Innovation summary

Mental ill-health, specifically in expecting mothers' and fathers' can affect their overall emotional, environmental and physical well-being1. Moreover, it has the ability to impact outcomes related to inter-personal relationships within families as well as developing new-borns and early childhood2-3.  

The Holistic Community Care for Parenthood (HCCP) program’s goal is to promote and develop sound perinatal mental health for both parents as well as the wellbeing of children starting in the earliest years of life. The HCCP program is implemented by the Society for Pre- and Post- Natal Services and provides the following services:

  • Mental health education to expecting mothers and the fathers during their routine antenatal and postnatal care visits
  • Professional listening visits based on Systemic Family Therapy
  • Early diagnosis and screening for mental health to every expecting parents
  • Awareness campaigns in communities on topics related to family mental health to improve uptake of mental health related services
  • Training community health care workers for early detection, screening and referral for treatment of maternal, paternal and child mental illness
  • Promoting engagement in economic self-sustenance projects as a means of alleviating mental health issues emanating from socioeconomic challenges

Impact summary

  • 134 participants utilised post-natal care in clinics
  • 3 awareness groups conducted, the majority of participants being mothers
  • Strong participation of 80% noted within discussions held during the group meetings indicating the perception that the approach is an effective platform for parents to discuss parenthood issues, share knowledge and contribute their input on the development of effective long-term interventions.
  • Costs for HCCP per month average US$1,100 for operational and staff costs (US$1000 as remuneration per Counsellor per month for services rendered and US$100 for communication and office costs).

Innovation details

The goal of the HCCP Program is;

  • To ensure holistic and sound support and care (including economic, physical, social, mental and emotional wellbeing) for parents to manage their personal and parental duties and be able to raise mentally and physically healthy and resilient children in Zimbabwe by 2030
  • To empower parents and reduce the incidence of childhood neglect and abuse by 2030.

The program is being implemented through the following components:

  • Prevention and promotion of awareness campaigns in communities about maternal, paternal and child mental health topics
  • Mental health education sessions to improve the uptake of maternal and paternal mental health services
  • Providing training for a Diploma in Systemic Family Therapy and Family Development in Maternal, Paternal and Child Mental Health
  • Providing one-on-one professional systemic family therapy coupled with subsequent sessions and follow up listening visits
  • Parenthood craft classes
  • Extending outreach through training to community healthcare workers for early screening, detecting and referring of mental health issues and illness to professionals

Key drivers

Social drivers

  • Due to a high prevalence of family inter-relationship problems within the family setup i.e. between parents, their in-laws or with the wider community, the intervention was adapted to be culturally sensitive to the social norms with respect to family dynamics in Zimbabwe.

Economic drivers

  • There always arise some cases of mismanagement of financial resources within the family, resultantly creating conflict and fights over money issues, while in other cases families may face difficulties in initiating self-income-generating projects for self-sustenance and to address the financial needs of the family. Zimbabwe being a low-income nation, this intervention makes HCCP’s economic self-sustenance initiatives approach very relevant and beneficial.

Cultural drivers

  • One of the marriage partners may have an identity crisis arising through many mothers being forced to conform to the cultural and religious identity of the husband’s family-a very common culturally accepted situation among the black Zimbabwean communities.

Challenges

Gender-based Cultural factors

  • Most fathers are not forthcoming to attend the group discussions or openly participate due to the cultural associations of being viewed as being “weak and feminine” by spending time in talk sessions. The belief that “real men” should be able to manage and solve their issues on their own has been ingrained in African men.

Unavailability of fathers

  • Due to constantly demanding economic activities, most fathers, who are the “providers” for the family find it challenging to make time to attend the group discussions. Consequently, our field counsellors mostly meet mothers only in their home visits.

Sustaining buy-in

  • Some members of the target population showed a lack of interest in the program since there were no financial incentives for their involvement and participation.

Continuation

Although the HCCP program is still in its infancy, efforts are being made to strengthen and perfect the model, based on the evidence of positive impact recorded through our efforts so far.

SPANS intends to conduct more prevention, promotion and early detection through the HCCP program. The focus will be on building capacity, improving access, education and assistance for all residents in both the rural and peri-urban local communities within the project sites before venturing into other districts within the Mashonaland East Province and then eventually taking the program to other provinces of Zimbabwe.

With sufficient technical and financial support, the HCCP program’s model has promise for benefiting the individual, families, parents and children in all communities of Zimbabwe and an evaluation is under way to provide more data-driven results to this end. 

Evaluation methods

Follow-up assessments

The Volunteer counsellors will make follow-ups through professional listening visits to family homes to assess progress made for example in the implementation on-one-one systemic family therapy and of self-reliance projects. After professional systemic family counselling sessions, the parents will be advised to come for subsequent sessions for further assessment of whether the issues discussed are being resolved through the informed decisions agreed on.

Clients Records

All systemic family therapy sessions will be conducted through a booking system which means that the receptionist will make sure all clients had a file opened before services provided at the centre

Supervisory Meetings

Family Therapist and Counsellors will hold weekly meetings to discuss all complicated issues they encounter and find possibly ways of doing better

Video Interaction Guidance or One-way Mirror

If funds permit SPANS will make this service available for the purpose of capturing the sessions for the purpose of professionally helping the clients.

Impact details

  • A total of 1560 participants (comprising both fathers and mothers) have attended the Mental Health Education sessions delivered since the start of the program
  • Given the high rate of attendance, the program will increase sessions on mental health education from 1 per week to 5 per week in 2020.
  • A considerable number of issues have been highlighted, and some very reasonable interventions suggested, indicating that a substantial number of parents are benefiting from the HCCP discussions (some parents are continue to attend the group discussions even outside of their post-natal care visits).
  • 25 clients were provided professional family therapy sessions
  • Saw the first three groups enrol in the newly launched SPANS Diploma (2019) in Systemic Family Therapy and Family Developmental Counseling in Maternal, Paternal and Child Mental Health which will run for 2 years

References

  1. Rahman A, Iqbal Z, Harrington R. Life events, social support and depression in childbirth: Perspectives from a rural community in the developing world. Psychol Med 2003;33:1161-7
  2. Venkatesh S, Vindhya J, Nath A. Maternal mental health and its influence on infant growth and development: A systematic review of observational studies in South and East Asia. Indian Journal of Health Sciences and Biomedical Research (KLEU). 2019 May 1;12(2):103.
  3. Rahman A, Bunn J, Lovel H, Creed F. Association between antenatal depression and low birthweight in a developing country. Acta Psychiatr Scand 2007;115:481-6
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