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Glob Ment Health (Camb). 2017 Dec 4;4:e24. doi: 10.1017/gmh.2017.21. eCollection 2017.

Factors promoting and inhibiting sustained impact of a mental health task-shifting program for HIV providers in Ethiopia.

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Management Sciences for Health, Addis Ababa, Ethiopia.
Department of Heath Science, Faculty of Medicine, Lund University, Lund, Sweden.
MERQ Consultancy Services PLC, Addis Ababa, Ethiopia.
Yale School of Medicine, New Haven, CT, USA.
Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA.
Division of Child and Adolescent Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD, USA.



Task-shifting mental health into general medical care requires more than brief provider training. Generalists need long-term support to master new skills and changes to work context are required to sustain change in the face of competing priorities. We examined program and context factors promoting sustainability of a mental health task-shifting training for hospital-based HIV providers in Ethiopia.


Convergent mixed-methods quasi-experimental study. Sustained impact was measured by trained/not-trained provider differences in case detection and management 16 months following the end of formal support. Factors related to sustainability were examined through interviews with trained providers.


Extent of sustained impact: Trained providers demonstrated modest but better agreement with standardized screeners (greater sensitivity with similar specificity). They were more likely to request that patients with mental health problems return to see them v. making a referral. Factors promoting sustainability (reported in semi-structured interviews): provider belief that the treatments they had learned were effective. New interactions with on-site mental health staff were a source of ongoing learning and encouragement. Factors diminishing sustainability: providers feelings of isolation when mental health partners left for work elsewhere, failure to incorporate mental health indicators into administrative data, to re-stock staff education materials, and to build formal mechanisms for generalist-mental health staff interaction.


An intervention seen as feasible and effective, and promotion of relationships across professional lines, helped generalists sustain new skills. Failure to address key system context issues made use of the skills unsustainable as external supports ended.


Mental health; sustainability; task-shifting

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