Why this is important
Insufficient financing limits disability and mental health service provision in Ghana.
Funding from aid and philanthropy is short-term and driven by donor priorities.
Changes in local, national and international politics also impact how and when funding
is available for disability and mental health services. Unforeseen emergencies such
as pandemics or natural disasters may divert funding or change priorities that impede
activities from operating as usual.
Supporting disability and mental health initiatives to be sustainable at community,
district or national levels is critical; it allows projects and activities to continue long
after funding has ended; it builds and deepens knowledge accumulated over time and,
critically, it allows people to access their rights and the treatment, care and support
they need.
Approaches that foster sustainability
Our programme was impacted by budget cuts and a pandemic at the moment of
inception, so we have been critically aware of the need to embed practices and ways
of working that support all those working and volunteering to support disability and
mental health to continue their work long after the programme ends. Our approaches
that foster sustainability include:
- building an evidence base that can be used
- providing technical assistance, and building skills and knowledge in
- government agencies and civil society
- establishing formal and community structures of support
Building an evidence base that can be used
Our program work has been informed by evidence. In the absence of evidence, we
have worked with grantees or partners to gather and document it. We also work to
publish evidence to ensure it will be used, read and actioned. We do this by creating
dissemination plans; writing summaries or creating toolkits; or having the resulting
research published or presented so that it can be accessed by the wider scientific
community.
The programme has recorded use of evidence by both government and civil society
partners of key evidence products, notably the investment case for mental health.
Other commonly cited pieces of evidence are the documents produced as part of the
District Mental Healthcare Plan Framework, used for government mental health policy
and planning; and the Evidence-based Review of the District Assembly Common
Fund, Disability Fund Disbursement and Management Guidelines report, used for
policy and advocacy work. This work led to the publication of new disbursement
guidelines in September 2024.
Providing technical assistance to, and building skills in government
We provided direct technical assistance to government ministries and agencies to
strengthen their operations, leadership and governance, strategic planning, and
data management. Technical assistance was delivered according to demand and
assistance was delivered in collaboration with and through the government. By
enabling the government to set their priorities for technical support and training, more
buy-in was achieved, ensuring progress will continue beyond the programme.
Technical assistance has resulted in greater stewardship of the mental health agenda
by government agencies and a change in institutional attitudes. For example, we
were able to work with the Ministry of Gender, Children and Social Protection, other
government agencies, Ghana Federation of Disability Organisations as well as other
civil society organisations to ensure that disability rights issues are promoted and
mainstreamed through the development of a roadmap to implement the commitments
Ghana made at the Global Disability Summit in 2022.
Providing technical assistance to, and building
skills in civil society
While our initial programme design intended to provide technical assistance only
to the government, it became apparent there was a need and appetite for technical
assistance and capacity building in civil society.
Technical assistance to two umbrella civil society groups – Ghana Federation of
Disability Organisations and the Mental Health Society of Ghana – was an important
way of ensuring a sustainable legacy for civil society. We collaboratively agreed
plans for technical assistance, which for Ghana Federation of Disability Organisations
included leadership training for regional leaders and Training of Trainers on rightsbased advocacy, monitoring and evaluation and safeguarding. For Mental Health
Society of Ghana, this included helping them develop strategic and advocacy plans.
The technical assistance we provided has supported the groups’ leadership and
governance, strengthened their networks and collaboration, and enabled better
engagement with government.
For self-help groups, training that focused on annual work planning, leadership, group
dynamics, safeguarding, conflict resolution, and the challenges faced by women in
leadership, built fundamental competencies to equip self-help group members to
ensure their groups are sustainable.
The programme supported the Mental Health Alliance with training in monitoring,
evaluation and learning; donor reporting; story-telling; and more, to provide knowledge
for efficiently and effectively continuing their work and collaboration beyond the
programme remit.
All three grant rounds delivered by the programme provided training to grantees, and
the final Legacy and Sustainability grants round particularly focussed on capacity
building. Four local disabled people organisations and women’s right organisations
benefited from additional capacity-building sessions, knowledge sharing events,
and mentorship, that was evaluated as making significant progress in building their
institutional and technical capacities.
Examples of the lasting legacy of our training, support and grants include:
- new operating manuals and policies on topics including: safeguarding;
- equalities, anti-corruption; data protection; whistleblowing; code of ethics;
- anti-slavery; procurement; and gender – the actions of which have been
- mainstreamed into operations for some grantees
- development and review of strategic and operational plans
- ability to attract new funding
Engaging formal and community structures of support
Our work targeted government and traditional authorities, as well as existing
community structures of support, with the intention of ensuring that programme work
was sustainable. The systems of engagement that we facilitated are also critical
to sustainability and include the engagement between self-help groups and local
government structures like district assemblies, through interface meetings.
The creation of new formal structures, including the implementation of legislation,
such as the Mental Health Review Tribunal, are human rights milestones that would
be difficult to revoke. We supported the launch of the Mental Health Authority’s policy
on mental health 2019 – 2030, and considerable work has been undertaken to add
mental health to the National Health Insurance Scheme, which would substantially
reduce out of pocket expenditure for people with mental health conditions.
By working with grantees to engage with traditional leaders and community support
structures, we have ensured that traditional authorities have greater awareness
and understanding on disability, mental health issues and people’s rights. The
work on addressing stigmatising words in local languages was so impactful that
some traditional authorities put in place local sanctions, which penalised anyone
discriminating against people with disabilities or mental health conditions. This was
a critical action that publicly declared a new expectation around what is acceptable
behaviour towards people with disabilities and mental health conditions.
This impact was replicated in an area where a grantee worked with the local authority
to implement by-laws outlawing discrimination.
Recognising the importance of volunteers
Volunteers are crucial in identifying potential mental health conditions, supporting
mental health services and supporting effective self-help groups. We supported
grantees and partners with different types of volunteering that will continue long
beyond the remit of this programme.
Evaluation of different volunteering activities demonstrated an increase in informed
attitudes and knowledge on mental health. This knowledge also led to an increased
reach of health services, as volunteers were able to connect and recommend
individuals to services. Evaluations also showed that volunteers were positive about
their experience, and had increased respect in the community, paving the way for a
sustainable volunteering culture.
Co-producing a social behaviour change strategy
Technical interventions alone won’t change lives for people with disabilities and mental
health conditions if stigma and discrimination continue to present a barrier to people
fulfilling their lives. We conducted a study in 2020 to detail the context and drivers
of disability and mental health stigma. We identified that empowering people with
disabilities alone to address stigma is not sufficient.
We co-produced a social behaviour change strategy which targeted a range of actors,
including traditional authorities, religious leaders and key people in the community, to
engage them as conduits to positively change social and cultural attitudes and reduce
negative stereotyping. Activities in the behaviour change strategy were delivered
through grantees as well as directly with partners and the media.
The behaviour change strategy has resulted in a more positive media culture, has
increased justice and enforcement of rights, and brought about reduction in stigma
and discrimination.
A grantee evaluation demonstrated that approximately eight out of ten interviewees
with disabilities, including people with mental health conditions, had seen a reduction
in various forms of stigma and discrimination. The case studies we collected in our
evaluation demonstrate powerful change for individuals at a personal level which
cannot be under-estimated. The legacy of this work is continued through civil society
groups, Inclusion Ambassadors, a more aware media culture, and new language
guides.
Resources produced on this topic
- Mental health and disability research priorities and capacity needs in Ghana
- journal article and policy brief.
- Mental health and disability research in Ghana: a rapid review journal article.
- Using an investment case for mental health
- Advocacy toolkit for implementation of Global Disability Commitments
- Social behaviour change strategy
- Learning product: From theory to practice: putting inclusive and accessible social
- behaviour change into action
- Learning Product: The role of the ‘Alliance for Mental Health and Development’ in
- mental health advocacy in Ghana
- Evidence-based Review of the DACF Disability Fund Disbursement and
- Management Guideline
