THE UNITED REPUBLIC OF TANZANIA

MINISRTY OF HEALTH

MUHUMBILI COLLEGE OF HEALTH AND ALLIED SCIENCES.

DEPARTMENT OF PHARMACEUTICAL SCIENCE

RESEARCH PROPOSAL

ASSESSMENT OF QUALITY OF MENTAL HEALTHCARE SERVICES

AT TANGA REGIONAL REFERRAL HOSPITAL

MODULE NAME: OPERATIONAL RESEARCH

MODULE CODE: PST 06210

SUPERVISOR: MR. RIAD

STUDENT NAMES
 MAGRETH CHARLES NS 4039/0062/2019
 SHAMSA ALI NS 0252/0045/2021
 WITNESS MBILINYI NS 5204/0031/2019
 HAPPY MATIKU NS 1241/0065/2020
 ROCK CHARLES NS 1487/0238/2021
 LWIDIKO ULIME NS 2506/0056/2021

DATE OF SUBMISSION: 04 JULY 2025

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 DECLARATION
We sincerely declare that this research report is our original work and that it has not been presented
to any other academic institution

Signature……………………….

Signature……………………….

Signature……………………….

Signature……………………….

Signature……………………….

Signature……………………….

Date……../……../2025

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 DEDICATION

This research is dedicated to all those who aspire to excel in the field of pharmaceutical sciences. It
is especially dedicated to our mentors and colleagues at Muhimbili College of Health and Allied
Sciences, whose guidance and support have been invaluable. May this work contribute to the
advancement of healthcare and serve as an inspiration for continuous learning and discovery.

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 ACKNOWLEDGEMENTS
We would like to express our deepest gratitude to a multitude of individuals and organizations who
have contributed to the development and success of this research proposal.

Firstly, our sincere thanks go to the faculty and staff of Muhimbili College of Health and Allied
Sciences, whose expertise and knowledge have been a beacon of guidance throughout our academic
journey. Their unwavering support and encouragement have been instrumental in shaping our
research skills.

Special appreciation is extended to our research supervisor, whose patience and scholarly insight
have greatly enhanced this work. Their critical feedback and constructive criticism have been
invaluable in refining our research objectives and methodologies.

We are also immensely grateful to our peers and fellow researchers for their collaborative spirit and
stimulating discussions, which have enriched our research experience.

Our heartfelt thanks to the healthcare professionals and patients who participated in this study,
sharing their experiences and insights, which are the foundation upon which this research is built.

We acknowledge the financial support received from various grants and scholarships, without which
this research would not have been possible. Their investment in education and research has opened
doors to countless opportunities for innovation and advancement.

To our families and friends, for their endless love, moral support, and patience during the demanding
periods of this research, we are eternally thankful. Their belief in our abilities has been a constant
source of motivation.

Lastly, we extend our appreciation to all those who have contributed directly or indirectly to this
work. Your collective wisdom and assistance have been a pillar of strength throughout this academic
endeavor.

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 Table of Contents
DECLARATION...................................................................................................................................ii
DEDICATION......................................................................................................................................iii
ACKNOWLEDGEMENTS..................................................................................................................iv
LIST OF ABBREVIATIONS................................................................................................................v
CHAPTER ONE....................................................................................................................................1
1.INTRODUCATION........................................................................................................................1
CHAPTER TWO...................................................................................................................................6
2.0 Literature Review.........................................................................................................................6
CHAPTER THREE................................................................................................................................9
3.0 Methodology................................................................................................................................9
CHAPTER FOUR................................................................................................................................13
4.0 Work Plan...................................................................................................................................13
CHAPTER FIVE..................................................................................................................................15
5.0 Budget........................................................................................................................................15
REFERENCES.....................................................................................................................................16
APPENDICES......................................................................................................................................17
Appendice I:.....................................................................................................................................17
Steps followed in data analysis.....................................................................................................17
Appendices II:..................................................................................................................................17
Characteristics of Participants......................................................................................................17
Appendices III:.................................................................................................................................17
Appendices IV:.................................................................................................................................18

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 LIST OF ABBREVIATIONS
DSM-IV
Diagnostic and Statistical Manual of Mental Disorders (fourth edition), 1
FGDs
Focus group discussion, 11
LMICs
Low and Middle Income Countries, 7
PHC
Population and Housing Census, 2
WHO
World Health Organization, 1

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 CHAPTER ONE
1.INTRODUCATION
1.1Background Information:

Mental disorders are very common in almost all countries of the world, and are known to
largely affect socioeconomic development and growth. The global DSM-IV disorders
lifetime prevalence is estimated to be between 18.1% and 36.1%, with no significant
difference between high and low and middle income countries. Mental disorders often have
an early age of onset, and are associated with considerable societal costs. The social and
economic impact of mental disability is diverse and far-reaching. Mental disorders inflict
emotional as well as financial burden on individuals, families and society as a whole. People
with mental disorders are usually victims of homelessness, incarceration, lack of educational
and income-generation opportunities, and human rights violation. This situation frequently
leads individuals and families into poverty and hindrance of economic development at the
national level.

The impact of mental disorders on human life dictates the basis for designing and
implementing effective strategies to address this problem. There is a need to scale up
treatment for mental disorders in low- and middle-income countries where most of the
treatment gap exist. This is thought to be potentially cost-effective and would result into
many communities of the world to be more functional and productive. For this reason, the
World Health Organization (WHO), put down key recommendations for organizing mental
health services through its Mental Health Policy and Service guidance package, to assist
countries to improve the mental health of their populations . The recommendations outline
key 7 principles for organizing comprehensive mental health services in order to address
various needs of people with mental disorders. These principles include accessibility,
comprehensiveness, coordination and continuity of care, effectiveness, equity, respect for
human rights, and coordination of specialized services with primary care and intersectoral
collaboration.

However, low- and middle-income countries like Tanzania continue to face many challenges
in the efforts to implement the WHO recommendations to improve mental health services.
Such challenges include human resource constraints, inadequate training in mental health
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care, misplacement of mental health care professionals, lack of drugs, low priorities, lack of
skilled care providers at primary health care level, problematic insurance coverage for mental
disorders, and stigma. Levels of public expenditures on mental health are very low in low and
middle-income countries (less than US$ 2 per capital).

These challenges are partly attributed to a lack of political will by governments in giving due
priority to mental health. As a result, a much lower proportion of low-income countries report
having a policy, plan, and legislation on mental health than high-income countries. For
example, while 92% of people in high income countries are covered by mental health
legislation, only 36% are covered in low-income countries. To effectively implement
programs aimed at meeting mental health needs, governments and health authorities of low-
and middle-income countries must first issue clear policies articulating measures for the
identification and treatment of patients with mental disorders.

This study was conducted in Tanga city in the northern part of Tanzania. It is one of the fast
growing cities in Tanzania, fueled by an influx of unemployed youth from upcountry and
rural areas. According to the 2022 Population and Housing Census (PHC) conducted by the
Tanzania National Bureau of Statistics, Tanga is the 13thpopulated region in Tanzania with a
population of 2,539,070. This is a population density of 109 people per square kilometer. The
PHC was conducted from August 23 to September 4, 2022, and President Samia Suluhu
Hassan released the results in Dodoma on October 31, 2022.

1.2 Statement of the Problem

This study was conducted to see how health facilities at the regional level were prepared to
meet the increasing mental health needs of the population, specifically, in Tanga region .
Results from this study are useful in shedding some light on the status of mental health
services, and in providing recommendations to improve services so that mental health needs
are adequately met. Results can also be applied in other settings with similar context within
and outside the country, especially in other low- and middle-income countries

1.3 Rational of The Study

An increasing portion of the city’s population, including the newcomers, faces limited
employment options and struggles under difficult living conditions. There is also a high rate
of illicit drug trafficking and drug abusers, according to Population and Housing Census of

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 2022. Such socioeconomic challenges are likely to cause mental health problems among the
population. With this trend, mental health needs are rising, and regional hospitals are being
bombarded with a huge number of clients seeking mental health care. It is, therefore,
imperative that the community and health facilities are well prepared to meet this demand. In
view of this situation. this study was conducted to see how health facilities at the regional
level were prepared to meet the increasing mental health needs of the population, specifically,
in Tanga region. Results from this study are useful in shedding some light on the status of
mental health services, and in providing recommendations to improve services so that mental
health needs are adequately met. Results can also be applied in other settings with similar
context within and outside the country, especially in other low- and middle-income countries

1.4 Hypothesis
Question: How can the mental health care delivery system in Tanga region be improved to
effectively meet the increasing mental health needs of its rapidly growing population?

This research question aims to explore strategies and interventions that can enhance mental
health services in Tanga region. It seeks to identify specific areas for improvement and
address the challenges faced by the existing system. Results can also be applied in other
settings with similar context within and outside the country, especially in other low- and
middle-income countries. The hypothesis proposes that specific actions (such as increasing
staff, enhancing training, and allocating resources) will positively impact mental health
services. It predicts that these improvements will ultimately benefit patients by providing
better care and addressing their needs more effectively.

1.5 Research Questions

interview questions that I can use when conducting research interviews with health workers
and patients related to mental health care delivery. These questions cover a range of topics,
from their experiences to their perspectives on improving mental health services:

For Health Workers:

 How long have you been working in mental health care, and what motivated you to pursue
this field?
 Can you describe a challenging case you’ve encountered in your practice and
how you addressed it?

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  What strategies do you use to ensure patient adherence to treatment plans?
 How do you handle communication with patients’ families and caregivers?
 What role do interdisciplinary teams play in providing comprehensive mental
health care?
 How do you stay up-to-date with the latest research and best practices in
mental health?

For Patients:
 Can you share your experience with accessing mental health services? What went well, and
what challenges did you face?
 How did you decide to seek professional help for your mental health concerns?
 What factors influence your choice of mental health care providers?
 How do you feel about the stigma associated with mental health issues, and how has it
affected your willingness to seek help?
 What improvements would you like to see in mental health services?
 How do you perceive the quality of care you’ve received so far?

For Both Health Workers and Patients:

 What barriers exist in the current mental health care system, and how can they be overcome?
 How can we better integrate mental health services into primary care settings?
 What role does community awareness and education play in promoting mental health?
 How can technology (telehealth, apps, etc.) enhance mental health service delivery?
 What are your thoughts on preventive mental health care?
 How can we address disparities in mental health care access and outcomes?
 What strategies can improve collaboration between health workers and patients in managing
mental health conditions?

1.5 Research Objectives

1.5.1 General Objective
The major aim of this study was to determine how mental health services were organized and
delivered at Tanga regional referral hospital, in Tanga.

1.5.2 Specific objectives

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1. Determine the health care facility’s human resource for mental health

2. Explore experiences of patients and caregivers in receiving mental health care services at
the healthcare facility

3. Describe the trend in the number of patients being seen at the mental health section of the
facility

4. Describe factors affecting provision of mental health services

5. Describe managerial support provided to the mental health section

1.6 Research Limitation

Limitation This study included care providers working in the mental health section, patients,
caregiver, and district and national mental health coordinators. Higher authorities within the
Tanga regional referral hospital were not included. May be, doing so might have altered the
results of this study because of the role they play in the delivery of health services such as
allocation of human and material resource and moral support.

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 CHAPTER TWO
2.0 Literature Review
2.1 introduction
Mental health care is a critical component of overall health systems, yet it often receives
inadequate attention and resources in Low- and Middle-Income Countries (LMICs). The
quality of mental health services directly impacts patient outcomes, well-being, and societal
functioning. In this literature review, we explore key aspects related to assessing mental
health care quality in LMICs.

2.2 literature review

During our study to this research proposal past papers and blogs on the internet, our eyes
caught different methods to assess the quality of mental health as well as different
interventions which were used in the past to improve the health care service which will help
us in our research to see how those interventions which were used in middle- and low-income
countries may be applied in Tanzania and how previous interventions worked to improve the
services and here summaries of what we had read.

Community-based mental health interventions have shown promise in LMICs. A study by

Clarissa Giebel et al. (2024) highlights the importance of integrating mental health services
into existing health infrastructures and involving stakeholders at all stages of intervention
development and implementation. This approach helps address logistical barriers and ensures
sustainability. Giebel and colleagues conducted a qualitative study with international experts,
emphasizing the need for public and stakeholder involvement to meet local needs and sustain
participant motivation. They identified key barriers such as transport, resources, and location,
which need to be addressed to ensure local sustainability.

Abhijit Nadkarni, Charlotte Hanlon, and Vikram Patel (2023) discuss various mental
health care models that aim to bridge the treatment gap in LMICs. These models include task-
sharing approaches, collaborative stepped care, and integration of care into alternative
platforms. Despite their success, challenges such as geographic inaccessibility and human
resource shortages persist. Nadkarni et al. highlight the importance of innovative solutions to
overcome these barriers, such as responding to distress, dimensional formulations of mental
ill health, and rights-based care. Future work needs to explore systematic implementation at
scale, transdiagnostic approaches, and digital solutions.

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Integrating mental health services into primary care has been found to be effective and cost-
efficient. A systematic review by Cambridge University Press (2023) emphasizes the
benefits of behavioral health integration in managing depression and unhealthy alcohol use in
LMICs. This approach leverages existing primary care structures to provide comprehensive
mental health care. The review identifies successful components of collaborative care
models, such as multi-disciplinary care teams, standardized protocols for evidence-based
treatments, and a stepped-care approach to treatment intensification. These elements are
crucial for addressing the mental health treatment gap in LMICs.

Improving help-seeking behavior is crucial for addressing mental health issues in LMICs. A
systematic review by Myrthe van den Broek et al. (2023) identifies interventions that
enhance help-seeking for mental health problems, focusing on both supply-side and demand-
side barriers1. The review categorizes intervention components into three main areas:

Raising Mental Health Awareness: This involves public awareness campaigns using printed
or audio-visual materials to educate the general population about mental health issues. These
campaigns aim to reduce stigma and increase knowledge about mental health, encouraging
individuals to seek help when needed.

Identification of Individuals Experiencing Mental Health Problems: Community-level

screening and detection programs are implemented to identify individuals who may be
suffering from mental health issues. These programs often involve training community health
workers to recognize symptoms and refer individuals to appropriate services.

Promoting Help-Seeking Among People in Need: Interventions in this category include

sending reminders and providing information about available mental health services to
individuals identified as needing help. These strategies aim to bridge the gap between
recognizing a mental health issue and actually seeking professional assistance.

The World Health Organization (WHO) has developed assessment tools to evaluate mental
health systems in LMICs, particularly for child and adolescent mental health services. These
tools help identify gaps and areas for improvement, ensuring that young populations receive
adequate mental health care.
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Assessment of Service Availability: The WHO’s tool assesses the availability of child and
adolescent mental health services within the existing health infrastructure. It examines the
presence of specialized clinics, trained personnel, and age-appropriate interventions. The goal
is to ensure that mental health services are accessible to children and adolescents in need.

Quality of Care: This aspect evaluates the quality of mental health services provided to
young populations. It considers factors such as evidence-based practices, continuity of care,
and adherence to treatment guidelines. The tool assesses whether services meet established
standards and promote positive outcomes for children and adolescents.

Integration with Education and Social Services: Recognizing that mental health extends
beyond clinical settings, the WHO tool examines integration with educational institutions and
social services. It assesses school-based mental health programs, community outreach, and
collaboration with child protection agencies. Integration ensures a holistic approach to mental
health care.

Stigma Reduction and Awareness: The tool evaluates efforts to reduce stigma associated
with mental health issues among children, adolescents, and their families. Stigma can hinder
help-seeking behavior and perpetuate discrimination. Strategies include awareness
campaigns, school-based education, and involving parents and teachers.

Child Participation and Rights: Ensuring that children and adolescents have a voice in their
mental health care is essential. The tool assesses whether services actively involve young
individuals in decision-making, respect their rights, and provide age-appropriate information.
Empowering children promotes better engagement and outcomes.

2.3 Conclusion
The assessment of quality mental health care in LMICs requires a multifaceted approach that
includes community-based interventions, integration into primary care, and targeted help-
seeking strategies. Continued research and innovative models are essential to overcoming the
persistent challenges and improving mental health outcomes in these regions.

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 CHAPTER THREE
3.0 Methodology
3.1 Study area
This study will be conducted in a randomly selected Tanga region. Tanga is a fast growing
city in Tanzania with the population of more than two million according to National Bureau
of Statistics of 2022. Tanga is one of the regions in Tanzania with socio-economic
characteristics likely to influence the occurrence of mental health problem/ disorders.

3.2 Study design

This will be a cross sectional qualitative study that looked at how mental health services is
organized and delivered. Study participants the study participants included in this study will
be health care providers, patients with mental illness, caregivers of the mentally ill, and
coordinators for mental health services at regional and national levels. Informed consent is to
be seen from all participants before starting the interviews . However, for mentally ill
individuals, informed consent will be taken twice, first from their guardians, and then from
patients themselves. Since interviews with patients will be conducted within the health
facility, it is convenient to provide further support to patients in case they need any help
related to their health. Patients will be repeatedly reminded that it was at their own discretion
to stop the interview and leave whenever they felt they needed to do so.

3.3 type of data

The type of data will use in this research is Qualitative data , refers to information that is
collected and analyzed in non-numerical form. Unlike quantitative data, which involves
numbers and statistical analysis, qualitative data focuses on understanding concepts,
opinions, or experiences. Here are some key points about qualitative data. Qualitative
research aims to gain in-depth insights, explore new ideas, and understand complex
phenomena that why I chose it to this study.

3.4 Data collection method

A total of 14 in-depth interviews will be conducted, 7 with mental health care providers, and
7 with patients attending the mental health clinics at the health facilities. One focus group
discussion (FGDs) were also conducted with 10 caregivers (each FGD comprising 8
caregivers). Areas to be covered in the interviews were human resource for mental health
situation, experiences of patients in receiving mental health care services, number of patients

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being seen, managerial support provided to the mental health section, factors affecting
provision of mental health services, and satisfaction with mental health services. In-depth
interviews and FGDs will be in Swahili, a common language to all participants, A semi-
structured interview guide will be used to interview participants. All interviews will be
conducted in the rooms located within the hospital premises. During FGDs, the moderator
(author) will lead the discussion and keep the conversation flowing while recording the
interviews and taking some notes.

3.5 Data analysis

All the audio data will be transcribed verbatim. The content analysis method (Graneheim &
Lundman, 2004) in accordance with qualitative analytical framework was used to analyze
data. NVivo 10 software was used in organizing data and coding the text. The coded text was
filtered and placed in similar contents that formed a family tree. The identified content of the
text was entered into memos which were eventually manually organized into patterns and
themes

3.6 reliability and validity of data

to ensure reliability and validity of data we will try several methods that will contribute to
this point like :

Use Reliable Instruments: Using measurement tools that have been rigorously tested for
reliability. These instruments should consistently yield similar results when applied under the
same conditions.

Pilot Testing: Conduct preliminary studies to refine your research design and instruments.
Pilot testing helps identify any issues or inconsistencies before full-scale data collection.

Triangulation: Employ multiple methods or sources to cross-verify your results. By

combining different approaches, we can enhance the reliability and validity of our findings.

Control Variables: we will try to be mindful of extraneous variables that might influence
our outcomes. Properly controlling these variables ensures more accurate and valid results.

3.7 sampling technique

Stratified sampling is a powerful technique used by researchers to ensure that every subgroup
(or stratum) within a larger population is adequately represented in the sample. And it will be

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the method used in selecting samples for our research. Because we have three to select from
care providers, patients and social workers . stratified sampling enhances the generalizability
and validity of research studies, minimizing biases like under coverage.

3.8 sampling size determination

The sampling size is carefully selected according to the objective of the study and the
difficulty to access to the patients and health care providers and the limited resources. 30
participants are the number I estimated to be able to interview due to the factors being stated
above.

3.9 Sampling procedure

A convenient sampling procedure will be applied to get all participants. Care providers,
Patients with mental illness, and caregivers who will present during data collection are
included. Participants will mainly recruit on the clinic days (Mondays, Wednesdays, and
Fridays) when the mentally ill patients are being seen. The inclusion criteria are; care
providers who had worked in the mental health section for at least six months, patients who
had a chronic mental illness and caregivers who had stayed with a mentally ill patient for at
least six months. The exclusion criteria are; caregivers who had serious patients, patients who
is mentally unstable, and care providers who is attending serious patients.

3.10 sampling criteria

3.10.1 inclusion criteria are; care providers who have work in the mental health section for
at least six months, patients who have a chronic mental illness and caregivers who have stay
with a mentally ill patient for at least six months.

3.10.2 exclusion criteria are; caregivers who have serious patients, patients who is mentally
unstable, and care providers who is attending serious patients.

3.11 Characteristic of participants

The study comprises three groups of participants, namely, health care providers, caregivers,
and patients. Health care providers included 2 Assistant Medical Officers (AMO), 3 Nurses, 1
Social Worker (SW), the District Mental Health Coordinator (DMHC), and the National
Mental Health coordinator (NMHC). Among nurses who were interviewed, 1 will be a
nursing officer, 2 are senior nursing officers, and one working as a social worker (See Table
1 below). The duration of providing mental health services among health care providers

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ranged from 3 to 8 years. Caregivers comprised both males and females. Patients who will be
included has schizophrenia, depression, and bipolar disorders.

3.12 Services offered

Mental health services being offered at Tanga health facility is both the outpatient clinic and
inpatient. counseling for drug abusers, and psychoeducation to relatives. When patients could
not receive effective treatment from places, including traditional healers, their last resort was
at this hospital.

3.13 ethical consideration

We used the following methods to ensure the patient rights and privacy of data: Informed
consent is to be seen from all participants before starting the interviews. However, for
mentally ill individuals, informed consent will be taken twice, first from their guardians, and
then from patients themselves. Since interviews with patients will be conducted within the
health facility, it is convenient to provide further support to patients in case they need any
help related to their health. Patients will be repeatedly reminded that it was at their own
discretion to stop the interview and leave whenever they felt they needed to do so.

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 CHAPTER FOUR
4.0 Work Plan
This plan is to be conducted within 7 weeks, where the whole activities that will be done
from the start of preparing research topic till dissemination of the report. The work plan has
to be followed accordingly so as to be punctual so as fulfil the recommendation of finalizing
the research work.

Task Responsible Timeframe Expected output

person (Number of days)

Prepare proposal Principal 2weeks Proposal prepared

investigator according to acceptable
format/guideline

Submit proposal to Principal 1 day Proposal submitted to

the college investigator college

Prepare data Principal 3 days Data collection

collection tools investigator prepared

Travel to data Principal 2 days Data collected travelled

collection sites investigator to data collection site

Pre-test and Principal 1 day Data collection tools

improve data investigator pre-tested
collection tools

Seek permission to Principal 1 day Permission to

conduct study at investigator conducted research is
Tanga regional granted
referral hospital

Collect Data Principal 5 days Data collected

investigator

Travel back to Principal Data collectors travel

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 college investigator/data 5 days back to college
collectors

Process and Principal 2 weeks Data analysis processed

analysis data investigator and analyzed

Write Principal 3 weeks Research report is

dissertation/report investigator written

Bind and submit the Principal 1 day Research report is

dissertation investigator submitted

CHAPTER FIVE

5.0 Budget

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S/N ACTIVITIES/ITEM AMOUNT/SIZE PRICE TOTAL

1 Transportation 10000 10,000

2 Emergency money 10,000 10,000

3 Pen 5 500 2,500

4 Pencil 2 200 400

5 Ruler 3 500 1,500

6 Correction fluid 1 bottle 1500 1,500

7 Glue 3 bottles 1000 3,000

8 Rubber 3 500 1,500

10 Notebook 4 2000 8,000

12 Rim paper 1 10000 10,000

13 Photocopy 50 copies 100 5,000

14 Binding 2 1500 3,000

15 Water 24 bottles 700 16,800

Total 73200

REFERENCES.
1. Kessler RC, Aguilar-Gaxiola S, Alonso J, Chatterji S, Lee S, Ormel J, et al. Theglobal
burden of mental disorders: an update from the WHO world mental health (WMH)
surveys. Epidemiol Psichiatr Soc. 2009;18(1):23–33.
15
2. Steel Z, Marnane C, Iranpour C, Chey T, Jackson JW, Patel V, et al. The global
prevalence of common mental disorders: a systematic review and metaanalysis 1980-
2013. Int J Epidemiol. 2014;43(2):476–93.
3. World Health Organization. Investing in mental health [Internet]. Geneva: World
Health Organization; 2003 [cited. Feb 15. 2017; Available from: http://
www.who.int/mental_health/media/investing_mnh.pdf].
4. Funk M, Drew N, Knapp M. Mental health, poverty and development. J Public Ment
Health. 2012;11(4):166–85.
5. Trautmann S, Rehm J, Wittchen H. The economic costs of mental disorders: do our
societies react appropriately to the burden of mental disorders? EMBO Rep.
2016;17(9):1245–9.
6. Saraceno B, van Ommeren M, Batniji R, Cohen A, Gureje O, Mahoney J, et al.
Barriers to improvement of mental health services in low-income and middle-income
countries. Lancet. 2007;370(9593):1164–74.
7. Organizzazione mondiale della sanità. Organization on services for mental health.
Geneva: World health organization; 2003.
8. Sikwese A, Mwape L, Mwanza J, Kapungwe A, Kakuma R, Imasiku M, et al. Human
resource challenges facing Zambia’s mental health care system and possible solutions:
results from a combined quantitative and qualitative study. Int Rev Psychiatry.
2010;22(6):550–7.
9. Improving-access-to-mental-health-services-in-Malawi.pdf.

10. Hanlon C, Luitel NP, Kathree T, Murhar V, Shrivasta S, Medhin G, et al. Challenges
and Opportunities for Implementing Integrated Mental Health Care: A District Level
Situation Analysis from Five Low- and Middle-Income Countries. Montazeri A,
editor. PLoS ONE. 2014;9(2):e88437.
11. World Health Organization, editor. Mental health atlas 2014. Geneva: World Health
Organization; 2015. p. 67.

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 APPENDICES
Appendice I:
Steps followed in data analysis

Appendices II:
Characteristics of Participants

Appendices III:
Consent Form

We are the third-year students at Muhimbili College of Health and Allied Sciences in the
field of Pharmaceutical Sciences.
We are conducting a research on ASSESSMENT OF QUALITY OF MENTAL HEALTH
SERVICES AT TANGA REGIONAL REFERRAL HOSPITAL
If you agree to participate you will be requested to sign in this form and to answer some
question that will be asked through interview and all information that will be obtained will
be confidential
Note: name is not required and also no effect will be occurred for your participation.
Participant signature…………………... Date………………………….

Researcher signature…………………. Date…………………………...

17
Appendices IV:
Translation of the research questions to Kiswahili
Kwa wafanyakazi wa afya:

Umekuwa ukifanya kazi kwa muda gani katika huduma ya afya ya akili, na ni nini
kilichokuhamasisha kufuata uwanja huu?

Je, unaweza kuelezea kesi yenye changamoto ambayo umekutana nayo katika mazoezi yako
na jinsi ulivyoishughulikia?

Ni mikakati gani unayotumia kuhakikisha uzingatiaji wa mgonjwa kwa mipango ya

matibabu?

Je, unashughulikiaje mawasiliano na familia za wagonjwa na walezi?

Timu za interdisciplinary zina jukumu gani katika kutoa huduma kamili ya afya ya akili?

Je, unakaaje up-to-date na utafiti wa hivi karibuni na mazoea bora katika afya ya akili?

Kwa wagonjwa:

Je, unaweza kushiriki uzoefu wako na kupata huduma za afya ya akili? Ni nini kilichokwenda
vizuri, na ni changamoto gani ulikabiliana nazo?

Uliamuaje kutafuta msaada wa kitaalam kwa matatizo yako ya afya ya akili?

Ni mambo gani yanayoathiri uchaguzi wako wa watoa huduma za afya ya akili?

Unahisije kuhusu unyanyapaa unaohusishwa na maswala ya afya ya akili, na imeathirije nia

yako ya kutafuta msaada?

Ni maboresho gani ungependa kuona katika huduma za afya ya akili?

Je, unatambuaje ubora wa huduma uliyopokea hadi sasa?

Kwa wafanyakazi wa afya na wagonjwa:

Ni vikwazo gani vilivyopo katika mfumo wa sasa wa huduma ya afya ya akili, na jinsi gani
wanaweza kushinda?

Tunawezaje kuunganisha huduma za afya ya akili katika mipangilio ya huduma ya msingi?

Je, ufahamu na elimu ya jamii ina jukumu gani katika kukuza afya ya akili?

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Teknolojia (telehealth, programu, nk) inaweza kuboreshaje utoaji wa huduma za afya ya
akili?

Nini maoni yako juu ya huduma ya afya ya akili ya kuzuia?

Tunawezaje kushughulikia tofauti katika upatikanaji wa huduma za afya ya akili na matokeo?

Ni mikakati gani inayoweza kuboresha ushirikiano kati ya wahudumu wa afya na wagonjwa

katika kusimamia hali ya afya ya akili?

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