Evaluation of the WHO Assessment Instrument for Mental Health Systems

Letters EBulletin of the World Health Organization | August 2008, 86 (8) a University Teaching Hospital, Lusaka, Zambia. b Institute for Global Health, Vanderbilt University, Nashville, TN, United States of America. Correspondence to Vikrant Sahasrabuddhe (e-mail: vikrant.sahasrabuddhe@vanderbilt.edu). c University of Alabama at Birmingham, Birmingham, AL, USA. d Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland. Correspondence to Shekhar Saxena (e-mail: saxenas@who.int). Horizontal and diagonal collabora- tions between agencies and individuals focusing on HIV/AIDS care and cancer prevention could open new vistas for expanding availability of care for women at risk of one or both of these conditions, thereby ensuring wider programme impact. The conjoint con- tributions of such collaborations may be larger than the sum of their parts. ■ Mulindi H Mwanahamuntu,a Vikrant V Sahasrabuddhe,b Jeffrey SA Stringer c & Groesbeck P Parhamc References Peckham S, Hann A. A sexual health prevention 1. priority. Bull World Health Organ 2008;86:490-1. PMID:18568280 doi:10.2471/BLT.08.053876 PEPFAR2. and the fight against HIV/AIDS. Lancet 2007;369:1141. PMID:17416238 doi:10.1016/ S0140-6736(07)60536-4 Franceschi3. S, Jaffe H. Cervical cancer screening of women living with HIV infection: a must in the era of antiretroviral therapy. Clin Infect Dis 2007;45:510-3. PMID:17638204 doi:10.1086/520022 Parham4. GP, Sahasrabuddhe VV, Mwanahamuntu MH, Shepherd BE, Hicks ML, Stringer EM, et al. Prevalence and predictors of squamous intraepithelial lesions of the cervix in HIV- infected women in Lusaka, Zambia. Gynecol Oncol 2006;103:1017-22. PMID:16875716 doi:10.1016/j.ygyno.2006.06.015 Stringer5. JS, Zulu I, Levy J, Stringer EM, Mwango A, Chi BH, et al. Rapid scale-up of antiretroviral therapy at primary care sites in Zambia: feasibility and early outcomes. JAMA 2006;296:782-93. PMID:16905784 doi:10.1001/jama.296.7.782 Parham6. GP, Mwanahamuntu MH, Pfaendler KS, Mkumba G, Sahasrabuddhe VV, Hicks ML, et al. Building a cervical cancer prevention program into an HIV care and treatment infrastructure. In: Marlink R, Teitelman S et al., eds. From the ground up: a guide to building comprehensive HIV/AIDS care programs in resource-limited settings. Washington, DC: Elizabeth Glaser Pediatric AIDS Foundation; 2008. Pfaendler KS, Mwanahamuntu MH, 7. Sahasrabuddhe VV, Mudenda V, Stringer JS, Parham GP. Management of cryotherapy- ineligible women in a “screen-and-treat” cervical cancer prevention program targeting HIV-infected women in Zambia: Lessons from the field. Gynecol Oncol 2008;e-pub 13 June. Evaluation of the WHO Assessment Instrument for Mental Health Systems We read with interest the recent paper by Hamid et al. on the WHO Assess- ment Instrument for Mental Health Systems (WHO-AIMS),1 an instrument that we are pleased to have developed and that fills a major gap in this field.2,3 We thank the authors for their interest and their mostly positive appraisal of WHO-AIMS. We would like to note that the primary objective of the WHO-AIMS project is to enable countries to generate information on the strengths and weak- nesses of their mental health system to facilitate improvement of services. Through a WHO-AIMS assessment, countries are enabled to develop infor- mation-based mental health plans with clear baseline information and targets, and to monitor progress in implement- ing reform policies. Given the objective of the project, the WHO-AIMS instrument has been designed to be used by a local team for comprehensive assessment of the coun- try’s mental health system (or an assess- ment of a region within the country). A complete assessment using WHO- AIMS usually takes 3 to 6 months and involves an iterative process of check- ing and triangulating data between the local team and the ministry of health (which is the source of many critical elements of the assessment). This work is carried out with continuous and sub- stantial technical support from WHO headquarters, regional and country offices. The final report is jointly pub- lished by the WHO country office and the ministry of health. WHO has now published WHO-AIMS assessments on 36 countries (available at: http://www. who.int/mental_health/who_aims_ country_reports/en/index.html). Though the Hamid et al. paper does not provide details of the method- ology followed in collection of WHO- AIMS data, it appears that the authors were not able to use the recommended WHO-AIMS method.4 Also, the paper gives data for just a few indicators out of 155 included in the instrument. In view of these limitations, we believe that this paper provides a less than adequate basis for evaluation of this instrument. WHO will soon publish a report on available WHO-AIMS data from a large number of countries. This report is likely to provide a more adequate basis to evaluate this instrument. ■ Shekhar Saxena,d Antonio Lora,d Mark van Ommeren,d Thomas Barrett,d Jodi Morris d & Benedetto Saracenod References Hamid H, Abanilla K, Bauta B, Huang KY. 1. Evaluating the WHO Assessment Instrument for Mental Health Systems by comparing mental health policies in four countries. Bull World Health Organ 2008;86:467-73. PMID:18568276 doi:10.2471/BLT.07.042788 Saxena2. S, Lora A, van Ommeren M, Barrett T, Morris J, Saraceno B. WHO’s Assessment Instrument for Mental Health Systems: collecting essential information for policy and service delivery. Psychiatr Serv 2007;58:816-21. PMID:17535942 doi:10.1176/appi.ps.58.6.816 Saxena3. S, van Ommeren M, Lora A, Saraceno B. Monitoring of mental health systems and services - comparison of four existing indicator schemes. Soc Psychiatry Psychiatr Epidemiol 2006;41:488-97. PMID:16565914 doi:10.1007/ s00127-006-0053-3 World4. Health Organization Assessment Instrument for Mental Health Systems, version 2.2. Geneva: WHO; 2005.