Training: Health center general nurses receive intensive training (40 hours) on assessing, diagnosing and managing four major neuropsychiatric disorders: schizophrenia, bipolar disorder, major depressive disorder, and epilepsy. Community health workers also receive sensitization on severe mental disorders case finding, referral system, patients follow up and behavior change for stigma reduction at community level.

Supervision: After the training, nurses receive intensive weekly supervision by trained Rwandan mental health nurse mentors. Mentors conduct regular supervision visits for clinical observation, case and documentation review, and brief didactic sessions, using a mental health supervision checklist. This checklist ensures standardization of activities and performance of key elements of psychiatric evaluation, diagnosis, and referral. Quality of care provided by health center nurses is defined by the successful completion of checklist items. During supervision visits, the nurse mentor also discusses system-based performance issues and “quality gaps” with the health center nurses and director to formulate specific plans to improve patient care, referral pathways, and coordination between services.

An evidence-based psychotherapy program for treating common mental disorders, including depression and anxiety, was integrated into the primary care system in 2017 through the adaptation of the WHO’s Problem Management Plus (PM+) intervention. To our knowledge, this is the first time PM+ has been being piloted in a rural, public setting worldwide, and the first time psychotherapy is being provided in Rwanda outside of the capital.

Patient psych-rehabilitation and reintegration at community level: IMB does extensive community outreach and provides social support for people living with mental health conditions, organizing psychoeducation/self-help groups and income-generating activities. As of 2019, there are 20 self-help groups with 1,838 members including people living with mental health conditions and their families.

Monitoring and evaluation system for mental health: The mental health team has transitioned to an electronic medical record system to be able to track patients overtime as well as monitor key quality improvement measures.