Abstract

In low- and middle-income countries (LMICs), mental health systems face persistent challenges in access, coverage, and quality, especially for vulnerable groups such as perinatal women. This case study from Pakistan describes an innovative, system-level model for scaling up a psychosocial intervention for perinatal depression - the World Health Organization Thinking Healthy Programme (THP). Originally designed for delivery by Community Health Workers, THP was adapted for delivery by trained lived-experience peers using a social franchise model led by a local non-governmental organization (NGO). The model integrated several innovations: public-private partnerships that leveraged the comparative strengths of government institutions, tertiary mental health services, and community organizations; a stepped-care service delivery framework embedded in primary health care; and digital platforms for intervention-delivery, training, supervision, and quality assurance. Community-based identification through informants and structured screening using PHQ-9 facilitated early detection. Health information generated by the NGO-led franchise was aligned with primary care data standards and partially integrated into the District Health Information System, enhancing accountability and visibility. This case-study illustrates how strategic innovation across multiple health system building blocks can enable the delivery of scalable, community-anchored mental health care in LMICs, offering a replicable model aligned with global goals for Universal Health Coverage and mental health equity.