Strengthening mental health systems in low- and middle-income countries: recommendations from the Emerald programme

This paper provides a set of proposed recommendations for mental health system strengthening in low- and middle-income countries (LMICs) that have arisen from the ‘Emerging mental health systems in LMICs’ (Emerald) research programme. Emerald was implemented in six LMICs in Africa and Asia (Ethiopia, India, Nepal, Nigeria, South Africa and Uganda) over a five-year period (2012-2017), and aimed to improve mental health outcomes in the six countries by building capacity and generating evidence to enhance health system strengthening. The proposed recommendations align closely with the World Health Organization’s key health system strengthening ‘building blocks’ of governance, financing, human resource development, service provision and information systems; knowledge transfer is included as an additional cross-cutting component. Specific recommendations are made in the paper for each of these building blocks based on the body of data that were collected and analysed during Emerald. These recommendations are relevant not only to the six countries in which their evidential basis was generated, but also to other LMICs; they may also be generalizable to other non-communicable diseases beyond mental, neurological or substance use disorders.