[#WHD2017 Africa Blog Series] Inspiring African innovations: The Biaber Project, Ethiopia
This blog is part of our series celebrating World Health Day 2017. This year's theme is Depression: Let's Talk and we're showcasing inspiring innovations addressing depression across Africa.
MHIN Africa innovation on depression 6: The Biaber Project
The Biaber Project provides training for specialist and non-specialist workers to detect and treat common mental disorders. They aim to reduce the treatment gap for common mental disorders through task-shifting.
Tell us about your country’s context and the circumstances that inspired your innovation
The inspiration for our Biaber Project is the possibility of working together to provide broad access to mental health service for Ethiopians as their requirements dictate. This is in line with Ethiopia’s National Mental Health Strategy which declares that integrating mental health services into Primary Health Care (PHC) is a corner stone of the Ministry of Health’s health policy and plan.
Ethiopia has a population of 100 million people and psychiatric care has always been provided by traditional healers throughout the country. In the last 10 years the number of psychiatrists has risen to 60, and there are now 3 residency programs to ensure an ongoing supply. There is, as well, an increasing number of mid-level mental health professionals (MLMHP) such as Masters of Mental Health, masters level Clinical Psychologists, and psychiatric nurses – there are perhaps 200 of these professionals and more graduating annually. However, providing real access to mental health services relies on integrating appropriate services into primary care, the first point of contact for patients. Training and supporting general nurses and health officers to screen and treat patients is the first tier in the provision of mental health services for all who need them.
What aspect of your project are you most excited about? How is the project innovative or unique?
We are particularly interested in incorporating into the structure of our project attention to culturally specific issues. For instance, we have chosen to train primary health workers (PCW) to screen and treat (with Interpersonal Therapy adapted for Ethiopia IPT-E) individuals with Common Mental Disorders (CMD) rather than depression. We have done this for several reasons e.g. most individuals have a complex overlapping set of symptoms which include anxiety, somatic concerns and culturally specific complaints as well as depression. We think it is a false dichotomy to try and separate out depression from PTSD, panic disorders, general anxiety disorder, and local idioms of distress. We have also found that the diagnosis of depression can add stigma and discrimination to the experiences of an already stressed individual.
Because the system of traditional healers has served the population for thousands of years, and provides highly culturally attuned psychosocial support and treatment, we are keen to find a way to work together that honours the current system. We want to avoid imposing a Western system of care that is largely built on evidence derived from a different and North American culture. As a first step, we are developing relationships with the traditional healers located around the Health Centers and hope to learn from them how they recognise and assist people who are significantly mentally distressed.
Finally, we are extremely excited to work with an inspiring group of MLMHP who we have trained and who will provide twice weekly follow-up to all the trained PCWs in their Health Centers.
Have you noticed an impact ‘on the ground’? What is the best feedback you have received (from service users, team members, or otherwise)?
We are moved by the responses of the patients and of the primary health care workers. The PCW tells us that they attend many trainings but we are the only training that provides ongoing and frequent guidance, support, encouragement and supervision through our mentoring system. We have many positive responses from patients. Some of the patients who screened positive for CMD are unable to return for treatment, nevertheless they report that being screened was a very beneficial experience, that no one had ever asked them about their inner life and issues before. Patients who have been able to come for the four Interpersonal Therapy (4 IPT) sessions say they have a new way of handling their problems, some who have multiple medically unexplained symptoms report these diminish as they link the difficulties in their lives with their distress. Some patients have returned to work or found new work. The PCWs have said such things as “now I can clap with 2 hands,” “I see people with mental health issues differently now, it’s not their fault and I can help,” “a man kept coming to the HC with suicidal attempts, the treatment I did stopped these and he is doing fine now,” “I helped a man with his problems and he came back to thank me with his wife and said I’d helped save their marriage.”
We are polishing our Biaber model currently focusing on five large Health Centers in Addis Ababa. If all goes well we hope that we will receive a scale-up grant to integrated mental health services into 40 Health Centers in Addis Ababa.
What is the one message about depression you want people to take away from your innovation?
Common Mental Disorders are treatable locally with talk therapy whether by traditional healers or by primary health workers in a group or individual format.
The Biaber Project is supported by Grand Challenges Canada.
For more African innovations featured in this series, please visit the [#WHD2017 Africa Blog Series].