Rohit Ramaswamy, Gillings School of Global Public Health
Globally, there is a large treatment gap for people with mental disorders, and this gap is especially extreme in Low and Middle Income Countries (LMICs). This gap can be potentially bridged by integrating evidenced based mental health interventions into primary care, but there is little knowledge about how to do this well in countries with weak health systems. Research into the best implementation approaches is a priority, but in order to do so, it is first necessary to extend implementation science principles and tools to systematic approaches to design the service delivery system before any implementation can take place. In this paper, we describe an implementation approach for low resource settings, called design-focused implementation, emphasizing the design of delivery systems using systematic methods as a necessary precursor to implementation in severely resource-constrained environments. This approach draws from existing literature on design thinking, quality implementation, improvement science and evaluation and we describe its use in creating the processes, organizations and the enabling environment for integration of mental health service delivery into primary care in India. This approach will be useful for guiding research and practice in closing the implementation gap for a wide variety of complex interventions in low resource settings.