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      Partnerships in mental healthcare service delivery in low-resource settings: developing an innovative network in rural Nepal

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          Mental illnesses are the largest contributors to the global burden of non-communicable diseases. However, there is extremely limited access to high quality, culturally-sensitive, and contextually-appropriate mental healthcare services. This situation persists despite the availability of interventions with proven efficacy to improve patient outcomes. A partnerships network is necessary for successful program adaptation and implementation.

          Partnerships network

          We describe our partnerships network as a case example that addresses challenges in delivering mental healthcare and which can serve as a model for similar settings. Our perspectives are informed from integrating mental healthcare services within a rural public hospital in Nepal. Our approach includes training and supervising generalist health workers by off-site psychiatrists. This is made possible by complementing the strengths and weaknesses of the various groups involved: the public sector, a non-profit organization that provides general healthcare services and one that specializes in mental health, a community advisory board, academic centers in high- and low-income countries, and bicultural professionals from the diaspora community.


          We propose a partnerships model to assist implementation of promising programs to expand access to mental healthcare in low- resource settings. We describe the success and limitations of our current partners in a mental health program in rural Nepal.

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          Most cited references 24

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          The metrics of the physician brain drain.

          There has been substantial immigration of physicians to developed countries, much of it coming from lower-income countries. Although the recipient nations and the immigrating physicians benefit from this migration, less developed countries lose important health capabilities as a result of the loss of physicians. Data on the countries of origin, based on countries of medical education, of international medical graduates practicing in the United States, the United Kingdom, Canada, and Australia were obtained from sources in the respective countries and analyzed separately and in aggregate. With the use of World Health Organization data, I computed an emigration factor for the countries of origin of the immigrant physicians to provide a relative measure of the number of physicians lost by emigration. International medical graduates constitute between 23 and 28 percent of physicians in the United States, the United Kingdom, Canada, and Australia, and lower-income countries supply between 40 and 75 percent of these international medical graduates. India, the Philippines, and Pakistan are the leading sources of international medical graduates. The United Kingdom, Canada, and Australia draw a substantial number of physicians from South Africa, and the United States draws very heavily from the Philippines. Nine of the 20 countries with the highest emigration factors are in sub-Saharan Africa or the Caribbean. Reliance on international medical graduates in the United States, the United Kingdom, Canada, and Australia is reducing the supply of physicians in many lower-income countries. Copyright 2005 Massachusetts Medical Society.
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                Author and article information

                Global Health
                Global Health
                Globalization and Health
                BioMed Central (London )
                13 January 2017
                13 January 2017
                : 13
                [1 ]Bayalpata Hospital, Possible, Sanfebagar-10, Achham Nepal
                [2 ]Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave, Langley Porter, San Francisco, CA 94143 USA
                [3 ]Shared Minds, Boston, MA USA
                [4 ]Department of Medicine, Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA USA
                [5 ]Department of Medicine, Division of General Pediatrics, Boston Children’s Hospital, Boston, MA USA
                [6 ]Department of Medicine, Harvard Medical School, Boston, MA USA
                [7 ]Department of Medicine, Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA USA
                [8 ]Department of Anthropology, University of Washington, Seattle, WA USA
                [9 ]Department of Global Health, University of Washington, Seattle, WA USA
                [10 ]Henry M. Jackson School of International Studies, University of Washington, Seattle, WA USA
                [11 ]Department of Psychiatry, University of Minnesota, Minneapolis, MN USA
                [12 ]Faculty of Medicine, Department of Psychiatry, B.P. Koirala Institute of Health Sciences, Dharan, Sunsari Nepal
                [13 ]Psychiatric Department, Kathmandu Medical College, Kathmandu, Nepal
                [14 ]Research Department, Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
                [15 ]Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC USA
                [16 ]Global Health Institute, Duke University, Durham, NC USA
                [17 ]Department of Cultural Anthropology, Duke University, Durham, NC USA
                [18 ]Policy Planning & International Cooperation Division, Ministry of Health, Kathmandu, Nepal
                [19 ]Department of Medicine, University of California, San Francisco, San Francisco, CA USA
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

                Funded by: FundRef, National Institute of Mental Health;
                Award ID: R25MH060482-14
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                © The Author(s) 2017


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