Technology transfer of hearing aids to low and middle income countries: policy and market factors

PURPOSE

The competitive market advantages of industry and the balancing force of international governmental organizations (IGOs) are examined to identify market and policy in support of sustainable technology transfer of hearing aids to low and middle income countries. A second purpose is to examine the usefulness of findings for other assistive technologies (AT).

METHODS

Searches of electronic databases, IGO documents, industry reports and journals were supplemented by informal discussions with industry and IGO staff and audiologists. The value chain is used to examine the competitive advantage of industry and the balancing tools of certain IGOs.

RESULTS

Both industry and IGOs engage in intellectual property (IP) and competition activities and are active in each segment of the hearing aid value chain. Their market and policy objectives and strategies are different.

CONCLUSIONS

IGOs serve as balancing forces for the competitive advantages of industry. The hearing aid market configuration and hearing aid fitting process are not representative of other AT products but IP, trade and competition policy tools used by IGOs and governments are relevant to other AT. The value chain is a useful tool to identify the location of price mark-ups and the influence of actors.

IMPLICATIONS FOR REHABILITATION

Market factors and reimbursement and subsidization policies drive hearing aid innovation. UN-related international government organization activities are responsive to the needs of disability populations who cannot afford assistive technology. Policy tools used by international governmental organizations are applicable across assistive technology. A partnership model is important to distribution of hearing aids to low and middle income countries.

HIV/AIDS communication in four Nigerian mainstream newspapers

Introduction

One consensus in discussions on HIV/AIDS communication in low and middle income countries (LMICs) is the need for communication models to focus on activity rather than cognitive indicators in order to achieve desired improvements in health behaviors and outcomes. Past failures of HIV/AIDS communication efforts in LMICs have been attributed to emphasis on cognitive indicators. This study analyses HIV/AIDS communication models in Nigerian newspapers.

Methods

Data were obtained through analysis of manifest content of four Nigerian papers issued between 2002 and 2004. Frequency, prominence and space dedicated to HIV/AIDS-related topics were measured. Descriptive statistics were used to highlight the frequency and percentage of cognitive- and activity-oriented informationon HIV/AIDS.

Results

A total of 464 HIV/AIDS-related articles were identified. Fifty-nine percent (274) of articles were activity-oriented. Over half of articles were news stories. No news story made front and back pages lead. There were only nine editorials on HIV/AIDS.

Conclusion

This study shows that the activity model of HIV/AIDS communication dominates the four Nigerian mainstream newspapers studied. However, it is worth noting the limited number of editorials and feature articles, which have the capacity to stimulate debate and foster a social environment in which AIDS is addressed in a spirit of openness. For a country that has thethird largest number of people living with HIV/AIDS globally, one would expect the mass media to deliberately play an instrumental and a more active role in the battle against the disease by engaging in in-depth contextual discourse on HIV/AIDS.

The value of screening in patient populations with high prevalence of a disorder

Thombs and colleagues have shown that screening consecutive attendees in primary care settings in high income countries for depression is not worthwhile. However, it is dangerous to generalize from high income countries such as the USA to the rest of the world. The positive predictive value of any screening test for depression is affected by the prevalence of the disorder in the population being considered. Populations with an increased prevalence of depression, such as those with chronic physical disorders, or with a history of depression or other mental health problems may benefit from screening, even in high income countries. Populations in low and middle income countries (LMIC) may also benefit from screening if they are experiencing severe social adversity, including poverty. Two examples are given, in which screening with a brief screening questionnaire was followed by collaborative stepped care, to the considerable benefit of the patients in LMIC. Please see related article: http://www.biomedcentral.com/1741-7015/12/13.

Doctoral training in Uganda: evaluation of mentoring best practices at Makerere university college of health sciences

BACKGROUND

Good mentoring is a key variable for determining success in completing a doctoral program. We identified prevailing mentoring practices among doctoral students and their mentors, identified common challenges facing doctoral training, and proposed some solutions to enhance the quality of the doctoral training experience for both candidates and mentors at Makerere University College of Health Sciences (MakCHS).

METHODS

This cross-sectional qualitative evaluation was part of the monitoring and evaluation program for doctoral training. All doctoral students and their mentors were invited for a half-day workshop through the MakCHS mailing list. Prevailing doctoral supervision and mentoring guidelines were summarised in a one-hour presentation. Participants were split into two homogenous students' (mentees') and mentors' groups to discuss specific issues using a focus group discussion (FGD) guide, that highlighted four main themes in regard to the doctoral training experience; what was going well, what was not going well, proposed solutions to current challenges and perceived high priority areas for improvement. The two groups came together again and the note-takers from each group presented their data and discussions were recorded by a note-taker.

RESULTS

Twelve out of 36 invited mentors (33%) and 22 out of 40 invited mentees (55%) attended the workshop. Mentors and mentees noted increasing numbers of doctoral students and mentors, which provided opportunities for peer mentorship. Delays in procurement and research regulatory processes subsequently delayed students' projects. Similarly, mentees mentioned challenges of limited; 1) infrastructure and mentors to support basic science research projects, 2) physical office space for doctoral students and their mentors, 3) skills in budgeting and finance management and 4) communication skills including conflict resolution. As solutions, the team proposed skills' training, induction courses for doctoral students-mentor teams, and a Frequently Asked Questions' document, to better inform mentors', mentees' expectations and experiences.

CONCLUSION

Systemic and infrastructural limitations affect the quality of the doctoral training experience at MaKCHS. Clinical and biomedical research infrastructure, in addition to training in research regulatory processes, procurement and finance management, communication skills and information technology, were highlighted as high priority areas for strategic interventions to improve mentoring within doctoral training of clinician scientists.

Contraception for adolescents in low and middle income countries: needs, barriers, and access

Substantial numbers of adolescents experience the negative health consequences of early, unprotected sexual activity - unintended pregnancy, unsafe abortions, pregnancy-related mortality and morbidity and Sexually Transmitted Infections including Human Immunodeficiency Virus; as well as its social and economic costs. Improving access to and use of contraceptives - including condoms - needs to be a key component of an overall strategy to preventing these problems. This paper contains a review of research evidence and programmatic experiences on needs, barriers, and approaches to access and use of contraception by adolescents in low and middle income countries (LMIC). Although the sexual activity of adolescents (ages 10-19) varies markedly for boys versus girls and by region, a significant number of adolescents are sexually active; and this increases steadily from mid-to-late adolescence. Sexually active adolescents - both married and unmarried - need contraception. All adolescents in LMIC - especially unmarried ones - face a number of barriers in obtaining contraception and in using them correctly and consistently. Effective interventions to improve access and use of contraception include enacting and implementing laws and policies requiring the provision of sexuality education and contraceptive services for adolescents; building community support for the provision of contraception to adolescents, providing sexuality education within and outside school settings, and increasing the access to and use of contraception by making health services adolescent-friendly, integrating contraceptive services with other health services, and providing contraception through a variety of outlets. Emerging data suggest mobile phones and social media are promising means of increasing contraceptive use among adolescents.

Antenatal Depression is Not Associated with Low-Birth Weight: A Study from Urban Pakistan

BACKGROUND

Low-birth weight (LBW) (<2500 g) is considered to be a leading cause of cognitive impairment and physical disabilities in children. Incidence of LBW in South Asia has been reported to be as high as 33%. We investigated the association between antenatal depression and LBW in an urban community, in Karachi, Pakistan.

METHODS

A total of 1357 pregnant women in their third trimester were recruited into the study. They were screened for antenatal depression with Edinburgh postnatal depression scale. Self-reporting questionnaire was also used to measure psychological distress. Birth weights of 763 newborns were obtained from the hospital records.

RESULTS

We did not find a significant association between antenatal depression and LBW (odds ratio 0.881, 95%CI 0.732-1.060) in mothers attending a charity run hospital in an urban setting in Pakistan.

CONCLUSION

Antenatal depression is not associated with LBW in this urban population in Pakistan. However, the prevalence of depression is high during pregnancy. There is a need to develop culturally adapted psychosocial interventions to address the high rates of depression for this population group.

Systematic review research on needle/syringe programs and opiate substitution programs in low- and middle-income countries

Persons who inject drugs (PWID) are at an elevated risk for human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection. In many high-income countries, needle and syringe exchange programs (NSPs) have been associated with reductions in blood-borne infections. However, we do not have a good understanding of the effectiveness of NSP in low/middle-income and transitional-economy countries. A systematic literature review based on PRISMA guidelines was utilized to collect primary study data on coverage of NSP programs and changes in HIV and HCV infection over time among PWID in low- and middle-income and transitional countries (LMICs). Included studies reported laboratory measures of either HIV or HCV and at least 50% coverage of the local injecting population (through direct use or through secondary exchange). We also included national reports on newly reported HIV cases for countries that had national level data for PWID in conjunction with NSP scale-up and implementation. Studies of 11 NSPs with high-coverage from Bangladesh, Brazil, China, Estonia, Iran, Lithuania, Taiwan, Thailand, and Vietnam were included in the review. In five studies, HIV prevalence decreased (range -3% to -15%) and in three studies HCV prevalence decreased (range -4.2% to -10.2%). In two studies, HIV prevalence increased (range +5.6% to +14.8%). HCV incidence remained stable in one study. Of the four national reports of newly reported HIV cases, three reported decreases during NSP expansion, ranging from -30% to -93.3%, whereas one national report documented an increase in cases (+37.6%). Estimated incidence among new injectors decreased in three studies, with reductions ranging from -11/100 person years at risk to -16/100 person years at risk. While not fully consistent, the data generally support the effectiveness of NSP in reducing HIV and HCV infection in low/middle-income and transitional-economy countries. If high coverage is achieved, NSP appear to be as effective in LMICs as in high-income countries. Additional monitoring and evaluation research is needed for NSPs where reductions in HIV/HCV infection among PWID are not occurring in order to identify and correct contributing problems.

Smoking prevalence and its impacts on lung cancer mortality in Sub-Saharan Africa: an epidemiological study

BACKGROUND

Reliable mortality data are sparse for developing countries. Furthermore, risk factor prevalence information is hardly available and thus not taken into consideration when estimating mortality.

METHODS

The authors used a validated, statistical model combined with representative smoking prevalence from WHO STEPS surveys to estimate lung cancer mortality for six Sub-Saharan African countries (Benin, Malawi, Mozambique, Niger, Sierra Leone, Swaziland). Results were compared to a reference database (GLOBOCAN). Using different smoking prevalence scenarios, future lung cancer deaths were estimated.

RESULTS

The prevalence of current moderate smoking among males ranged from 8.7% to 34.6%. Prevalence was much lower among females. For all countries considered, our mortality estimates were higher than GLOBOCAN estimates that do not consider prevalence: Overall, we estimated 2405 lung cancer deaths for 2008 compared to 531 deaths estimated by GLOBOCAN. Up to 2030, lung cancer deaths are expected to increase in general and by over 100% in Benin and Niger. Even under the assumption of decrease in smoking prevalence, lung cancer mortality will rise.

CONCLUSION

On the bases of detailed smoking prevalence information, our findings implicate a higher lung cancer burden in low income countries. The epidemiologic transition in African low-income countries alludes to the need for targeted health prevention efforts.

Magnesium sulphate versus phenytoin in eclampsia - Maternal and foetal outcome - A comparative study

BACKGROUND

Eclampsia manifests as seizures and is unique to the pregnant state. It remains an important cause of maternal mortality especially in resource-challenged countries that lack access to prenatal care.

AIMS

The aim of our study was to compare maternal and foetal outcomes in mothers with eclampsia with the administration of either magnesium sulphate or phenytoin in a resource- challenged situation.

METHOD

The work was conducted from January 2012 to December 2012. A total of 80 patients were assigned alternately to two groups - one group was treated with magnesium sulphate (Group-M; n=40), and the other treated with phenytoin (Group-P; n=40) (Figure 1). The magnesium sulphate was administered according to Pritchard's regimen; phenytoin administered according to Ryan's regimen. With either regimen, anticonvulsant therapy was continued for 24 hours postpartum or 24 hours after the last convulsion, whichever was later.

RESULTS

Fifty-four per cent of patients regained consciousness within eight hours of treatment onset in Group-P compared to 5.3 per cent in Group-M (p=0.0001, χ(2)=19.24). Seven patients in Group-P had recurrence of convulsions as compared to none of the 40 women assigned to Group-M (p=0.032, χ(2)=4.62). The incidence of Caesarean section was greater (62.5 per cent) in Group-M compared to Group-P (25 per cent; p=0.001, χ(2)= 9.96). No statistically significant differences were found in the foetal outcomes between the two groups.

CONCLUSION

Phenytoin use may be reconsidered in selective cases in low and middle income countries (LMIC) as it has been found simpler to use, has several benefits and also curtails treatment cost. Magnesium sulphate is substantially more effective than phenytoin with regard to recurrence of convulsions. Proper training in the management of eclampsia should be given to all health care workers to ensure appropriate management of eclamptic mothers. Thus, the treatment of this disease calls for more research especially in resource-challenged settings.

A systematic review of the effectiveness of mental health promotion interventions for young people in low and middle income countries

BACKGROUND

This systematic review provides a narrative synthesis of the evidence on the effectiveness of mental health promotion interventions for young people in low and middle-income countries (LMICs). Commissioned by the WHO, a review of the evidence for mental health promotion interventions across the lifespan from early years to adulthood was conducted. This paper reports on the findings for interventions promoting the positive mental health of young people (aged 6-18 years) in school and community-based settings.

METHODS

Searching a range of electronic databases, 22 studies employing RCTs (N = 11) and quasi-experimental designs conducted in LMICs since 2000 were identified. Fourteen studies of school-based interventions implemented in eight LMICs were reviewed; seven of which included interventions for children living in areas of armed conflict and six interventions of multicomponent lifeskills and resilience training. Eight studies evaluating out-of-school community interventions for adolescents were identified in five countries. Using the Effective Public Health Practice Project (EPHPP) criteria, two reviewers independently assessed the quality of the evidence.

RESULTS

The findings from the majority of the school-based interventions are strong. Structured universal interventions for children living in conflict areas indicate generally significant positive effects on students' emotional and behavioural wellbeing, including improved self-esteem and coping skills. However, mixed results were also reported, including differential effects for gender and age groups, and two studies reported nonsignficant findings. The majority of the school-based lifeskills and resilience programmes received a moderate quality rating, with findings indicating positive effects on students' self-esteem, motivation and self-efficacy. The quality of evidence from the community-based interventions for adolescents was moderate to strong with promising findings concerning the potential of multicomponent interventions to impact on youth mental health and social wellbeing.

CONCLUSIONS

The review findings indicate that interventions promoting the mental health of young people can be implemented effectively in LMIC school and community settings with moderate to strong evidence of their impact on both positive and negative mental health outcomes. There is a paucity of evidence relating to interventions for younger children in LMIC primary schools. Evidence for the scaling up and sustainability of mental health promotion interventions in LMICs needs to be strengthened.

Study protocol for valuing EQ-5D-3L and EORTC-8D health states in a representative population sample in Sri Lanka

BACKGROUND

Economic evaluations to inform decisions about allocation of health resources are scarce in Low and Middle Income Countries, including in Sri Lanka. This is in part due to a lack of country-specific utility weights, which are necessary to derive appropriate Quality Adjusted Life Years. The EQ-5D-3 L, a generic multi-attribute instrument (MAUI), is most widely used to measure and value health states in high income countries; nevertheless, the sensitivity of generic MAUIs has been criticised in some conditions such as cancer. This article describes a protocol to produce both a generic EQ-5D-3 L and cancer specific EORTC-8D utility index in Sri Lanka.

METHOD

EQ-5D-3 L and EORTC-8D health states will be valued using the Time Trade-Off technique, by a representative population sample (n = 780 invited) identified using stratified multi-stage cluster sampling with probability proportionate to size method. Households will be randomly selected within 30 clusters across four districts; one adult (≥ 18 years) within each household will be selected using the Kish grid method.Data will be collected via face-to-face interview, with a Time Trade-Off board employed as a visual aid. Of the 243 EQ-5D-3 L and 81,290 EORTC-8D health states, 196 and 84 respectively will be directly valued. In EQ-5D-3 L, all health states that combine level 3 on mobility with either level 1 on usual activities or self-care were excluded. Each participant will first complete the EQ-5D-3 L, rank and value 14 EQ-5D-3 L states (plus the worst health state and "immediate death"), and then rank and value seven EORTC-8D states (plus "immediate death"). Participant demographic and health characteristics will be also collected.Regression models will be fitted to estimate utility indices for EQ-5D-3 L and EORTC-8D health states for Sri Lanka. The dependent variable will be the utility value. Different specifications of independent variables will be derived from the ordinal EQ-5D-3 L to test for the best-fitting model.

DISCUSSION

In Sri Lanka, a LMIC health state valuation will have to be carried out using face to face interview instead of online methods. The proposed study will provide the first country-specific health state valuations for Sri Lanka, and one of the first valuations to be completed in a South Asian Country.

Caesarean delivery and neonatal mortality rates in 46 low- and middle-income countries: a propensity-score matching and meta-analysis of Demographic and Health Survey data

BACKGROUND

Previous research on the association between caesarean delivery (CD) and neonatal mortality has had methodological limitations and given conflicting results. We conducted a study to: (i) estimate the association between CD at the individual level and neonatal mortality rates (NMR) in 46 countries; and (ii) examine whether this association varies among countries according to country-level rates of CD or gross domestic product (GDP).

METHODS

We obtained data from nationally representative Demographic and Health Surveys of women aged 15-49 years and their children aged 0-59 months (N = 392 883). Propensity-score matching, meta-analysis, and meta-regression were used to address the study objectives.

RESULTS

The pooled odds ratio (OR) for the association between individual level CD and NMR in 46 countries was 1.67 (95% confidence interval (CI) 1.48-1.89), with moderate heterogeneity (I(2) = 39%). A meta-analysis of subgroups indicated that CD at the individual level was positively associated with NMR in countries with low (OR = 1.99, 95% CI 1.71-2.33, I(2) = 8.5%) and medium (OR = 1.53, 95% CI 1.29-1.82, I(2) = 24%) rates of CD. There was substantial heterogeneity of the effects of CD among countries with high rates of CD (I(2) = 63%). Results of meta-regression showed that the association of individual-level CD with NMR depended upon country-level rates of CD. Compared with countries with high rates of CD, the OR of the NMR associated with individual-level CD in countries with low rates of CD was estimated to increased by a factor of 1.48 (95% CI 1.09-1.97).

CONCLUSIONS

Studies are needed to better understand the risks posed by CD in countries with low and medium rates of CD and to identify possible reasons for the heterogeneity in effects of CD among countries with high rates of CD.

Randomized trial of early developmental intervention on outcomes in children after birth asphyxia in developing countries

OBJECTIVE

To determine if early developmental intervention (EDI) improves developmental abilities in resuscitated children.

STUDY DESIGN

This was a parallel group, randomized controlled trial of infants unresponsive to stimulation who received bag and mask ventilation as part of their resuscitation at birth and infants who did not require any resuscitation born in rural communities in India, Pakistan, and Zambia. Intervention infants received a parent-implemented EDI delivered with home visits by parent trainers every other week for 3 years starting the first month after birth. Parents in both intervention and control groups received health and safety counseling during home visits on the same schedule. The main outcome measure was the Mental Development Index (MDI) of the Bayley Scales of Infant Development, 2nd edition, assessed at 36 months by evaluators unaware of treatment group and resuscitation history.

RESULTS

MDI was higher in the EDI (102.6 ± 9.8) compared with the control resuscitated children (98.0 ± 14.6, 1-sided P = .0202), but there was no difference between groups in the nonresuscitated children (100.1 ± 10.7 vs 97.7 ± 10.4, P = .1392). The Psychomotor Development Index was higher in the EDI group for both the resuscitated (P = .0430) and nonresuscitated children (P = .0164).

CONCLUSIONS

This trial of home-based, parent provided EDI in children resuscitated at birth provides evidence of treatment benefits on cognitive and psychomotor outcomes. MDI and Psychomotor Development Index scores of both nonresuscitated and resuscitated infants were within normal range, independent of early intervention.

Outcomes that matter: a qualitative study with persons with schizophrenia and their primary caregivers in India

BACKGROUND

Involving persons with schizophrenia and their families in designing, implementing and evaluating mental health services is increasingly emphasised. However, there is little information on desired outcomes from the perspectives of these stakeholders from low and middle income countries (LMIC).

AIMS

To explore and define outcomes desired by persons with schizophrenia and their primary caregivers from their perspectives.

METHOD

In-depth interviews were held with 32 persons with schizophrenia and 38 primary caregivers presenting for care at one rural and one semi-urban site in India. Participants were asked what changes they desired in the lives of persons affected by the illness and benefits they expected from treatment. Data was analysed using thematic and content analysis.

RESULTS

Eleven outcomes were desired by both groups: symptom control; employment/education; social functioning; activity; fulfilment of duties and responsibilities; independent functioning; cognitive ability; management without medication; reduced side-effects; self-care; and self-determination. Social functioning, employment/education and activity were the most important outcomes for both groups; symptom control and cognitive ability were more important to persons with schizophrenia while independent functioning and fulfilment of duties were more important to caregivers.

CONCLUSIONS

Interventions for schizophrenia in India should target both clinical and functional outcomes, addressing the priorities of both affected persons and their caregivers. Their effectiveness needs to be evaluated independently from both perspectives.

Economic cost of childhood unintentional injuries

AIMS

This study aims to review the economic cost of childhood (0-18 years) unintentional injuries (UI) and focuses upon comparing the cost burden between developing and developed countries.

METHODS

Articles were selected from PUBMED using the search words "Economic Cost", "Unintentional injuries" and "Children". Nine articles were selected.

RESULTS

Studies in China focused upon cost to hospitals, in Bangladesh they focused on personal payment in rural areas, and in Vietnam they focused upon community-based cost analysis. There was one study from Norway on UI at home. There were 5 articles from the USA focusing on submersion injury, UI insurance, unintentional traumatic brain injury, UI due to firearms and UI medical costs. The cost of childhood UI is enormous, ranging from US $516,938 to US $9,550,704 per year. This represents a large economic burden on society. Additionally, there is a large gap between lower-middle income countries (LMIC) and high income countries (HIC) in the burden of injury, injury health care and insurance systems.

CONCLUSION

Different bases and contexts of studies make it difficult to draw a solid conclusion about the amount of costs of UI among children. Therefore, more studies of children's unintentional injuries should be carried out in low and middle income countries.

Neurodevelopmental outcomes in infants requiring resuscitation in developing countries

OBJECTIVE

To determine whether resuscitation of infants who failed to develop effective breathing at birth increases survivors with neurodevelopmental impairment.

STUDY DESIGN

Infants unresponsive to stimulation who received bag and mask ventilation at birth in a resuscitation trial and infants who did not require any resuscitation were randomized to early neurodevelopmental intervention or control groups. Infants were examined by trained neurodevelopmental evaluators masked to both their resuscitation history and intervention group. The 12-month neurodevelopmental outcome data for both resuscitated and non-resuscitated infants randomized to the control groups are reported.

RESULTS

The study provided no evidence of a difference between the resuscitated infants (n = 86) and the non-resuscitated infants (n = 115) in the percentage of infants at 12 months with a Mental Developmental Index <85 on the Bayley Scales of Infant Development-II (primary outcome; 18% versus 12%; P = .22) and in other neurodevelopmental outcomes.

CONCLUSIONS

Most infants who received resuscitation with bag and mask ventilation at birth have 12-month neurodevelopmental outcomes in the reference range. Longer follow-up is needed because of increased risk for neurodevelopmental impairments.

Breast Cancer Systemic Therapy: The Need for More Economically Sustainable Scientific Strategies in the World

The world-wide incidence of cancer is expected to increase to 20 million by 2020. 70% of new cases occur in countries with 5% of the global cancer control resources. Breast cancer is the most common malignancy among women in high income, as well as low and middle income countries (LMCs). For the leading pharmaceutical companies, the current market for breast cancer systemic therapy (BCST) in LMCs is likely to decline in the future due to increasing costs of novel drugs. Breast cancer provides a strong example for multiple drug management of solid tumors. Development of economically sustainable scientific strategies for BCST in LMCs could improve affordability of therapy for other cancers throughout the world. Examples of recent and ongoing studies using protocols that could decrease costs of treatment without compromising outcomes are reviewed. The Win-Win initiative proposed by ICEDOC's (International Campaign for Establishment and Development of Oncology Centers) Experts in Cancer without Borders starts with small pilot meetings for oncologists with key stakeholders, including leading pharmaceutical companies. The participants would develop a roadmap for actionable strategies for crafting affordable BCST tailored to regional conditions and the diverse populations of women with breast cancer.

A competencies-based mental health training model for health professionals in low and middle income countries

This paper describes a competencies-based training model specifically created to teach needed mental health skills to health professionals in low and middle income countries (LMICs). The model combines a mental health training needs assessment with the delivery of mental health training modules aligned with national/regional mental health priorities and designed to be used by all health professionals at various levels of the health care system. The model also defines a sustainability framework that involves the creation of a multidisciplinary training team embedded in the national/regional health system. The training program consists of a number of modules, each one designed to enhance specific mental health competencies for a variety of health care workers. These modules are linked to a number of clinically useful tools that facilitate knowledge transfer into clinical care while concurrently addressing health equity issues. This model may provide an efficient and cost-effective alternative to traditional profession-based mental health training approaches, which have to date not been successful at meeting mental health delivery needs and mental health service priorities in LMICs.