STATEMENT OF THE PROBLEM: Despite the huge burden of mental health problems, about 85% of people with severe mental illness in sub-Saharan Africa (SSA) do not receive any form of treatment. Integrating mental health services into primary health care (PHC) has been advocated as the most viable means of closing this treatment gap. The linear model of intervention development, efficacy testing and implementation led to problems with sustainability over time and in real world setting. As there are policy and ethical implications of developing effective heath programmes without sustainability and scale-up, an understanding of the factors and processes that influences sustainability and scale up of an evidence-based intervention is needed for proactive planning OVERALL AIM: This feasibility study aims to identify the strategies to facilitate the health system changes necessary to sustain and scale up mental health services in primary care in Lagos, Nigeria. SPECIFIC QUESTIONS TO BE ADRESSED BY THE PROJECT 1) what is the state of implementation of the MeHPriC Project and what are the factors that are currently underlying its implementation?; 2) What are the dynamic interactions between the different components of the programme as regards contexts (inner and outer), implementation processes, implementation actors and intervention outputs and outcomes?; 3) How do these components influence the sustainability of the programme; and 4) What strategies may be required to facilitate the changes necessary for sustainability and scale-up METHODOLOGY There are 5 phases of the study. 1. In Phase 1, We will review policy documents and conduct in-depth interviews with selected policy makers to develop hypotheses, assess whether the target indicators for the project are met, identify how they are met, identify the key contextual facilitators and constraints and the way they affect the outcome. 2. In Phase 2, we will conduct a quantitative survey amongst the stakeholders including policy makers and administrators, programme managers, PHC health workers and recipients of care. They will complete scales to assess organisational readiness to change, sustainability and perceived intervention acceptability and feasibility 3. In Phase 3, we will conduct a brief evaluation of the implementation and through in-depth interviews, we will examine the stakeholders' perception about the health systems constraints to delivering, scaling up and sustaining the intervention. We will also observe selected PHC facilities to enable us to understand the factors that act as facilitators or barriers to sustenance of the intervention delivery. 4. In Phase 4, we will conduct a Theory of Change (ToC) workshop that will draw mainly on the results from the analysis of the earlier phases in combination with scientific knowledge and programme experience to identify health system changes that will improve sustainability in the delivery of the intervention. 5. In Phase 5, we will analysis and present the project report to the funders and the stakeholders RESEARCH IMPACT: 1. The individual care recipients will benefit from sustained level of evidence-based interventions leading to better outcomes and improved quality of life. 2. This study will enhance the health workers knowledge, motivation and attitude in providing effective mental health interventions in a sustainable way. 3. The programme implementers will be able to identify and include sustainability components to their design and implementation of complex interventions. 4. Evidence generated in this study will be shared with the WHO team to inform potential strategies for a sustainability and scalability of mental health interventions in LMICs. 5. The project will inform Policy makers on methods of sustaining beneficial interventions thereby maximizing the judicious use of funds

Sub-Saharan Africa faces the highest burden of stillbirths with Nigeria contributing around 12% of global burden of stillbirth (with about 314,000 stillbirths/year) and an estimated stillbirth rate of 42.9 per 1000 births . Stillbirth is associated with substantial psychological, social, economic and intangible cost to women, their families, healthcare providers and the wider society . Stillbirth in SSA countries brings many challenges to the mother including poor health, grief, sadness, and coping with community perceptions. The mothers' grief experiences following stillbirth are further complicated by the biological fact of death occurring within the body; generating feelings of anxiety, failure, and guilt. Studies have shown that guild and shame plays a very important role in predicting the intensity of later grief . The father is not left out of these difficulties. High rates of depression, anxiety, post-traumatic stress disorders and marital breakup has been observed in couples with stillbirth. For many couples in SSA, it takes a long time to recover from stillbirth, and in many instances only when another baby is born and survives, some few other never recovers. In Nigeria and many parts of SSA, the couple's grief is further compounded by many of the communities deeply rooted cultural practices and beliefs. Many Africa communities attribute stillbirth to spirits or supernatural powers, so bereaved parents avoid public burials and displays of grief, fearing such action could evoke future malice or lead to infertility. In many Africa traditions, women with stillbirth are accused of induced abortion and couples with stillbirth are forbidden from mourning and those who repeatedly lose their babies are blamed, mistreated, and dishonored. These harsh traditional value judgments about stillbirth in most African communities' results in high level of stigma and pushes many couples to keep stillbirths a secret. Problem with health systems: Apart from the stigma from the community, mothers who experience stillbirths are often overlooked midwives and other perinatal health workers who tend to focus on maternal and child health. Many health workers are ill equipped to handle grief that comes with stillbirth. Also, studies have shown that many healthcare providers may be avoidant, feel helpless and guilty or they may experience a sense of failure when the baby dies. Many health workers are not equipped to handle perinatal bereavement care. Also most of the guidelines of care after stillbirth reflect the western sociocultural perspectives and may not be appropriate in the African setting in view of the socio-cultural norms and nuances regarding stillbirth. In order to design a n effective, sociocultural acceptable intervention package of care and support for couples with stillbirth in Nigeria, it is necessary to first have a detail understanding of the peculiar sociocultural issues regarding stillbirth in the community, the specific psychological and social impacts of stillbirth that needs to be prevented, the preferences and perception of the affected couple to perinatal bereavement care and the health systems challenges and opportunities for delivering the intervention. Outcome expected as immediate result of the proposal: TThe results of this proposal will provide a deeper understanding of social perceptions of stillbirth in Nigeria and other SSA countries which is a crucial step towards reducing the isolation, grief, and stigma attached to stillbirth. It will also provide insight into the psycho-social burden of stillbirth, enumerate the challenges and opportunities for providing socio-culturally relevant bereavement care to coupes with stillbirth and most importantly lead to the development and feasibility assessment of an intervention package for support and care for Nigerian women with stillbirth