Innovation summary

About 50% of people over the age of 15 in Afghanistan experience some kind of mental health problem. The prevalence is reportedly higher in young adults (18-25), with the most common problems being depression and post-traumatic stress disorder.1 The Government of Afghanistan’s Mental Health Strategy (2009-2014), focuses on community based interventions and improving treatment; however, it does not have the capacity to implement solutions, including decentralizing care outside of Kabul.

The innovation aims to leverage an existing health infrastructure of community health workers, community health centers and a district hospital, clinical networks and available communication capabilities to establish a sustainable and scalable option for young adults living with common mental health problems.

The program’s approach will consist of:

  • Reducing stigma, emphasizing mental health disorders are treatable
  • Improving mental health skills and knowledge of healthcare providers and information available to them
  • Introducing e-health facilitated service delivery for rural and remote communities

Impact summary

  • Approximately 100 community health workers will be trained in mental health triage and non-pharmacological strategies
  • Over 800 young adult and adult community members and 250 mental health providers and community health workers will take part in mental health awareness and stigma phase
  • $891,548 USD funded over three years

Innovation details

The program will perform focused activities using evidence based interventions delivered to specific groups (community groups, healthcare providers and young adults) with evaluation of their impact and outcomes. Activities will include:

Raising mental health awareness

Mental health awareness building at the community, community health center and district health levels through SMS technology and other approaches to reduce stigma and emphasize that mental health disorders are treatable:

  • Community groups: Interventions such as dramas, dialogues and videos and already circulating announcements and pamphlets for religious gatherings and community meetings will be leveraged to raise mental health awareness
  • Healthcare providers: Regular sessions at health facilities and district health offices to improve awareness about mental health issues in young adults and the role of families and health professionals. SMS messages will also be sent to providers every week.
  • Young adults: Individual and group sessions conducted by community health workers and healthcare providers, to improve knowledge about common mental health problems. Sessions will be conducted in a confidential environment. In addition, regular SMS messages will be sent to the registered young adults.

Skills and knowledge development of health providers

Face-to-face and virtual educational strategies for community health workers and clinicians (community health centers and district health level clinicians) to raise mental health skills, knowledge and information of healthcare providers consisting of:

  • Capacity building training with support and supervision follow up, aligned with resources and needs of local settings
  • Specific teaching modules through blended learning techniques for health providers at different levels

Health providers: Standardized and culturally sensitive material and guidelines assembled from the mental health Gap Action Program (mhGAP)

Facility based health providers: Culturally sensitive material distributed in the form of manuals, complemented by cell phone reminders for CHWs and video-conferencing or educational CDs

Health management information system

The existing district level health management information system will be improved to support mental health service delivery, mobilize resources and improve the supply of medicine by:

  • Ensuring mental health is an integral component of the existing district health information system
  • Developing and introducing a community health worker information system to allow proper reporting and managing medication supplies
  • Compiling, managing and analyzing all information at the provincial level

Creating accessible mental health

Introducing web based and video conferencing consultation options to enhance service delivery in mental health in rural and remote communities:

  • Health providers at the community health centers will conduct live consultations with the psychiatrist through a desktop based video conferencing software like ooVoo or Polycom PVX
  • Health providers at the provincial hospital will conduct tele-consultations using video conferencing equipment

Key drivers

Involvement, support and consideration of local communities​ and government

Involving local communities and seeking support from religious and other leaders to create program ownership.

Constant contact with Ministry and local Department of Health team to foster government awareness of and involvement in project activities to ensure that project is sustained after funding period expires.

Project designed to be in line with Afghanistan Ministry of Public Health Mental Health Strategy.

Challenges

  • Difficult geographical terrain and weather conditions
  • High turnover of senior staff
  • Remote management of activities due to security conditions

Continuation

The research project is designed, implemented and evaluated as a sustainable and scalable program. It will serve as a model for future expansion of mental health interventions to other age groups and mental health issues, and within similar settings in Afghanistan and elsewhere.

Future plans are to replicate the project in other parts of Afghanistan and many other similar locations in the world.

Partners

Funders

Evaluation methods

Community based randomized control evaluation

The project will use a community based randomized control design by implementing the innovation and control arms in four districts of Badakshan each, to evaluate the effects of implementation.

Cost of implementation

Total cost of the research project is approximately $891,548 USD.

References

  1. Ministry of Public Health (2009) National Mental Health Strategy.

Research

Tools

Multimedia

Reports
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Country

Afghanistan

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