Integrating Mental Health and Neglected Tropical Disease Interventions to Support Equitable People-Centred Care in Ghana
Phase: NA
Conditions: Leprosy, Lymphatic Filariases, Buruli Ulcer, Onchocerciasis, Yaws
Sponsor: Liverpool School of Tropical Medicine

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Integrating Mental Health and Neglected Tropical Disease Interventions to Support Equitable People-
Centred Care in Ghana (IMAGINE GHANA) 
Investigators: Laura Dean (LSTM), Rosalind McCollum (LSTM), Alfred Kwesi (UHAS), Margaret 
Gyapong (UHAS), Maaike Seekles (LSTM), India Hotopf (LSTM), Irene Tsey (UHAS), Hubert Amu 
(UHAS), Mustapha Immurana (UHAS), Evelyn Acquah (UHAS), Vincent Gmayinaam (UHAS), Joy Kim 
(Effect Hope), Anna Gine (ANESVAD), Manuel Pozatti (ANESVAD), Sally Theobald (LSTM), Julie Irving 
(LSTM) 
Version control:  
V1.0 01.04.2025 
V2.0 30.10.2025 
Background and Rationale 
Neglected Tropical Diseases (NTDs) disproportionately affect the world’s most impoverished 
populations, particularly in low- and middle-income countries (Hotez et al., 2016, Singer et al 2012). 
These conditions lead to severe physical disabilities, chronic pain, and disfigurement, often resulting 
in stigma and discrimination (Dean et al., 2022). The social exclusion experienced by individuals 
affected by NTDs significantly impacts their mental health, increasing the prevalence of anxiety, 
depression, and other psychological distress (Dean et al., 2022, Abdulmalik et al., 2018, Bailey et al., 
2019A, Bailey et al., 2019B, Koschorke et al., 2022, Obindo et al., 2017, WHO, 2020, Semrau et al., 
2020, Ton et al., 2015). Despite the well-documented burden of NTDs and their mental health 
consequences, the integration of mental health services within NTD management remains limited 
(Bailey et al., 2019a). The World Health Organization recently developed an Essential Care Package 
(ECP) for NTDs, stigma, and mental health conditions to provide a comprehensive framework for 
managing these diseases (WHO, 2022). However, limited research exists on the best strategies for 
implementing this package effectively within existing health systems, particularly in Ghana. This study, 
IMAGINE GHANA, aims to address this knowledge gap by operationalizing key components of the ECP 
in Ghana to understand what works for who in terms of its implementation, ensuring accessibility, 
fairness, and effectiveness in its implementation. 
 
Why is the research important in terms of improving the health and/or wellbeing of the relevant 
populations and healthcare services in the LMIC(s)? 
Despite the increasing recognition of the intersection between NTDs and mental health, there remains 
a lack of integrated approaches for addressing both conditions simultaneously (Osborne et al., 2021). 
Existing health services in Ghana prioritize the physical manifestations of NTDs, often neglecting the 
psychosocial consequences such as stigma, social exclusion, and mental health distress (Agyemang et 
al., 2022; Dua et al., 2020). This results in a fragmented care system that fails to address the full scope 
of patient needs, contributing to delayed health-seeking behaviour and poor treatment adherence. 
Furthermore, limited research exists on how to effectively implement the WHO ECP at scale within 
health systems in Ghana (Owusu et al., 2023). Key questions remain unanswered, including what the 
most effective, equitable, and sustainable strategies for integrating mental health services within NTD 
management are and how to ensure that such services are accessible and acceptable to affected 
individuals and their communities. Addressing these gaps is critical to developing a comprehensive 

V1.0 01.04.2025 
 
and person-centered approach to NTD care, ultimately improving health outcomes and quality of life 
for affected individuals.  
 
This study is essential for multiple reasons. Strengthening the health system through the provision of 
evidence-based recommendations on how Ghana’s health system can incorporate mental health 
services into NTD care will lead to more holistic and effective interventions (Addo et al., 2020). 
Additionally, ensuring equitable access by identifying barriers to care and proposing solutions will 
make certain that services are inclusive, culturally appropriate, and accessible to marginalized 
populations (Osei et al., 2019). Understanding what works at scale will inform national and regional 
policies, ensuring long-term sustainability of integrated NTD and mental health interventions (WHO, 
2021b). Furthermore, aligning with global health priorities such as WHO’s strategic focus on NTD 
elimination and Universal Health Coverage will provide the necessary foundation for implementing 
sustainable interventions that address both physical and mental health needs (WHO, 2021c). 
 
Research question  
How can mental health be integrated into person centred care for people affected by skin NTDs in 
Ghana? 
Primary Aim and Objectives 
IMAGINE Ghana is a collaboration between UHAS, the Ghanaian Health System and Liverpool School 
of Tropical Medicine, which seeks to co-design, pilot and evaluate an Essential Care Package for skin 
NTDs, over the course of three years. The programme uses learning from the REDRESS project in 
Liberia.  
Overall Aim 
To strengthen person-centred care for the integrated management of mental health and NTDs in 
Ghana. 
Objectives:  
Table 1. Study objectives and outcomes 
Objective 
Outcome 
Objective 1: 
Identifying the most effective, acceptable, 
equitable, affordable, inclusive and sustainable 
context-specific community, health and social 
systems-based strategies for the integrated 
management of NTDs and MHCs. (Outcome 1) 
(Situational Analysis Phase) 
Outcome 1 
Evidence on the most effective, acceptable, 
affordable, equitable, inclusive and sustainable 
context-specific community, health and social 
systems-based interventions for co-occurring 
NTDs and MHCs integrated into programme 
strategies 
by 
government, 
regional 
and 
international stakeholders. 
Objective 2: 
Collaborating 
with 
affected 
persons, 
communities, health providers, and policy 
Outcome 2 
Improved capacity among health system and 
community stakeholders to identify intervention 

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makers through co-production approaches to 
support 
the 
identification, adaptation 
and 
implementation 
of 
new 
and 
existing 
interventions that are responsive to biomedical 
and psychosocial support needs and community 
development priorities. (Outcome 2 & 3) (Design 
Phase) 
solutions, and to promote a culture of working 
together to co-produce, implement, assess and 
adapt interventions to respond to holistic care 
needs and rights of people affected by co-
occurring NTDs and common MHCs.  
Systematic inclusion of the needs and priorities 
of affected persons within the design, delivery, 
monitoring and evaluation of system-based 
interventions to ensure equitable management 
of co-occurring NTDs and common MHCs that 
meets the needs of vulnerable populations and 
promotes social inclusion and stigma reduction. 
Objective 3: 
Enhancing equity of approaches that will 
support people affected by NTDs and MHCs to 
receive essential, effective and affordable 
treatment, care and support at the individual, 
community and facility level. (Outcome 1) 
(Implement and Monitor Phase) 
Outcome 3 
Evidence on the most effective, acceptable, 
affordable, equitable, inclusive and sustainable 
context-specific community, health and social 
systems-based interventions for co-occurring 
NTDs and MHCs integrated into programme 
strategies 
by 
government, 
regional 
and 
international stakeholders. 
Objective 4:   
Strengthening a culture of learning in health 
systems to make links between past actions, the 
effectiveness of those actions, and in planning 
for future activities, to identify generalisable 
factors that could influence policy, practice and 
intervention sustainability for NTDs and MHCs. 
(Outcome 2) (Adapt and Adjust Phase) 
Outcome 4 
Improved capacity among health system and 
community stakeholders to identify intervention 
solutions, and to promote a culture of working 
together to co-produce, implement, assess and 
adapt interventions to respond to holistic care 
needs and rights of people affected by co-
occurring NTDs and common MHCs.  
Objective 5:   
Strengthening capacity for multi-disciplinary 
implementation research focused on NTDs and 
MHCs within the MoH, Ghana, that engages with 
persons affected, policy makers, practitioners 
and researchers. (Outcome 4). 
 
Outcome 5 
Established technical and community advisory 
groups 
of 
policy 
makers, 
practitioners, 
researchers, 
persons 
affected 
and 
other 
community stakeholders collaborating together, 
and learning from each other, to identify and 
implement 
solutions 
for 
the 
integrated 
management of NTDs and common MHCs.  
 
Study Sites and Population and Selection 
This study will be carried out in Ghana, where we have selected intervention areas that we will use as 
‘learning sites’ to allow us to explore the feasibility of operationalising an ECP for co-occurring NTDs 
and MHCs.  We have chosen to focus our work in specific geographical areas to enable a longer-term 
process of engagement and collaboration with systems actors and persons affected (Sheikh et al, 
2021). Learning sites are an emerging phenomenon in health systems research as they: ‘provide an 

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opportunity for researchers to understand health systems by seeing their complexity through the eyes 
of those working at the frontline of care delivery, whilst providing opportunity to support health 
systems strengthening’ (Sheikh et al, 2021). We will extend the process to include the perspectives of 
persons affected by NTDs and MHCs as part of our learning journey, for example, through their 
inclusion as co-researchers within this project (Work Package 6- see below). Central to the learning 
site methodology is flexible reflexive practice to facilitate a process of co-production that is multi-
layered, dynamic and independent in each setting (Sheikh et al, 2021). The centrality of co-production 
will enable us to undergo a process of collective enquiry within each of our ‘learning sites’ that is 
guided by collaboration between researchers, persons affected and health systems actors (e.g. district 
health managers) through regular cycles of planning, implementation and reflection to support 
decision making related to key activities being implemented within the IMAGINE GHANA intervention 
activities.  
The learning sites have been selected in partnership with Ministry of Health collaborators and based 
on:  
• 
Disease co-endemicity (i.e. locations where multiple target NTDs (based on MoH priorities) 
are endemic)  
• 
Geographic and ecological diversity within countries (rural/ peri-urban)  
• 
MoH/FMoH priority areas for integration  
• 
Security- with safe access for the research team  
The learning sites selected following discussion and selection in collaboration with Ghana National 
Programme are:   
• 
Savanna Region (Bole District)  
• 
Western Region (Ellembele District)  
• 
Volta Region (Ho and Hohoe municipalities)  
The study population will include primary participants such as individuals affected by skin NTDs, 
including LF, BU, Leprosy, CL and yaws. Additionally, secondary participants such as healthcare 
providers, policymakers, community health workers, and traditional healers will be involved. 
Study Design and Phases  
A participatory action research (PAR) approach will inform overall design and study phases (design, 
implement and monitor, evaluate, adjust) as shown in Figure 1.  
 
 

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Figure 1. Overview of IMAGINE Ghana study phases and work packages 
The underlying principle of co-production and methodology of PAR are critical to our Research 
approach as they necessitate: working directly with persons affected, policy makers and programme 
implementers to define the problem, generate and evaluate solutions to facilitate rapid uptake of best 
practices; and utilising accessible and adaptable communication techniques to ensure that findings 
are packaged and disseminated to target audiences through a two-way process of dialogue and 
exchange. Additionally, specific attention will be given to the inclusivity in accessibility of programme 
outputs, with, for example, easy read versions of outputs being produced. We are working in direct 
collaboration with the Ministry of Health, Ghana Health Services and persons affected whose needs 
this research responds to. 
Four core and two cross-cutting work packages (WP) will synergistically enable co-production, 
measurement, implementation and evaluation of interventions to drive forward integrated 
management of NTDs and MHCs.  
A mixed methods approach will be used to achieve the five objectives through the four study phases. 
Phase 1:  Design phase 
In order to respond to workpackage 1, we will seek to document the readiness of the health system 
to facilitate integrated implementation of interventions for NTDs and MHCs and to catalyse 
collaborative action amongst regional, national and sub-national stakeholders, including persons 
affected.  This rapid context analysis will take three main approaches: 
1) A health systems readiness survey will involve the collation a series of key indicators at health facility 
level, which will be collated based upon review of existing ledgers and data within the facility, as well 

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as qualitative responses with health workers (the qualitative questions are integrated within existing 
qualitative tools).   The purpose of this tool is to understand the readiness of the health system across 
levels at hospital, health centre and clinic level to integrate mental health and stigma reduction 
activities as part of the Essential Care Package for patients with skin NTDs. 
2) A qualitative approach to capture the experiences and perspectives of key health systems decision 
makers, providers, persons affected, their families and communities.  We will seek to carry out the 
following qualitative methods (see table 1 for an overview of the methods and participants).  
Qualitative methods have been selected in order to provide opportunity to gain in-depth insights of 
the views, experiences and perspectives of persons with lived experience of skin NTDs and/ or mental 
health conditions, as well as health workers providing care for people affected by skin NTDs. 
• 
Key informant interviews (KIIs) with health systems actors at national level  - these interviews 
will be conducted to understand the current situation within Ghana regarding existing 
strategies for the integrated management of co-occurring NTDs and mental health conditions 
from the perspective of national stakeholders.  See table 1 for the range of national 
stakeholders who will be interviewed.   
• 
KIIs with health systems actors at district level - these interviews will be conducted to 
understand the current situation within Ghana regarding existing strategies for the integrated 
management of co-occurring NTDs and mental health conditions from the perspective of 
district stakeholders.   
• 
In depth interviews (IDI) with health workers at facility level – these interviews will explore 
the current care available within each level of facility (hospital, health centre, clinic) from the 
perspective of health workers.  As well as exploring through the use of vignettes their current 
care practices. 
• 
FGDs with CHWs – these FGDs will explore with CHWs their current responses and care 
practices for persons affected by skin NTDs and mental health conditions. 
• 
Focus group discussions (FGDs) including asset mapping with community groups, e.g. student 
club for NTDs, men, women and adolescents – these FGDs will map existing community 
support and explore avenues for strengthening existing assets and forming new partnerships.   
• 
IDIs including asset mapping with community leaders – these IDIs will map existing community 
support and explore avenues for strengthening existing assets and forming new partnerships.   
• 
IDIs including vignettes with pluralistic providers with traditional healers, herbalists and faith 
healers – through the use of vignettes this method will explore and understand how pluralistic 
providers care for persons affected by skin NTDs and mental health conditions. 
• 
FGDs and photovoice with persons affected by skin NTDs and/ or mental health conditions - 
This method looks at perceptions and experiences of patient’s treatment journey, including 
enablers and barriers, and the impact of living with an NTD on their mental wellbeing and 
social participation, captured through photos taken to reflect on patient journey.   
• 
Participatory workshops involving persons affected, utilising problem tree analysis and matrix 
ranking – these workshops will be used to encourage persons affected to identify their main 
problems experienced which affect mental wellbeing, as well as exploring the underlying root 
causes and consequences of these.  The matric ranking will assist them in identifying their 
priority problems and the priority interventions to address these.   

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• 
Illness narrative case studies with persons affected by skin NTDs:  these narratives will be 
completed with persons affected by skin NTDs. Two narrative interactions will be facilitated 
with persons affected (to form the illness narrative) and one in-depth interview will be 
completed with a selected family member based on the choice of the person affected as the 
person who is most critical in their life journey. These case studies will support to understand 
the syndemic relationships between NTDs, mental health conditions and disability in the 
Ghanaian context to support to assess the applicability of intervention approaches used to 
address these interactions from other settings (e.g. Liberia and Malawi).  
 
Table 2  Overview of qualitative and participatory methods, sampling and participants for situational 
analysis 
Participant 
Method 
Research question 
National 
level 
(7 
participants) 
MOH – MH dept 
GHS – MH unit 
GHS - data manager 
NTD programme (covers LF, 
Oncho) 
 BU/yaws 
programme 
director 
Leprosy programme director 
 
Public health Director  
 
KII 
Who are the types of health workers currently 
managing and delivering NTD and mental health 
services at all health system levels? 
What are the governance structures and policies 
of the health system that are currently helping 
and hindering collaboration and co-ordination 
between NTD and mental health service 
providers? (e.g. policies on organisational 
interactions and communications between 
ministerial 
departments; 
review 
of 
NTD 
masterplans and associated targets etc). 
What are the current budgeting processes, 
financing mechanisms, and resources available 
to support the delivery of interventions for NTDs 
and MHCs? 
District/ 
DHMS 
(5 
participants*4 districts)  
Data manager 
Disease control officer 
District MH nurse 
District PH nurse 
District director of health 
services 
KII 
Who are the types of health workers currently 
managing and delivering NTD and mental health 
services at all health system levels? 
What are the views of health providers on the 
advantages and disadvantages, opportunities 
and constraints of integrated service delivery for 
NTDs and MHCs? 
Facility level (3 facilities*4 
districts) One hospital, one 
health centre and one clinic 
per district 
 
Health systems 
readiness 
assessment  
What is the readiness of the health system to 
integrate mental health within care for people 
with NTDs? 

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Participant 
Method 
Research question 
Health facility (3 facilities*4 
districts*6 
participants)   
One hospital, one health 
centre and one clinic per 
district 
Disease control officer (some 
facilities only) 
MH nurse 
PH nurse 
In charge (facility manager) 
OPD clinician 
Adolescent corner 
IDI 
 
Who are the types of health workers currently 
managing and delivering NTD and mental health 
services at all health system levels? 
What are the views of health providers on the 
advantages and disadvantages, opportunities 
and constraints of integrated service delivery for 
NTDs and MHCs? 
Community level (IDI*2CHW 
per 
facility*3 
facilities*4 
districts) 
CHWs 
 
IDI 
Community level (1FGD*3 
facilities*4 districts) 
Community 
health 
volunteers/ Community drug 
distributors 
FGD 
Community level (3 FGDs*4 
districts*6 participants) 
Leprosy group,  
Student club for NTD 
Other NGOs working with 
MH or NTDs 
Male group, female group, 
adolescent group 
Asset 
mapping 
FGD 
Asset mapping to explore what is happening 
already 
 
Community 
level 
(2 
participants*4 districts) 
Community leaders 
Asset 
mapping 
IDI 
Pluralistic 
provider 
(3*4 
districts*6 participants) 
Traditional Healer 
Herbalist 
Faith healer 
 
IDI with vignette 
What are the existing and potential roles of 
pluralistic providers (e.g. religious leaders, 
traditional 
healers) 
in 
the 
delivery 
of 
interventions for NTDs and/or MHCs? 
Persons 
affected 
and 
caregivers (2 groups* 4 
districts*2) 1 male FGD, 1 
female FGD 
FGD followed by 
Photovoice 
 
What do people affected believe are the priority 
interventions and strategies that could improve 
their mental wellbeing? 

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Participant 
Method 
Research question 
NTDs and MHC  
 
Persons affected (1group* 4 
districts) 
NTDs and MHC 
Problem tree 
Matrix ranking 
Narrative 
Case 
Study 
Interviews (20 case studies 
(5 per district) 
Person affected leprosy + 
caregiver 
Person 
affected 
BU 
+ 
caregiver 
Person 
affected 
LF 
+ 
caregiver 
Person 
affected 
by 
cutaneous leishmaniasis + 
caregiver 
Person 
affected 
by 
onchocerciasis + caregiver 
 
Narrative Case 
Study 
Interviews 
 
What are the syndemic relationships between 
NTDs, mental health conditions and disability? 
How applicable are existing intervention 
approaches from other settings relevant to 
addressing these interactions in Ghana? 
 
3)  Policy analysis of existing programme documents to understand the necessary tools and resources 
required to facilitate integrated implementation, as well as the current policy context within Ghana 
relating to NTDs and mental health. 
The primary purpose of the policy analysis will be to develop an understanding of the policy processes, 
stakeholders and structures that may impact the development and delivery of the integration of 
mental health within care for people with NTDs in Ghana. This will inform the research design as well 
as the way that evidence is synthesised, packaged and disseminated. The policy analysis will primarily 
focus on national policy. 
Documents will be obtained by liaising with stakeholders in the Ministry of Health and Ghana Health 
Service. Once documents are obtained, we will develop a thematic framework to rapidly extract data 
from the documents, before synthesising the data from all the reports. 
 
 
 
At this stage, a census approach will be used to survey all persons affected by NTDs in our study sites. 
The purpose of this survey is to establish the prevalence of mental health conditions amongst persons 
affected and examine factors associated with reduced mental health/wellbeing; and gather data that 
will serve as the baseline for our impact evaluation. The survey will consist of tools recommended in 
the NTD morbidity toolkit, including the PHQ-9, GAD-7, Warwick mental wellbeing scale, to capture 
our main study outcomes, namely depression, anxiety and wellbeing. We will also use the EQ-5L-5L 
Baseline survey with persons affected and general population 

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for Quality of Life, Washington Group questionnaire to capture disability, Sari Stigma Scale, and 
Participation scale, in addition to capturing socio-demographic data (gender, age, education level), 
disease specific data (NTD type, time since diagnosis, symptom level) and costing questions. Some of 
these tools have been used previously in our setting; those that have not will be translated and piloted 
before use. 
 
Participatory intervention design workshops 
The final component of phase 1 will be the intervention design workshops, where we will bring together 
persons affected, key stakeholders from within GHS and MOH and researchers and other key 
stakeholders e.g. pluralistic providers in a participatory planning workshop. During this workshop 
findings from phase 1 (policy analysis, health systems readiness assessment, qualitative and 
participatory research findings) will be presented. Stakeholders will then be asked to reflect on these 
findings to prioritise and develop interventions to integrated mental health and stigma reduction within 
care for persons with skin NTDs in Ghana, based on the new and consolidated evidence base. 
Interventions will draw on global expertise, but will be discussed and reviewed together to ensure these 
are applicable within the Ghanaian setting. 
 
Phase 2:  Implement and monitor phase 
This phase will build on the findings from the design phase to introduce a Ghanaian version of the 
essential care package for NTDs, stigma and mental health.   Intervention design and delivery will draw 
on evidence and expertise. MOH actors will provide technical support during this research phase to 
ensure interventions developed are feasible and sustainable within routine health systems operations, 
as well as being aligned to the funding cycles for the NTD programme. This will be led by the national 
programme, with interventions leveraging on existing programme plans (e.g. updating training 
materials to include a focus on psychosocial support to be rolled out in routine activities). We will 
bring together persons affected, health systems stakeholders, researchers and collaborators in a 
participatory design workshop. This workshop will also engage additional community and health 
systems stakeholders identified as critical during the design phase and through stakeholder mapping 
activities linked to the adaption and adoption of final interventions. 
Phase 3:  Evaluate phase 
This phase will involve a multi-disciplinary evaluation of the intervention bundle to make 
recommendations for future delivery of an essential care package for co-occurring NTDs and 
MHCs.   The details of the evaluate phase will be determined following development of the 
intervention, and so the methods included in table 2 are provisional for now, and may be adjusted 
and updated in the amendment to be submitted once details on the intervention are known.  
Participant numbers for these methods have not yet been estimated and will be included in the 
subsequent amendment.   
Our evaluation takes a realist theory-based approach and is concerned with understanding; what 
components of our intervention bundle are effective, with which implementation strategies, for 
whom, in what settings and for how long (Holtrop et al, 2021). We are focused on understanding the 
impact of the different dimensions of our intervention bundle and the contexts in which they are and 

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are not effective. Our multi-disciplinary evaluation will be guided by the RE-AIM framework (Holtrop 
et al, 2021). The RE-AIM framework consists of five core domains that are designed to be considered 
at different implementation levels from the perspective of different stakeholders: Reach and 
Effectiveness (Individual level); Adoption and Implementation (facility, system and policy level); and 
Maintenance (all levels) (Holtrop et al, 2021).   
A range of qualitative methods will be used to evaluate the intervention alongside the quantitative 
aspects.   
The quantitative aspect of the evaluation will consist of a longitudinal cohort study with repeated 
measures at baseline and 12 months after the start of intervention, to track individual level changes 
and do an initial assessment of sustainability of the intervention. We will track engagement with the 
intervention via an ‘intervention passport’, in which persons affected will collect stamps/stickers for 
every engagement with the health system in relation to their NTD/Mental Health condition. The 
evaluation will also include a cost-consequence and cost-effectiveness analysis.  
 
 
This phase will work with all stakeholders to review and adapt interventions and to embed successful 
components within the routine health system management of co-occurring NTDs and MHCs and to 
make recommendations for the scale-up of the essential care package within Ghana and across the 
West African region, which may take the form of participation of West African MOH during final 
dissemination workshop with linked learning visit.   
 
Overview of Methods 
Key informant interviews  
National and district level KIIs will be conducted with different stake holders to understand the current 
situation within Ghana regarding existing strategies for the integrated management of co-occurring 
NTDs and mental health conditions from the perspective of national stakeholders.  Envisaged national 
and district-level stakeholders to be interviewed are listed in Table 3. 
Key informants will be purposively selected, according to their knowledge and experience linked to 
their job role and knowledge of NTD programme, health systems service delivery including human 
resource management, and broader health and wellbeing in Ghana. The country research teams will 
approach the key informants through a letter and a follow up telephone call. The purpose of the 
interview will be made clear to each participant, and they will be asked to provide informed consent 
and, where relevant, consent of the organisation that they are representing.  
Table 3. KII sampling frame and research questions 
Participant 
Research question 
National 
level 
(7 
participants) 
MOH – MH dept 
GHS – MH unit 
GHS - data manager 
Who are the types of health workers currently 
managing and delivering NTD and mental health 
services at all health system levels? 
What are the governance structures and policies 
of the health system that are currently helping 
Phase 4:  Adjust phase 

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NTD programme (covers LF, 
Oncho) 
 BU/yaws programme 
director 
Leprosy programme director 
Public health Director  
 
and hindering collaboration and co-ordination 
between NTD and mental health service 
providers? (e.g. policies on organisational 
interactions and communications between 
ministerial 
departments; 
review 
of 
NTD 
masterplans and associated targets etc). 
What are the current budgeting processes, 
financing mechanisms, and resources available 
to support the delivery of interventions for NTDs 
and MHCs? 
District/ 
DHMS 
(5 
participants*4 districts)  
Data manager 
Disease control officer 
District MH nurse 
District PH nurse 
District director of health 
services 
Who are the types of health workers currently 
managing and delivering NTD and mental health 
services at all health system levels? 
What are the views of health providers on the 
advantages and disadvantages, opportunities 
and constraints of integrated service delivery for 
NTDs and MHCs? 
 
In-depth interviews 
IDIs will be conducted with health workers at facility level, to explore the current care available within 
each level of facility (hospital, health centre, clinic) from the perspective of health workers.  As well as 
exploring through the use of vignettes their current care practices. 
IDIs, including asset mapping, will also be conducted with community leaders to map existing 
community support and explore avenues for strengthening existing assets and forming new 
partnerships.   
IDIs, including vignettes, will also be conducted with pluralistic providers (including traditional healers, 
herbalists and faith healers) to explore how pluralistic providers care for persons affected by skin NTDs 
and mental health conditions. 
Envisaged stakeholders for IDIs are listed in table 4.  
Participants will be purposively selected based on their knowledge and experience linked to their role 
and knowledge of NTDs, health systems service delivery and broader health and wellbeing in Ghana. 
The purpose of the interview will be made clear to each participant, and they will be asked to provide 
informed consent and, where relevant, consent of the organisation that they are representing. 
Table 4. IDI sampling frame and research questions 
Participant 
Research question 

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Health facility (3 facilities*4 
districts*6 participants) 
Disease control officer (some 
facilities only) 
MH nurse 
PH nurse 
In charge (facility manager) 
OPD clinician 
Adolescent corner 
What is the readiness of the health system to 
integrate mental health within care for people 
with NTDs? 
Who are the types of health workers currently 
managing and delivering NTD and mental health 
services at all health system levels? 
What are the views of health providers on the 
advantages and disadvantages, opportunities 
and constraints of integrated service delivery for 
NTDs and MHCs? 
Community 
level 
(2 
participants*4 districts) 
Community leaders 
Community level (IDI*2CHW 
per 
facility*3 
facilities*4 
districts) 
CHWs 
 
What is the readiness of the health system to 
integrate mental health within care for people 
with NTDs? 
Who are the types of health workers currently 
managing and delivering NTD and mental health 
services at all health system levels? 
What are the views of health providers on the 
advantages and disadvantages, opportunities 
and constraints of integrated service delivery for 
NTDs and MHCs? 
Pluralistic 
provider 
(3*4 
districts) 
Traditional Healer 
Herbalist 
Faith healer 
 
What are the existing and potential roles of 
pluralistic providers (e.g. religious leaders, 
traditional 
healers) 
in 
the 
delivery 
of 
interventions for NTDs and/or MHCs? 
 
Focus group discussions 
Focus group discussions will be conducted at the community level with two types of respondents: 
CHWs and community groups e.g. student club for NTDs, men, women and adolescents. FGDs with 
CHWs will explore their current responses and care practices for persons affected by skin NTDs and 
mental health conditions. Community group FGDs will include asset mapping and will map existing 
community support and explore avenues for strengthening existing assets and forming new 
partnerships.   
The envisaged sampling frame is listed in table 5. Respondents will be purposively selected per study 
site to ensure maximum variation in geography, disease burden and health systems infrastructure. 

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The discussions will be tape recorded after gaining permission from the participants. One researcher 
will facilitate the discussion using a topic guide whilst another researcher takes notes and observes 
the interactions. The discussions will take place in a private room. It is anticipated that most of these 
FGDs will be conducted in English and will take 1 ½ to 2 hours. 
Table 5. FGD sampling frame and research questions 
Participant  
Research question 
Community 
level 
(1FGD*3 
facilities*4 
districts) 
CHVs/CDDs 
What is the readiness of the health system to 
integrate mental health within care for people with 
NTDs? 
Who are the types of health workers currently 
managing and delivering NTD and mental health 
services at all health system levels? 
What are the views of health providers on the 
advantages and disadvantages, opportunities and 
constraints of integrated service delivery for NTDs 
and MHCs? 
 
Community level (3 FGDs*4 districts) 
Leprosy group,  
Student club for NTD 
Other NGOs working with MH or NTDs 
Male group, female group, adolescent group 
Asset mapping to explore what is happening 
already 
 
 
Photovoice 
Photovoice will be used to make visible the often ‘hidden’ context of everyday lives of persons affected 
by skin NTDs and/or mental health conditions, not just through the images themselves but through 
the discussion and interpretation of the images. This method will explore perceptions and experiences 
of patient’s treatment journey, including enablers and barriers, and the impact of living with an NTD 
on their mental wellbeing and social participation, captured through photos taken to reflect on patient 
journey.   
Participants will be asked to take photographs of their work, their work environment, their 
interactions with the health system, with a particular focus on skin NTDs, however, photographs will 
not be limited to these areas. Participants will choose themselves what they want to photograph and 
will discuss what this means to them. Should a participant wish to take a photo of people, then 
participants will be advised to ask verbal consent from the person to be photographed. All participants 
will initially be provided with a one-day training, facilitated by the researchers to provide an overview 
of the research, the ethics of taking photos, safeguarding concerns and how to use the cameras or 
smart phones provided.  The photovoice process adapted from Ronzi et al (2019) is described below.  
Step One: Participants will be asked to take pictures over a three-month period. 
Step Two: Separate monthly reflective meetings between persons affected and the research team will 
take place. Perceptions and experiences of patient’s treatment journey will be explored through the 

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following questions: describe your photo, what is happening in the photo, why did you take this photo, 
how does this photo affect us, what can we do about it. These discussions will be recorded following 
permission from each of the participants and notes from the discussions taken. 
Step Three: At the end of the three month-period, participants will be asked to pick 10-20 key photos 
that they would be willing to talk about in a group and take forward for further analysis. 
Step Four: Focus groups (separated by the categories of participants), where participants will then be 
asked to present their key photographs using similar questions to those described above will be 
facilitated by the research team. As each participant presents the group will be asked to group photos 
that show similar things together and a description of that theme written on flipchart with the support 
of the research team. Participants will collectively decide which photograph(s) they want to display at 
the photo exhibition to represent each theme and their associated captions agreed. The group will 
also be asked to discuss solutions to the challenges identified. This discussion will be recorded 
following permission. 
Step Five: Photos will be disseminated in a photo exhibition which will also involve discussion of 
solutions to challenges faced with wider stakeholders. 
Data analysis will occur alongside the photovoice study with participants identifying the research 
findings which they want to present and identifying captions to explain their photos as part of the 
process. The recordings from the discussions will be transcribed verbatim and analysed using the 
thematic framework approach described within the data analysis section 
Illness narratives   
Illness narrative case studies with persons affected by skin NTDs:  these narratives will be completed 
with persons affected by skin NTDs. Two narrative interactions will be facilitated with persons affected 
(to form the illness narrative) and one in-depth interview will be completed with a selected family 
member based on the choice of the person affected as the person who is most critical in their life 
journey. These case studies will support to understand the syndemic relationships between NTDs, 
mental health conditions and disability in the Ghanaian context to support to assess the applicability 
of intervention approaches used to address these interactions from other settings (e.g. Liberia and 
Malawi). 
Illness narratives will be conducted in the language of preference of the participant by one member 
of the research team. They will last for approximately one hour. Prior to the activity commencing 
participants will be approached to take part either in person or through telephone contact. The study 
will be explained to participants who will have the right to refuse. Information sheets will be shared 
with participants either verbally or in writing depending on the literacy level and preference of the 
participant. Participants will be given the opportunity to ask any questions in advance of the activity 
and the study re-explained prior to the activity commencing. If participants are willing to take part, 
they will be asked to sign a written consent form or verbal consent taken in the presence of a witness 
if they are illiterate or unable to sign. As with other methods, participants will be made aware at the 
outset that they will have the opportunity to be referred to a mental health provider if they feel they 
need it as a result of workshop participation. All participants will be given the right to withdraw from 
the study at any time. 
Participatory workshops 

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We will conduct a series of participatory workshop with persons affected utilising problem tree 
analysis and matrix ranking. Workshops will be used to encourage persons affected to identify their 
main problems experienced which affect mental wellbeing, as well as exploring the underlying root 
causes and consequences of these.  The matric ranking will assist them in identifying their priority 
problems and the priority interventions to address these. 
For all participatory workshops, participants will initially be approached in person and the study will 
be explained to them. Information sheets will be shared with participants in advance of the interview 
either verbally or in writing depending on the literacy level and preference of the participant. 
Participants will be given the opportunity to ask any questions in advance of the workshop and the 
study re-explained prior to the activity commencing. If participants are willing to take part, they will 
be asked to sign a written consent form or verbal consent taken in the presence of a witness if they 
are illiterate or unable to sign. Participants will be made aware at the outset that they will have the 
opportunity to be referred to a mental health provider if they feel they need it as a result of workshop 
participation. All participants will be given the right to withdraw from the study at any time. Each 
workshop will take no more than 2 hours. 
 
Recruitment and sampling 
Qualitative recruitment of participants 
 
The following diagram shows the flow of recruitment of participants for the qualitative components 
of this study. All information sheets that will be used can be found in our study toolkit.   
 
 
 
 
National level representatives have already been involved in grant development workshops and 
previous engagements and will be contacted via email or phone by one of our research fellows. 
Information sheet and consent form will be sent via email, after which the participant will be asked to 
propose a suitable date and time for a remote or in-person interview. On the day of data collection, 
National level participants: 

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our researcher will go over the information sheet, offer the opportunity for questions, and take 
informed consent via signature. 
 
District level 
We will obtain a letter from relevant regional health directors, to inform district director of our study. 
After providing approval, the district director will provide the research fellows with contact details for 
other relevant directorate staff (director MH/PH nurses, data manager).  These will be approached via 
phone to schedule a suitable time for a visit from our research fellow. During the visit, the research 
fellow will provide a verbal explanation about the study and information sheet and will schedule 
another appointment for an in-person interview, at least 24 hours later. Written informed consent will 
be obtained via signature prior to interview. 
 
Health centres: 
After they have given permission, district directorates will provide our research fellows with the 
contact details of the in-charge at selected sub-district health facilities. These will be approached via 
phone to schedule a suitable time for a visit from our research fellow. During the visit, the research 
fellow will provide a verbal explanation about the study and information sheet and will schedule 
another appointment for an in-person interview, at least 24 hours later. The in-charge will also be 
asked to provide contact details for other facility staff (e.g. MH nurse, PH nurse, etc), for whom the 
recruitment process will be the same. Written informed consent will be obtained via signature. 
 
Community level (CHPS) 
At community level, the District Directorate will also provide contact details for the in-charge of the 
CHPS facilities, who will put the team in touch with CHWs and CHVs. The study team will visit the CHPS, 
to speak to the in-charge, CHWs and CHVs.  Community groups will be identified through the 
directorate, CHWs and CHVs. Our research team will make a first approach by visiting the group 
leaders, together with the CHWs/CHVs.  Community leaders (e.g. chiefs) will be identified by the CHPS 
in-charge, who will be asked to pre-inform the leaders about our study, and who will accompany the 
study team when making a first approach in person. Persons-affected will be identified through CHWs, 
CHVs, or through snowballing via other persons affected. The CHW/CHV or person affected will join 
the research team in making the first approach and introducing the study.  
For group/community leaders and persons affected, the rest of the consenting process will be as 
follows: during a first visit, our research team will verbally explain the study, going over the 
information sheet. At least 24 hours later, they will return to provide another verbal explanation, the 
opportunity to ask questions, and obtain informed consent via signature or thumbprint, before 
proceeding with the interview.  
 
 
We will conduct use a census approach to survey the NTD population in the 4 
intervention sites (expected n=200). NTD patients will be identified as follows: We 
will work with the district health directorate to identify health facilities with NTD cases in each 
intervention district (CHPS and health centres). Where available, we will obtain a list from the district 
health officer with names and contact numbers of persons affected with NTDs registered in these 
facilities. We will also visit traditional/faith healers in the vicinity of the selected health facility, to ask 
if they have any NTD patients under their care. Finally, we will speak to community health workers 
Baseline survey: 

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attached to the local facility, and, upon completion of the survey, we will ask persons affected if they 
know of anyone else who is affected by one of the target conditions, to identify any non-registered 
persons affected via snowballing method. As such, it is expected that our census will contribute to 
case finding. The number of target health facilities will be expanded until we reach the required 
sample size; once a health facility is selected, we will complete our census, even if this takes us beyond 
the required sample size. 
The first approach will be made by a research assistant, together with a CHV, who will visit the 
person affected in the community. The research assistant will verbally explain the purpose of the 
study and provide an information sheet. If the participant is happy to participate, the research 
assistant will agree to return the next day, or at a date and time of the participants choosing. On the 
day of the survey, the research assistant will again explain the purpose of the study, provide an 
opportunity to ask questions and obtain written informed consent via thumbprint or signature.  
 
Policy brief  
The primary purpose of the policy analysis will be to develop an understanding of the policy processes, 
stakeholders and structures that may impact the development and delivery of the integration of 
mental health within care for people with NTDs in Ghana. This will inform the research design as well 
as the way that evidence is synthesised, packaged and disseminated. The policy analysis will primarily 
focus on national policy. 
Documents will be obtained by liaising with stakeholders in the Ministry of Health and Ghana Health 
Service. Once documents are obtained, we will develop a thematic framework to rapidly extract data 
from the documents, before synthesising the data from all the reports. 
Data Analysis 
Analysis will be completed collaboratively between all members of the research team. 
Qualitative data  
The participatory nature of workshops involved in phase one of this study mean that analysis will be 
an ongoing process involving study participants. The products of each of the participatory workshops, 
will each feed into the participatory planning meeting in phase two to allow for informed action 
planning. To harmonise across activities however, the research team will keep a log of key issues and 
discussion points from each of the participatory workshops to feed into the participatory planning 
activities. 
For components of participatory workshops phase one, where notes and recordings (with the 
agreement of participants) are transcribed, these will be analysed thematically using a framework 
approach as described below31. All other qualitative data will also be analysed using this approach. 
This thematic analysis will be conducted by the research team and also feed into the participatory 
planning activities for validation and consideration. 
Thematic Framework Approach 
Phase 1: Data Management 
 

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Step 1: Familiarisation - the analysis team will read and re-read the verbatim transcripts to ‘familiarise’ 
themselves with the data. Whilst doing this they take note of key themes emerging. 
Step 2: Developing a thematic/coding framework - a framework through which to sort the data will be 
developed based on original aims and objectives and any inductive themes identified during the 
familiarisation process. 
Step 3: Indexing/coding data - the thematic/coding framework will be applied to all the data. This will 
be assisted by the use of NVIVO software. If teams are unfamiliar with NVIVO software, training will 
be provided. 
Phase 2: Data Explanation 
Step 4: Charting - data will be lifted from its original context based on its allocation to the 
coding/thematic framework and placed within a chart. 
Step 5: Mapping - the final stage of the process will be to interpret, and map the range of polarities 
and similarities within the data. 
Qualitative analysis software NVIVO 12 will be used to support data management and analysis.  
Quantitative data  
Data will be analysed using R.  
At baseline, we will first use the NTD population dataset, to explore our main outcomes (mental health 
and quality of life of people affected). Using descriptive statistics, we will calculate the prevalence of 
depression and anxiety and summarise other key variables. The data will be presented separately by 
sex. We will use inferential statistics (multivariable linear regression analysis) to explore associations 
between mental health, quality of life, stigma and demographic variables. We will include interaction 
effects to see if the effect of predictors on our main outcomes differs from sex.  
We will also specifically explore the relationship between mental health and time since diagnosis, 
symptom severity, disability and functioning, using inferential statistics (multivariable linear 
regression), including interaction terms between key variables and sex.  
 
The endline analysis will include descriptive statistics to summarise outcomes at each time point, 
stratified by sex. To evaluate changes over time and potential sex differences, we will use linear mixed-
effects models with random intercepts for participants. Fixed effects will include time, sex, and a time 
× sex interaction term to assess whether the trajectory of mental health outcomes differs between 
males and females. Model assumptions will be checked, and sensitivity analyses will be conducted as 
appropriate. 
 
Findings from both qualitative and quantitative analyses will be integrated to provide a holistic 
understanding of how mental health services can be effectively incorporated into NTD programs. 
Triangulation of data sources will enhance the reliability and validity of study findings, ensuring that 
recommendations are evidence-based and actionable. 
Dissemination, Outputs and Anticipated Impact 
Our approach to impact is guided by our IMAGINE Ghana Theory of Change (Figure1); and which will 
be regularly reviewed at consortium meetings to reflect any changes in context.  

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Figure1. Overview of IMAGINE Ghana study phases and work packages 
Our impact at the global level will be to: Drive advances in the development and evaluation of 
interventions and strategies for improved treatment and management of co-occurring NTDs and 
MHCs within LMICs. 
Our global impact will be accompanied by impact within Ghana at three key levels: 
Individual: People affected (and their families) have access to integrated services for the prevention, 
treatment and management of co-occurring NTDs and MHCs, they experience less stigma and 
discrimination, and have more opportunity to participate within the life of their community. 
Community: Contribute to increasing health literacy related to NTDs and MHCs leading to a reduction 
in stigma, social exclusion and poverty (through reduced discrimination in social and work spaces). 
National: Effective co-ordination collaboration and access to evidence-based information for the 
provision of an essential care package for co-occurring NTDs and MHCs delivered as part of integrated 
case management interventions that are embedded within stronger and more responsive health 
system. 
 
Impacts will be realised through achieving the following outcomes: 
 

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Outcome 1: Evidence on the most effective, acceptable, affordable, equitable, inclusive and 
sustainable context-specific community, health and social systems-based interventions for co-
occurring NTDs and MHCs integrated into programme strategies by government, regional and 
international stakeholders. 
 
Outcome 2: Improved capacity among health system and community stakeholders to identify 
intervention solutions, and to promote a culture of working together to co-produce, implement, 
assess and adapt interventions to respond to holistic care needs and rights of people affected by co-
occurring NTDs and common MHCs.  
Systematic inclusion of the needs and priorities of affected persons within the design, delivery, 
monitoring and evaluation of system-based interventions to ensure equitable management of co-
occurring NTDs and common MHCs that meets the needs of vulnerable populations and promotes 
social inclusion and stigma reduction. 
 
Outcome 3: Evidence on the most effective, acceptable, affordable, equitable, inclusive and 
sustainable context-specific community, health and social systems-based interventions for co-
occurring NTDs and MHCs integrated into programme strategies by government, regional and 
international stakeholders. 
 
Outcome 4: Improved capacity among health system and community stakeholders to identify 
intervention solutions, and to promote a culture of working together to co-produce, implement, 
assess and adapt interventions to respond to holistic care needs and rights of people affected by co-
occurring NTDs and common MHCs. 
 
Outcome 5: Established technical and community advisory groups of policy makers, practitioners, 
researchers, persons affected and other community stakeholders collaborating together, and learning 
from each other, to identify and implement solutions for the integrated management of NTDs and 
common MHCs. 
 
Our approach to Engagement, Research Uptake and Maximising Impact 
 
Our approach to research uptake builds on many years’ experience of generating policy relevant 
research in partnership with a range of stakeholders; working directly with program managers and 
policy makers in the definition of the problem and execution of the research to facilitate rapid uptake 
of best practices; overcoming barriers to the use of evidence; and applying best practice 
communications techniques to ensuring that findings are packaged and disseminated to target 
audiences through a two-way process of dialogue and exchange. We have designed IMAGINE Ghana 
to maximise impact based on prior experience through REDRESS.  
Partners already have strategic platforms for research uptake, with relationships established with 
persons affected, Ministry of Health Mental Health and NTD programmes, health workers and 
community actors (e.g. religious leaders or traditional healers).  We will engage with digital means of 
dissemination building on existing networks of persons affected e.g. leprosy patient groups, where 
these exist.  We will engage with key audiences as follows: 

V1.0 01.04.2025 
 
With persons affected and community public involvement organisations: We will engage with 
persons affected through involvement in community advisory board, as co-researchers, during regular 
participatory workshops and dissemination meetings.   
Within government bodies and key stakeholders in Ghana: We will actively communicate through 
presentations and dialogue at technical review meetings and NTD annual review processes. We will 
also work with stakeholders such as the NTD ambassador for Ghana, Rev. Dr Joyce Aryee, to reach 
high-level decision makers; build new platforms and engage with pre-existing coalitions (e.g. National 
Union(s) of the Disabled); conduct sensitisation meetings with national bodies and supporting their 
capacity to access, understand and apply research evidence; and participate in national meetings and 
research forums. 
Within the wider LMIC community: We are actively connected to many working groups and networks 
that are of strategic benefit to the uptake of this work. E.g. NGDO Network on NTDs (NNN) Disease 
Management, Disability and Inclusion (DMDI) technical working groups, including those which focused 
on the development of the ECP for NTDs and Mental Health.  Members of the IMAGINE GHANA team 
also serve as members of key bodies to WHO involved in NTD strategy and research, such as WHO 
Operational Research Working Group on Skin NTDs (Dean). IMAGINE GHANA will also leverage 
additional formal dissemination channels where there is discussion with the wider LMIC community, 
for example; COR-NTD, ASTMH, Health Systems Global. 
 
 
Capacity strengthening 
 
Individual- To meet our capacity and capability strengthening objectives a capacity needs assessment 
will be carried out followed by working with early career researchers to development plans identifying 
short, medium and long-term opportunities to develop individual skills against need. Training will be 
nested in a wider approach to capacity strengthening with the development of individual personal 
development plans reviewed on an annual basis.   
 
Institutional- we will develop the capacity of all partners and their systems to support the 
development of research infrastructure for the evaluation of interventions and strategies for 
improved treatment and management of NTDs and MHCs in Ghana. Plans for areas of strengthening 
will be established following an institutional needs assessment and planned according to budget.   
 
Given the sensitivity of the issues we are working on, we will focus on generating and sharing lessons 
from navigating ethical challenges and co-producing and monitoring safeguarding risk assessments 
and strategies to minimise risk (Mansaray et al, 2022, Aktar et al, 2020). Inclusion will be central within 
our co-produced safeguarding plans, ensuring that people with disabilities are kept safe and enabled 
to access reporting mechanisms (e.g. ensuring there is not a single methodology for reporting cases 
of concern). We also recognise the barriers for many lived experience organisations in participation 
and will seek to provide organisational support for leadership through the programme to enable them 
to more consistently be equipped to contribute to IMAGINE GHANA and future programmes. 
 
 

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References  
Abdulmalik J, Nwefoh E, Obindo J, et al.; Emotional difficulties and experiences of stigma among 
persons with lymphatic filariasis in Plateau State, Nigeria. Health and human rights 2018;20(1):27.   
Bailey F, Eaton J, Jidda M, et al.; Neglected tropical diseases and mental health: progress, partnerships, 
and integration. Trends in parasitology 2019A;35(1):23-31.   
Bailey F, Mondragon-Shem K, Haines LR, et al.; Cutaneous leishmaniasis and co-morbid major 
depressive disorder: a systematic review with burden estimates. PLoS neglected tropical diseases 
2019B;13(2):e0007092.   
Bailey, F., Eaton, J., Jidda, M., van Brakel, W. H., Addiss, D. G., & Molyneux, D. H. (2019). Neglected 
Tropical Diseases and Mental Health: Progress, Partnerships, and Integration. Trends in 
parasitology, 35(1), 23–31. https://doi.org/10.1016/j.pt.2018.11.001  
Dean, L., Theobald, S., Nallo, G., Bettee, A., Kollie, K., & Tolhurst, R. (2022). A syndemic born of war: 
Combining intersectionality and structural violence to explore the biosocial interactions of neglected 
tropical diseases, disability and mental distress in Liberia. PLOS Global Public Health, 2(6), e0000551. 
https://doi.org/10.1371/journal.pgph.0000551 
Dua, T., Kestel, D., Chowdhary, N., Kolappa, K., Votruba, N., Drew, N., Funk, M. K., Minguell, J. R. F., 
Gabrielli, A. F., Djirmay, A. G., Hanna, F., King, J., Krupchanka, D., Malecela, M. N., Mbabazi, P. S., 
Moloo, A., Montresor, A., Postigo, J., Poznyak, V., . . . Bailey, F. (2020). Mental health of people with 
neglected 
tropical 
diseases: 
towards 
a 
person-centred 
approach. 
https://iris.who.int/bitstream/handle/10665/335885/9789240004528-eng.pdf?sequence=1  
Holtrop JS, Estabrooks PA, Gaglio B, et al.. (2021) Understanding and applying the RE-AIM framework: 
Clarifications and resources. Journal of Clinical and Translational Science 5(1):e126. 
Hotez, P.J., Fenwick, A. & Molyneux, D. The new COVID-19 poor and the neglected tropical diseases 
resurgence. Infect Dis Poverty 10, 10 (2021). https://doi.org/10.1186/s40249-020-00784-2  
Koschorke M, Al-Haboubi Y, Tseng P-C, Semrau M, Eaton J. Mental health, stigma, and neglected 
tropical diseases: A review and systematic mapping of the evidence. Front Trop Dis. (2022) 3:808955. 
doi: 10.3389/fitd.2022.808955 
Obindo J, Abdulmalik J, Nwefoh E, et al.; Prevalence of depression and associated clinical and socio-
demographic factors in people living with lymphatic filariasis in Plateau State, Nigeria. PLoS neglected 
tropical diseases 2017;11(6):e0005567.   
Osborne, S. P., Nasi, G., & Powell, M. (2021). Beyond co-production: Value creation and public services. 
Public Administration, 99(4), 641–657. https://doi.org/10.1111/padm.12718  
Owusu, L., Tuwor, R.D., Ackam, N. et al. (2023). Role and capacity needs of community based 
surveillance volunteers in the integrated management of skin neglected tropical diseases (skin NTDs): 

V1.0 01.04.2025 
 
a qualitative study from central Ghana. BMC Public Health 23, 1086. https://doi.org/10.1186/s12889-
023-16015-w  
Ronzi S, Puzzolo E, Hyseni L, Higgerson J, Stanistreet D, Hugo MNB, Bruce N, Pope D. Using photovoice 
methods as a community-based participatory research tool to advance uptake of clean cooking and 
improve health: The LPG adoption in Cameroon evaluation studies. Soc Sci Med. 2019 May;228:30-40. 
doi: 10.1016/j.socscimed.2019.02.044. Epub 2019 Mar 5. PMID: 30875542; PMCID: PMC7081729. 
Semrau M, Davey G, Bayisenge U, et al.; High levels of depressive symptoms among people with lower 
limb lymphoedema in Rwanda: a cross-sectional study. Transactions of The Royal Society of Tropical 
Medicine and Hygiene 2020;114(12):974-982.   
Sheikh K, Abimbola S, Organization WH; Learning health systems: pathways to progress: flagship 
report of the alliance for health policy and systems research. 2021.   
Singer M, Bulled N; Interlocked infections: the health burdens of syndemics of neglected tropical 
diseases. Annals of Anthropological Practice 2012;36(2):328-345.   
Ton TG, Mackenzie C, Molyneux DH; The burden of mental health in lymphatic filariasis. Infectious 
diseases of poverty 2015;4(1):1-8.  
World Health Organization. WHO. (2021b). Neglected Tropical Diseases. Retrieved February 24, 2025, 
from https://www.who.int/news-room/questions-and-answers/item/neglected-tropical-diseases  
World Health Organization. WHO. (2021b). The third National Neglected Tropical Diseases Strategic 
Plan 
2021-2025 
(2013/14 
– 
2017/18 
E.C.). 
https://espen.afro.who.int/system/files/content/resources/Third%20NTD%20national%20Strategic
%20Plan%202021-2025.pdf 
World Health Organization: WHO. (2020). Neglected Tropical Diseases: Tackling stigmatization, 
discrimination 
and 
mental 
health 
through 
a 
person-centred 
approach. 
https://www.who.int/news/item/12-10-2020-neglected-tropical-diseases-tackling-stigmatization-
discrimination-and-mental-health-through-a-person-centred-approach