Innovation summary

This innovation addresses the lack of psychiatrists or mid-level mental health care specialists to adequately provide mental health services and access in Ethiopia.  Although good training programs exist, the need to task-shift mental health services to primary health care workers has been identified as an important strategy to increase access and treatment availability.

The Biaber Project features:

  • Six “hubs” of psychiatric training and service delivery
  • Coordinated system and materials for training the trainer on screening and treatment of people with common mental disorders
  • Three levels of health care professionals trained by the trainer, from mental health specialists to primary health care workers
  • System of on-site mentors and peer coaches to ensure quality, uptake and ongoing development of services
  • Brief, safe and effective interpersonal therapy, culturally adapted for use in Ethiopia
  • Mobile and tablet technology to enhance sustainable training platforms, manage data and improve communication, access and quality of care

Impact summary

  • Project covers 20 district health centers and six “hubs” of training and service delivery
  • $900,480 USD funding over three years from Grand Challenges Canada

"A culturally specific adaptation of… interpersonal psychotherapy that integrates an understanding of Ethiopian cultural practices and traditional pathways to care… is a brief, safe, effective and affordable treatment. This project will ensure it can be delivered by health care providers and lay workers with little or no previous mental health experience." 

 

-The Biaber Project

This innovation is funded by Grand Challenges Canada.

Innovation details

The aims of the Biaber Project are to improve access to treatment for common mental disorders, improve the quality of treatment provided and reduce stigma. In order to achieve these aims, the Biaber Project delivers a training system for trainers, counsellors and peer supervisors to exponentially increase the number of patients receiving mental health treatment when and where it is needed.

A major component of the treatment provided is interpersonal therapy. Interpersonal therapy has been demonstrated to be effective in multiple randomized control trials in other low-resource settings.1-5 For example, in Goa, India, the MANAS trial showed interpersonal therapy delivered by lay counsellors to be effective for patients with common mental disorders attending public primary care facilities.4-5

The Biaber Project offers a culturally-specific adaptation of interpersonal therapy that integrates an understanding of Ethiopian cultural practices and traditional pathways to care, providing a brief, safe, effective and affordable treatment. This project will ensure that interpersonal therapy can be delivered in the Ethiopian context by healthcare providers and lay workers with little or no previous mental health experience.

Key drivers

Partnership and collaboration

  • Integrated network of Ethiopian interpersonal therapy providers and trainers will facilitate sustainable knowledge transfer and exchange processes to expand care for the mentally ill
  • Network will be strengthened by robust links to university-based and primary care training programs in medical schools and the public sector with future plans of embedding the program into centralized training for future health workers and leaders
  • Collaboration with the Ministry of Health will promote sustained best care practices for CMD and improved access to diagnosis and treatment options for urban and rural populations

Challenges

Training challenges

  • Difficulty of finding practicum placements for graduate students
  • Competing educational priorities in training programs

Barriers to practice and uptake

  • Reluctance to use western treatments to deal with mental health issues because they are understood as spiritual problems and not assisted by health care workers
  • Attitudinal or practical barriers and restrictions on inter-professional collaboration
  • Counsellors may be non-compliant or struggle to stay “on-model” due to inexperience and clinical challenges

Infrastructural challenges

  • Difficulty communicating by mobile phones due to network problems

Continuation

A plan is currently in place to embed the program into centralized training for future health workers and leaders in psychiatry, psychiatric nursing and family medicine in Ethiopia.

Partners

Funders

Evaluation methods

No evaluation has yet taken place.

Cost of implementation

  • Grand Challenges Canada is providing $900,480 USD over three years (September 2012-2015)
  • Addis Ababa University and University of Toronto Departments of Psychiatry, Family Medicine and Nursing are donating an estimated $469,000 in faculty time, materials, space and loaned equipment

Impact details

Impact has not yet been evaluated.

References

  1. Bass J, Neugebauer R, Clougherty K, Verdeli H, Wickramaratne P, Ndogoni L, et al. (2006)Group interpersonal psychotherapy for depression in rural Uganda: 6-month outcomes. British Journal of Psychiatry, 188:567-73.
  2. Bolton P, Bass J, Neugebauer R, Verdeli H, Clougherty K, Wickramaratne P, et al. (2003)Group interpersonal psychotherapy for depression in rural Uganda: a randomized controlled trial. JAMA, 289:3117-24.
  3. Bolton P, Bass J, Betancourt T, Speelman L, Onyango G, Clougherty K, et al. (2007)Interventions for depression symptoms among adolescent survivors of war and displacement in Northern Uganda. JAMA, 298:519-27.
  4. Patel V, Weiss HA, Chowdhary N, Naik S, Pednekar S, Chatterjee S, et al. (2010) Effectiveness of an intervention led by lay health counselors for depressive and anxiety disorders in primary care in Goa, India (MANAS): a cluster randomized controlled trial, 376:2086-95.
  5. Patel V, W Weiss, Chowdhary, Naik, Pednekar, Chatterjee, et al. (2011) Lay health worker led intervention for depressive and anxiety disorders in India: impact on clinical and disability outcomes over 12 months. British Journal of Psychiatry, 199:459-66.

Comments

I am looking for access to training materials for non specialist counselors to develop their capacity as counselors. Is there a contact to request access to training materials?

We developed and tested extensive training materials for screening and treating Common Mental Disorders in Addis Ababa, Ethiopia with significant support from Grand Challenges Canada. We are now adapting these materials to the needs of refugees in Ethiopian Refugee Camps. We look forward to opportunities to share our approach and materials with other programmes and projects worldwide.

Hi Norman, As project manager, am up to speed on all training materials developed and tested on Biaber - for ToT and training primary care staff to screen and treat Common Mental Disorders using IPT. as well as data collection, etc. for monitoring & reporting on progress. Would be happy to share with you. All materials were developed with support from Grand Challenges Canada and are in the public domain.
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