Mental health reporting performance in primary health care: a comparative mixed-methods study of mhGAP-trained and untrained health facilities in Nepal

Abstract Background Mental health disorders are significant contributor to the global burden of disease. The quality of routine reporting of mental health indicators is poor, particularly in low- and middle-income countries. The World Health Organization’s Mental Health Gap Action Programme (mhGAP) is widely implemented to improve primary health care facility capacity. The effect of mhGAP on routine mental health reporting remains poorly understood. This study aimed to compare the performance of routine mental health reporting between mhGAP-trained and untrained primary healthcare facilities in Nepal. Methods An explanatory mixed-methods study was conducted in twenty-eight primary healthcare facilities in Parsa District, Nepal. The twenty-eight health facilities, fourteen of were mhGAP-trained and fourteen were untrained. Quantitative data were collected through a retrospective analysis of 12 months of routine mental health reporting data from the Health Management Information System (HMIS)/DHIS2. Reporting performance was compared between mhGAP-trained and untrained primary healthcare facilities. Qualitative data were collected through in-depth interviews with 11 health workers. The Consolidated Framework for Implementation Research (CFIR) was used to analyze the data. Results Mental health reporting performance was consistently poor in both mhGAP-trained and untrained health facilities. Completeness of mental health reporting was extremely low, with most health facilities reporting no mental health cases over a 12-month period. Accuracy in mental health reporting was not observed in all the health facilities, as no consistency was observed between facility registers and DHIS2 data. However, the timeliness of reporting was high in both groups (100% among mhGAP-trained facilities and 96.4% among untrained facilities), whereas completeness was 0% in both groups. Timeliness was not subjected to a statistical comparison because it was analyzed as a continuous reporting indicator. Although structural readiness was higher in mhGAP trained health facilities, the overall performance in the mental health reporting domain was rated as poor in all the health facilities, indicating a lack of functional routine reporting systems. Conclusions Mental health reporting performance in primary healthcare facilities in Nepal remains critically weak and is similar in both the mhGAP-trained and untrained health facilities. Training increases structural preparedness, but without supportive supervision, system-level coordination, and integration of mental health into regular health information systems, reporting performance may not be improved. Comprehensive system-level interventions beyond training are needed to strengthen routine mental health reporting.