Lagos adapts WHO advice to improve mental healthcare
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In Lagos, Nigeria, a research team led by Abiodun O. Adewuya of the Lagos State University College of Medicine worked to improve mental health services by adapting global guidelines from the World Health Organization (WHO) to the local context.
Nigeria faces a large gap in mental healthcare, with up to 85 percent of people with mental disorders receiving no treatment due to limited specialists and resources.
The team focused on the WHO Guideline: recommendations on digital interventions for health system strengthening, known as WHO-GRDI, recognizing that general guidelines need customization to work effectively in places with unreliable infrastructure and stretched healthcare workers. The researchers used a systematic process called guideline adaptation, involving local experts and stakeholders to modify the WHO recommendations for Lagos’s primary care clinics. They assessed existing resources, including mobile phone and internet access, finding strong connectivity despite challenges.
The team then worked with a panel of specialists to tailor the guideline, merging some recommendations and clarifying language to fit the local context. The adapted guideline was piloted in five primary health centres, providing health workers with mobile devices and training. Evaluations showed high acceptance and effectiveness for recommendations related to drug stock notifications, health worker communication, and client outreach.
However, digital communication with clients and clinical decision support tools faced challenges, as workers prioritized in-person care for emergencies and worried about the impact of technology on patient relationships. The researchers emphasize the importance of stakeholder engagement, supportive digital infrastructure, and integrating new recommendations into existing programs for successful implementation.
