Strengthening of mental health information systems (MHIS) is essential to monitor and evaluate mental health services in low and middle-income countries. While research exists assessing wider health management information systems, there is limited published evidence exploring the design and implementation of MHIS in these settings. This paper aims to identify and assess the key factors affecting the design and implementation of MHIS, as perceived by the key stakeholders in Ghana and South Africa.

We report findings from the Mental Health and Poverty Project, a 5-year research programme implemented within four African countries. The MHIS strengthening in South Africa and Ghana included two related components: intervention and research. The intervention component aimed to strengthen MHIS in the two countries, and the research component aimed to document interventions in each country, including the key influences. Data were collected using semi structured interviews with key stakeholders and reviews of key documents and secondary data from the improved MHIS. We analyzed the qualitative data using a framework approach.

Key components of the MHIS intervention involved the introduction of a redesigned patient registration form, entry into computers for analysis every 2 months by clinical managerial staff, and utilization of data in hospital management meetings in three psychiatric hospitals in Ghana; and the introduction of a new set of mental health indicators and related forms and tally sheets at primary care clinics and district hospitals in five districts in the KwaZulu-Natal and Northern Cape provinces in South Africa. Overall, the key stakeholders perceived the MHIS strengthening as an effective intervention in both countries with an enhanced set of indicators in South Africa and introduction of a computerized system in Ghana.

Influences on the design and implementation of MHIS interventions in Ghana and South Africa relate to resources, working approaches (including degree of consultations during the design stage and communication during implementation stage) and the low priority of mental health. Although the influencing factors represent similar categories, more influences were identified on MHIS implementation, compared with the design stage. Different influences appear to be related within, and across, the MHIS design and implementation and may reinforce or negate each other thus leading to the multiplier or minimization effects. The wider context, similar to other studies, is important in ensuring the success of such interventions.

Future MHIS strengthening interventions can consider three policy implications which emerged from our analysis and experience: enhancing consultations during the intervention design, better consideration of implementation challenges during design, and better recognition of relations between different influences.

Information is needed for development of mental health (MH) services; and particularly in low- and middle-income countries (LAMICs), where the MH systems are relatively weak. World Health Organization (WHO) has worked intensively during the last 15 years for developing a strategy in the field of MH information.

The paper analyzes WHO instruments developed in this area [MH Atlas series and WHO Assessment Instrument for Mental Health Systems (WHO-AIMS)].

Data from Atlas series and WHO-AIMS demonstrated that the role of information is often neglected at all the steps: from data collection and processing to analysis, dissemination and utilization, particularly in LAMIC. By implementing several sets of feasible MH indicators WHO has technically supported the improvement of the MH information systems in LAMICs.

In the last few years the importance of information in MH has increased and has been successfully highlighted; but a lot of work still needs to be done for achieving a minimum set of MH indicators and reliable data that can be used by both high-income countries and LAMIC.