Framework for implementation

This section explains an implementation framework (EPIS) applied to the MHPSS service model to enhance its effectiveness, sustainability, and scalability ^[1]. According to this framework, the process of implementing the MHPSS plan is structured into four phases: Exploration, preparation, implementation, and sustainability (EPIS). The EPIS implementation framework has already been successfully employed to accelerate the use of evidence-based practices to develop mental health systems, improve processes, and bring system-level change ^{[2] [3]}.

THE EXPLORATION PHASE

The objectives of the exploration phase are to:

1.1. Conduct a comprehensive needs assessment to establish baseline data for system-level planning for MHPSS interventions.

1.2. Assess technical and financial needs and explore possible sources of funding.

1.3. Establish inter-sectoral collaboration.

1.4. Access the MHPSS digital solution.

1.5. Plan a comprehensive mental health education campaign.

THE PREPARATION PHASE

The objectives of the preparation phase are to:

2.1 Build capacity: Recruit a mental health workforce.

2.2 Build capacity: Conduct initial training.

2.3 Pilot test MHPSS services.

2.4 Initiate mental health education campaign.

THE IMPLEMENTATION PHASE

The objectives of the implementation phase are to:

3.1 Build capacity: Provide supervision.

3.2 Provide regular MHPSS services.

3.3 Ensure program fidelity.

3.4 Continue the mental health education campaign.

THE SUSTAINABILITY PHASE

The objectives of the sustainability phase are to:

4.1 Assess sustainability

4.2 Prepare a sustainability report

4.3 Re-evaluate the services to scale up

The Gantt chart for the MHPSS implementation plan shows a systematic approach to roll out mental health services across a province over five years (see Figure 6.1). The chart demonstrates a phased implementation strategy, beginning with a pilot site, e.g., district(s) in Year 1 and gradually expanding to new sites (districts). Once tested, the pilot district(s) can repeat the EPIS cycle to build the capacity of a new workforce and scale up services. During the final year, a comprehensive evaluation of MHPSS services and sustainability assessments should be completed before designing a strategy to scale up in consultation with the relevant stakeholders. Depending on available resources, this strategy includes scaling up services both as new EPIS cycles in existing sites and expanding to new sites.

After the pilot implementation, new sites (districts) may be introduced in Year 2, following the same EPIS framework. The overlapping plan for implementation will help to learn and adapt from pilot experiences while maintaining service delivery. The plan ensures that by Year 5, all participating districts will have established sustainable MHPSS services, with earlier districts serving as models and support bases for newer sites (districts).

Note:
E: Exploration phase
P: Preparation phase
I: Implementation phase
S: Sustainability phase

REFERENCES

1. Aarons et al., 2011 https://doi.org/10.1007/s10488-010-0327-7

2. Gotham et al., 2022 https://doi.org/10.1016/j.genhosppsych.2022.01.004

3. Tyack et al., 2024 https://doi.org/10.1186/s13012-024-01391-7

4. All sources of funding include public funds, development partners; public-private partnership.

5. The sustainability of MHPSS services will be maintained throughout the duration of the project. However, upon completion of implementation phase, a detail evaluation of internal and external factors will be conducted and presented to stakeholders to inform scaling-up efforts and long-term viability.