Our vision for SCOPE is to see scalable interventions developed and implemented to achieve early detection and optimal recovery of people with psychosis in sub-Saharan Africa, grounded in local evidence and context and anchored in the priorities of people with lived experience of psychosis. Within the 5-year period of SCOPE, we envision development of acceptable, feasible and affordable interventions for rural, urban and homeless populations in Ethiopia, with potential applicability to other countries of sub-Saharan Africa. In this timeframe we seek to create momentum for greater priority to be given to the timely and effective care of people with psychosis across the continent through demonstrating home-grown solutions. In the next 10 years, our vision is for the generation of robust evidence on the transferability and effectiveness of SCOPE interventions when implemented and evaluated in diverse settings and for diverse populations of people with psychosis in sub-Saharan Africa. In this timeframe we aspire to make early detection and effective interventions for psychosis a policy imperative in sub-Saharan Africa. In SCOPE our key goals are (1) to determine the rate of new cases of psychosis in rural and urban settings in Ethiopia; identify possible risk factors for onset; and characterise needs of people with psychosis and factors that affect early course and outcome; and (2) use this evidence to co-develop bottom-up innovations to improve early detection and optimise recovery of people with psychosis that are applicable to rural, urban and homeless populations in Ethiopia, with potential generalisability to other low- and middle-income countries. In the formative phase of the project (year 1), we will develop a detection strategy and explore perspectives of people with lived experience of psychosis on the concept of recovery. In years 2-4 we will conduct an epidemiological study to identify people with untreated psychosis in rural districts in south-central Ethiopia (240 people with psychosis/600,000 population screened) and a sub-city of Addis Ababa (150 people with psychosis/400,000 people screened), and approximately 50 people with current or recent experience of homelessness. We will assess mental and physical health, social and economic status, and follow up participants for one year. In years 3-5 we will work with key stakeholders, including people with lived experience of psychosis, to incorporate emerging evidence into development of interventions to improve early detection and recovery. We will pilot test interventions for rural settings in a feasibility randomised controlled trial (n=75); and models for urban and homeless populations in uncontrolled pilot studies (each n=15). Implementation research methods will facilitate adaptation to other LMICs.

A crisis of governance which has emerged as a result of the extreme centralization of power, weak institutions and failure to institutionalise the responsible use of power is a key challenge in the Horn of Africa region. This research project will investigate the promises and pitfalls of federalism and devolution in the respective countries with a view to proposing concrete policy alternatives. The project will examine the institutional design mechanisms that help address the crisis of governance in the region and ensure unity but at the same also provide political space for sub-state elements. It will analyse the impact of devolution and federalism in a context of weak institutions and proposes areas for reform that assist in strengthening institutions and facilitate the process of devolution and federalism. Addressing the crisis of governance through federalism, devolution and inclusive political institutions as well as ensuring the institutionalization of power through strengthening the rule of law has the potential to make the government more accountable and able to deliver critical services. Such systems ensure relative stability and peace and reduce the risks of state fragmentation. Key research questions target the countries in the Horn of Africa region (Ethiopia, South Africa, South Sudan, Somalia), and the research will draw relevant lessons from countries in Africa (such as South Africa) and Europe (UK). Key experts from partner institutions have been chosen for their key skills and research excellence in this area, as well as their ability to address the research themes and engage with key leaders, political actors, civil society groups, women, members of parliament and other sections of society in each country. During the course of the research and while conducting the primary data through focus groups, key stake holder consultations and roundtables, gender equality will be ensured by all researchers. During the process of research key experts will engage with major stake holders in each country in four high level round tables and dialogues with political party leaders, academics, youth, women and civil society to gather relevant data on the state of governance. Based on the research outputs and existing knowledge, three rounds of short trainings (105 trainees in total) will be provided to relevant stake holders (parliaments, leaders, political parties, civil society groups, youth, women) in each country to disseminate the findings and create impact on actors and institutions. Four Policy briefs from each research theme will be prepared to guide the direction of reform in the system of governance in each country. Dialogue among leaders, political parties and civil society groups in each country will be the means to get policy buy in. Key experts will be commissioned to deliver key notes and summary of the policy briefs during training and seminar events. The final outputs and policy briefs will be shared in a regional seminar and dialogue where major stake holders will attend and engage by way of dialogue in the outputs. Four journal articles will be published in reputable journals (Regional and Federal Studies, Journal of Gender Studies, African Affairs, International Journal of Constitutional Law). An edited book with all the contributions will be published towards the end of the project. Improved knowledge on inclusive governance system, built capacity of major stake holders and actors on inclusive governance modalities ensures peace, stability and enhances service delivery- a major problem in the Horn of Africa As part of building the capacity of the CoE and strengthening linkages with and cooperation between the CoE and partner institutions, professors from partner institutions will be hosted as visiting scholars to provide lectures and seminars in the CoE in Good Governance. There will be joint research including research exchanges, lectures and short term trainings.