Innovation summary

About 45% of 800,000 citizens of the Union of Comoros live below the poverty line. The UN’s Human Development Index ranks the country 163rd of 187. On the country’s main island, Grande Comore, the Bambao Itsandra district (population 60,000) has an estimated 600 people with epilepsy and 600 with schizophrenia. However, there is only one psychiatrist in the whole country and mental health care is in its infancy.1

The innovation aims to leverage an existing health infrastructure of community health workers, community health centres and a district hospital, and available communication capabilities to establish a sustainable and scalable solution for people living with mental health disorders.

The programme’s approach is to:

  • Reduce stigma and emphasize that mental health disorders are treatable
  • Raise mental health skills and knowledge of healthcare providers by informing them of available information
  • Introduce telepsychiatry in order to allow people with mental health disorders and healthcare providers in remote areas to be able to get in contact with the psychiatrist in the main hospital via Skype

Impact summary

  • 60 000 people will be served in two regions and the capital city
  • 30% or 380 patients are expected to recover as a result of the innovation
  • $211,600 USD funded over 2 years

"Mental health is a country priority"


Plan National de Dévelopement Sanitaire and le code National de la Santé 2

This innovation is funded by Grand Challenges Canada.

Innovation details

This pilot project aims to introduce access to care for people with schizophrenia and people with epilepsy at the community level in the Union of Comoros. Three levels are targeted:

  1. Patients need to be identified and encouraged to go visit the community health center for treatment. This step involves increased levels of education to remove misconceptions about these two diseases and reduce the stigma surrounding them
  2. General Practitioners and nurses working in the primary healthcare centers need to be trained to care for the patients
  3. Specialists need to be brought closer to the community by means of telemedicine in order to avoid costly travel for patients and to overcome specialists’ paucity

Increasing mental health literacy in the community

The Comoros healthcare system already employs field workers in each district, to spread awareness on several issues like HIV/AIDS and Malaria. This project, within an integrated approach, aims to train these “Community Healthcare Workers” (CHWs) about epilepsy and schizophrenia.

Reducing stigma in the community through community healthcare workers

Community healthcare workers will strive to achieve three main goals:

  1. Inform the population using I-E-C tools
  2. Identify new patients and directing them to care
  3. Support patients and their families via home visits

In order to guide their activities, 3 nurses (already working in the healthcare system) have been employed as Coordinators and will be responsible of following up on the plan.

Increasing mental health literacy in the primary healthcare centres​

Training General Practitioners and other primary healthcare professionals

4 General Practitioners and 7 nurses, in 8 community healthcare centers and 1 district hospital have been trained. The training program consists of 5 half-day sessions during one week and is conducted under the supervision of the Comorian health school and by project team specialists.

The content of the training focuses on key concepts based on the interactive version of the mhGAP-IG and videos of clinical cases and interviews. Participants are also trained in the use of tablets so they can use tablets during their sessions.

The participants have had a pre-test to know of how much they were aware of mental health illnesses, then the training. After the training there is a post training test or evaluation. If a trainee reaches 80% of mark, it means he/she is qualified or else disqualified fewer than 50%.

Identifying new cases of schizophrenia and epilepsy

During the activities phase, the healthcare professionals will be responsible for managing cases of schizophrenia and epilepsy. Patients will either be new cases identified by the community healthcare workers or those currently receiving care at the national hospital.

Implementation of telemedicine to extend specialist reach

Telemedicine is used when primary care health workers require advice from a specialist; Skype is used to facilitate patient cases. Through telemedicine, patients are able to avoid long and costly travel to see a psychiatrist.

A usage protocol will be developed to aid the discussions and build mutual trust and understanding between all the providers.

Finally, in order to aid the Comorian specialist with complex cases, external advisors, Dr. Ratsifandriahamanana, (Madagascar), Pr. Raharivelo (Madagascar), and Pr. Martin (France) will participate in the telemedicine sessions.


  • Sustainability due to costs
  • Telecommunication problems
  • Lack of motivation in healthcare providers and CHWs


The innovation will likely be scaled up to a larger population depending on the outcome of this initial project. This approach can be used with other mental health disorders as well as other non-communicable diseases in Union of Comoros and other low and middle income countries.



Evaluation methods

Healthcare provider’s activities are measured on the basis of the number of patients successfully sent to health centers. Tablets are used for mhGAP to develop a weekly report and are submitted via email. The Project Coordinator visits the centers every month and checks the records of each healthcare provider.

In addition, continuous education is provided through e-Education that is set up between the University hospital, the district hospital and the eight community healthcare centres. This post graduate training is implemented using the Université Numérique Francophone Mondiale format, which has proven to be efficient.

The success of this project will be measured by how often the tools are used at regular intervals, by the number of telemedicine sessions delivered and by the number of patients sent to the National Hospital (before/after comparison).

Success will also be measured by the number of CHWs who complete the training, the number of patients identified, and the number of home visits and their satisfaction with the visit.

Cost of implementation

211,600 USD (KMF 96 000 000) funded over two years.

Impact details

  • ~90 CHWs have been trained, equipped with tools and recruited and 60 Community Leaders have been sensitized
  • 11 healthcare providers trained, equipped with computers, tablets, and e-patient files


  1. National Reinforcement Program of the Union of Comoros  (N/A)
  2. Plan National de Dévelopement Sanitaire
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