CONVOCATORIA A JUNTA GENERAL DE ACCIONISTAS

In order to determine the current characteristics of the mental health system in Gaza in relation to policy development, service development and delivery, and availability of human resources (Research Question 1), the World Health Organization- Assessment Instrument for Mental Health Systems (WHO-AIMS) questionnaire

98

(Version 2.2) was used to conduct a comprehensive assessment of the mental health system in Gaza (WHO, 2005a). This tool has been developed by the WHO to gather information on mental health systems, especially in Low and Middle Income Countries (LMICs), for the purpose of improving mental health services and strengthening mental health systems (WHO, 2005a). The ten recommendations proposed by the WHO report “Mental Health: New Understanding, New Hope” for improving mental healthcare in LMICs provide a scientific background for areas that need to be assessed and strengthened to improve mental healthcare (WHO, 2001). The ten recommendations for action that form the main areas for assessment of the WHO-AIMS questionnaire are: (1) provide treatment in primary care, (2) make psychotropic drugs available, (3) give care in the community, (4) educate the public, (5) involve communities, families and consumers, (6) establish national policies, programmes and legislations, (7) develop human resources, (8) link with other sectors, (9) monitor community mental health, and (10) support more research (WHO, 2001).

The WHO-AIMS questionnaire consists of six main domains: (1) policy and legislative framework, (2) mental health services, (3) mental health in primary healthcare, (4) human resources, (5) public education and link with other sectors, and (6) monitoring and research. The six domains include 28 facets and 156 questions (WHO, 2005a). Each domain contains sets of items and sub-domains to assess the system development in a particular area. Domain (1) contains five sub-domains and 21 items, domain (2) contains 11 sub-domains and 63 items, domain (3) contains three sub-domains and 19 items, domain (4) contains four sub-domains and 25 items,

99

domain (5) contains three sub-domains and 18 items, and domain (6) contains two sub-domains and eight items.

Because required information sometimes overlaps between one domain and another, the source of information and questions varied according to the information necessary. Therefore, I redistributed the questionnaire‟s questions into six different surveys according to the similarity of topics and the relevancy to the source of information. Survey (a) covered the mental health directorate and included 30 items; survey (b) covered services at the mental hospital and included 23 items; survey (c) covered services at CMHCs and included 19 items; survey (d) covered mental health services in primary healthcare and included 15 items; survey (e) covered research and mental health learning at the main university in Gaza and included four items; and survey (f) covered psychosocial and mental health services in the Ministry of Education and included four items (see Appendix Two). The total number of items was 95. After checking the relevance of questions to the mental health system in Gaza, 61 questions were excluded because they were not applicable. For example, many questions explore services provided by community-based psychiatric inpatient units or day treatment facilities or community residential facilities. All questions related to those facilities were removed because such facilities are not available in Gaza.

Grouping questions into six surveys was done to facilitate obtaining the information from the data sources. Such grouping is permitted by the guidelines for using the

100

WHO-AIMS; however, entering the data into the WHO-AIMS data sheet followed the order of the questions in the original instrument (WHO, 2005a).

3.7.1 Sampling

Based on the main topic in each of the developed surveys, a purposive sample of six focal points was recruited. The sampling followed the WHO-AIMS‟s guidelines (WHO, 2005a) that recommend selecting focal points who are professionals with access to all information that is needed, and it is preferable that they work in the governmental sector so that they have a comprehensive view on the development of their survey section.

3.7.2 Recruitment

Because four surveys investigate the development of the mental health system in the MoH in Gaza, four focal points from that Ministry were recruited. In addition, one focal point from the Ministry of Education and one focal point from the Islamic University of Gaza were recruited to answer questions on mental health in schools and mental health research, respectively.

The recruitment process followed the procedures and rules of recruitment for participating in research studies at the MoH in Gaza. Permission was obtained from the Directorate of Human Resources in the MoH in Gaza to recruit four focal points. This was followed by sending a separate letter for the recruitment of every focal point with an attachment of a copy of the written permission obtained from the MoH to implement this study, a copy of the questionnaire and a copy of the information

101

sheet. The letters were directed to general managers of the departments relevant to the implementation of the WHO-AIMS surveys (WHO, 2005a).

To appoint focal points to answer the survey questions on the mental health hospital, CMHCs and Mental Health Directorate, the General Director of Mental Health in the MoH was sent three separate letters to nominate three different focal points to answer the surveys. The General Director of Primary Healthcare was sent a letter to nominate one focal point to answer the primary care survey. The General Director of Counselling and Guidance at the Ministry of Education was sent a letter to nominate a focal point to answer the survey‟s questions on mental health in schools. The President of the Islamic University in Gaza was sent a letter to nominate a focal point to answer the survey questions on mental health research and mental health training at the university.

The recruitment of selected key focal points from different health and education backgrounds helped to provide a variety of views from health, research, education, and mental health professionals working in different settings.

3.7.3 Participants

The selected six focal points were among the senior technical level in each organisation/department that can access the information needed to complete the WHO-AIMS surveys (WHO, 2005a). From the MoH, the nominated focal points were: the Director of the Mental Hospital, the Director of CMHCs, the Director of the Mental Health Directorate and the Director of Primary Healthcare. From the Ministry of

102

Education, the selected focal point was the Director of the Psychosocial Counselling and Guidance Department. Finally, from the Islamic university, the selected focal point was the Director of the Mental Health Nursing Programme.

3.7.4 Research Procedures

The six developed WHO-AIMS surveys were handed to the nominated key participants in each setting. Meetings were organised with each focal point to describe the purpose of the study and their role in gathering and verifying the required information. I provided a comprehensive description of the WHO-AIMS 2.2 questionnaire (WHO, 2005a), with a particular focus on questions included in the surveys relevant to each participant. My contact details were circulated to each focal point to allow direct and continued communication with them. After completion of the surveys, I conducted another meeting with each of the key participants to double check the accuracy of the data gathered and to ensure the accuracy of data sources.

3.7.5 Data Analysis Plan

All data collected from the six participants in the surveys were entered onto the WHO-AIMS standardised data sheet that was developed by the WHO team for the WHO-AIMS 2.2 questionnaire (WHO, 2005a). Data were entered according to the order of questions in the original instrument and analysed by the researcher (WHO, 2005a). Based on an analysis of the data collected from the six participants, a final report describing the main findings was prepared by the researcher according to the WHO guide developed by the WHO team for writing the WHO-AIMS final report (WHO, 2005a).

103