burden of non-communicable diseases. However, there is extremely limited access to high quality, culturally-sensitive, and contextually-appropriate mental healthcare services. This situation persists despite the availability of interventions with proven efficacy to improve patient outcomes. A partnerships network is necessary for successful program adaptation and implementation. Partnerships network We describe our partnerships network as a case example that addresses challenges in delivering mental healthcare and which can serve as a model for similar settings. Our perspectives are informed from integrating mental healthcare services within a rural public hospital in Nepal. Our approach includes training and supervising generalist health workers by off-site psychiatrists. This is made possible by complementing the strengths and weaknesses of the various groups involved: the public sector, a non-profit organization that provides general healthcare services and one that specializes in mental health, a community advisory board, academic centers in high- and low-income countries, and bicultural professionals from the diaspora community. Conclusions: We propose a partnerships model to assist implementation of promising programs to expand access to mental healthcare in low- resource settings. We describe the success and limitations of our current partners in a mental health program in rural Nepal

Addressing Ceiling Effects in IPE Assessments

To aid proper development of interprofessional competencies, assessment systems much provide reliable and valid feedback to students and professionals

Recommendations from primary care providers for integrating mental health in a primary care system in rural Nepal.

BackgroundGlobally, access to mental healthcare is often lacking in rural, low-resource settings. Mental healthcare services integration in primary care settings is a key intervention to address this gap. A common strategy includes embedding mental healthcare workers on-site, and receiving consultation from an off-site psychiatrist. Primary care provider perspectives are important for successful program implementation.MethodsWe conducted three focus groups with all 24 primary care providers at a district-level hospital in rural Nepal. We asked participants about their concerns and recommendations for an integrated mental healthcare delivery program. They were also asked about current practices in seeking referral for patients with mental illness. We collected data using structured notes and analyzed the data by template coding to develop themes around concerns and recommendations for an integrated program.ResultsParticipants noted that the current referral system included sending patients to the nearest psychiatrist who is 14 h away. Participants did not think this was effective, and stated that integrating mental health into the existing primary care setting would be ideal. Their major concerns about a proposed program included workplace hierarchies between mental healthcare workers and other clinicians, impact of staff turnover on patients, reliability of an off-site consultant psychiatrist, and ability of on-site primary care providers to screen patients and follow recommendations from an off-site psychiatrist. Their suggestions included training a few existing primary care providers as dedicated mental healthcare workers, recruiting both senior and junior mental healthcare workers to ensure retention, recruiting academic psychiatrists for reliability, and training all primary care providers to appropriately screen for mental illness and follow recommendations from the psychiatrist.ConclusionsPrimary care providers in rural Nepal reported the failure of the current system of referral, which includes sending patients to a distant city. They welcomed integrating mental healthcare into the primary care system, and reported several concerns and recommendations to increase the likelihood of successful implementation of such a program

Recommendations from primary care providers for integrating mental health in a primary care system in rural Nepal.

BackgroundGlobally, access to mental healthcare is often lacking in rural, low-resource settings. Mental healthcare services integration in primary care settings is a key intervention to address this gap. A common strategy includes embedding mental healthcare workers on-site, and receiving consultation from an off-site psychiatrist. Primary care provider perspectives are important for successful program implementation.MethodsWe conducted three focus groups with all 24 primary care providers at a district-level hospital in rural Nepal. We asked participants about their concerns and recommendations for an integrated mental healthcare delivery program. They were also asked about current practices in seeking referral for patients with mental illness. We collected data using structured notes and analyzed the data by template coding to develop themes around concerns and recommendations for an integrated program.ResultsParticipants noted that the current referral system included sending patients to the nearest psychiatrist who is 14 h away. Participants did not think this was effective, and stated that integrating mental health into the existing primary care setting would be ideal. Their major concerns about a proposed program included workplace hierarchies between mental healthcare workers and other clinicians, impact of staff turnover on patients, reliability of an off-site consultant psychiatrist, and ability of on-site primary care providers to screen patients and follow recommendations from an off-site psychiatrist. Their suggestions included training a few existing primary care providers as dedicated mental healthcare workers, recruiting both senior and junior mental healthcare workers to ensure retention, recruiting academic psychiatrists for reliability, and training all primary care providers to appropriately screen for mental illness and follow recommendations from the psychiatrist.ConclusionsPrimary care providers in rural Nepal reported the failure of the current system of referral, which includes sending patients to a distant city. They welcomed integrating mental healthcare into the primary care system, and reported several concerns and recommendations to increase the likelihood of successful implementation of such a program

Countries and total number of papers associated with geographical regions.

Countries and total number of papers associated with geographical regions.</p

Descriptive characteristics, inclusion criteria, and factors associated with decolonisation by advocates in the field of global health and evaluation within included studies.

Descriptive characteristics, inclusion criteria, and factors associated with decolonisation by advocates in the field of global health and evaluation within included studies.</p

Number and types of papers included in our review published between 1994–2020.

Number and types of papers included in our review published between 1994–2020.</p

PRISMA flow chart of scoping review (based on Arksey & O’Malley 2005).

PRISMA flow chart of scoping review (based on Arksey & O’Malley 2005).</p