Region of Study
The study will be conducted in the district of Swat, which has been affected by multiple humanitarian crises including military operations in 2009 and floods in 2010. The health system is weak and fragile. The rationale for selecting this challenging area as the field site is twofold:
- Large parts of the world’s population are increasingly affected by humanitarian crises and research into delivery of effective interventions for this population is scarce
- By choosing a site with multiple challenges both at the community and health systems level the study will demonstrate proof of concept in the most difficult settings so it is generalizable to any setting
Objective and Innovation
The main objective of this study is to scale up the THP, a cognitive behaviour therapy (CBT)-based intervention for maternal depression, delivered by LHWs (non-specialists).11
In a recent meta-analysis commissioned by the World Health Organization (WHO), THP was shown to have the largest effect and has been adopted by the WHO for global dissemination through its mhGAP programme.6 However, a major challenge in scaling up of this evidence-based intervention is the provision of training and supervision at scale, especially in post-conflict areas with weak health systems. The study team aims to meet this challenge by providing a technology based solution. Building on the team’s previous work in this area, a technology-assisted assessment, cascade training and supervision (TACTS) system will be developed which will include:
- A technology assessment tool to diagnose depression in the community
- A tablet-based manual allowing standardized training to be delivered without the need for a specialist trainer
- A cascade training model whereby specialists supervise, from distance, the LHW program supervisors, who in turn, supervise the LHWs as part of their normal routine
The LHW Programme covers 85% of Pakistan’s rural population through 115,000 LHWs. Through this technological solution for their training and supervision, they have the potential to provide treatment to an estimated 5 million women in rural Pakistan with maternal depression.
The project will be implemented in two phases:
Phase 1 (months 0-12)
TACTS will be developed in partnership with technology experts at the Human Development Research Foundation. This will include the mobile-phone based detection tool, the tablet based training manual, and the cascade model of supervision. The instruments for evaluation of the system will also be developed.
Phase 2 (months 13-24)
Evaluation of TACTS in district of Swat Union Councils through a feasibility cluster trial.