Planning and evaluating mental health services in low- and middle-income countries using theory of change

BACKGROUND: There is little practical guidance on how contextually relevant mental healthcare plans (MHCPs) can be developed in low-resource settings. AIMS: To describe how theory of change (ToC) was used to plan the development and evaluation of MHCPs as part of the PRogramme for Improving Mental health carE (PRIME). METHOD: ToC development occurred in three stages: (a) development of a cross-country ToC by 15 PRIME consortium members; (b) development of country-specific ToCs in 13 workshops with a median of 15 (interquartile range 13-22) stakeholders per workshop; and (c) review and refinement of the cross-country ToC by 18 PRIME consortium members. RESULTS: One cross-country and five district ToCs were developed that outlined the steps required to improve outcomes for people with mental disorders in PRIME districts. CONCLUSIONS: ToC is a valuable participatory method that can be used to develop MHCPs and plan their evaluation.