Innovation summary

Conflict in Northeast Uganda destroyed infrastructure and systems of care and support, caused physical maiming and a more perverse psychological traumatisation of the population which still remains unaddressed.1-6 Traditional methods of managing ill-health at individual, family or community level are often lacking and the situation even worse due to stigma and non-prioritization of mental health by government and other  agencies leaving the population to the recourse of  uninformed traditional and faith healers.7 High levels of psychological distress in a scattered community, coupled with inadequate medicine-supply and poor human resources make mental health services inaccessible.

This project proposes three approaches to improve access to mental health services for the war-affected and scattered rural population of Soroti district:

  1. Introduction of Mobile Mental Health Clinics
  2. Service Owned Users Pharmacy (SOUP) Medicines model
  3. Psychological First Aid (PFA) intervention

Impact summary

  • 20,000 patients with mental illness (including epilepsy and substance use) to be screened/identified using WHO mhGAP Intervention Guide
  • 4800  people experiencing trauma in the community will receive PFA
  • 1,094 persons with mental illness have received treatment in the last six months of the project (in two out of the seven rural sub-counties) (January 2015)

Innovation details

Building capacity of health care workers and community members

The project primarily seeks to build the capacity of human resources in the health care system (Primary healthcare (PHC) workers) and the community members (Village Mental Health Team (VMHT)) by training them to identify and manage mental health problems in their own community supported by a Mobile Mental Health Team (MMHT) which provides outreach services.

The PHC health workers in Soroti District were invited for a five day training on management of common mental illness using WHO mhGAP adapted Intervention Guide. The common mental illnesses in post-conflict communities, like Soroti district, include: post-traumatic stress disorder (PTSD), depression, anxiety disorders, alcohol and drug abuse, Epilepsy, somatoform disorders and stress management. These health workers then manage mental illness in the units they work and are supported by the district mental health specialists. The mental health specialists also hold clinics at accessible community posts which were identified by service users. Treated patients are evaluated for quality of life at entry into care and after six months of follow up treatment.

In order to mobilize communities, improve knowledge and attitudes as well as deliver PFA to survivors of current traumatic events, community health workers (CHWs) were trained and mentored in the rural communities. The CHWs deliver the standardized Psychological First Aid model (more below).

The project has other three components which are complementary: mobile mental health clinics, Service Owned Users Pharmacy (SOUP) Medicines, and the Psychological First Aid (PFA) model.

Mobile Mental Health Clinics

Mobile Mental Health Clinics are defined as service user organised outreach clinics whereby service users gather and a team of health workers from the centralised clinic at the district hospital (MMHT) work together  to provide clinical services to outreach rural patients, and at the same time train and supervise the village community who form the VMHT.

A team of health workers from the mental health clinic at Soroti Regional Referral Hospital comprising of Psychiatry Clinical Officers or Psychiatric Nurse and Counsellors travel and locate the VMHT members and service users at the outreach post on a designated mental health clinic day. The clinic day may be selected to coincide with a major community activity e.g. the market day.

Queuing service users, at the health clinics, participate in peer support sessions and group meetings in the form of peer-counselling sessions. Service users mobilise themselves and schedule these sessions.

Service Owned Users Pharmacy (SOUP) Medicines model

In order to increase accessibility of common mental health medicines, a SOUP Medicines model was initiated. In this model, mental health service users and their caregivers were asked to form groups through which members mobilized funds, saved and used them to buy medicines when the required medicines were not available in the public health units. Service users recognized that by raising funds beforehand and buying medicines as group, they would benefit from cheaper whole sale prices and that they would ensure continuity of treatment. The groups also helped them to support each other intermesh of treatment as well as increased productivity.

Psychological First Aid Model

An adaptation of the Psychological First Aid model to manage mental health problems in crisis situations in these rural communities where, often, there are no mental health workers.

Community education activities

Communities have been mobilized to participate in the project through education on radio, gatherings and household. The mental health specialists from the district, primary healthcare workers and CHWs have carried out public education.

Feasibility and Scale up

The intervention was first piloted in two sub-counties before scaling it up to a total of seven sub-counties.

Key drivers

Integration of new services and existing resources, structure of National Healthcare System

Services were taken to the community through mobile clinics to ensure accessibility and mobilize participation of many community members. Afterwards, services were integrated into public health care system.

The resources and structures of the national healthcare system were used such as Community Health Workers, mental health specialists in the District.

Empowered service users

Service users were empowered to increase demand for mental health services and increase their ability to afford the common mental health medicines


Expectation of increase in payment by CHWs

CHWs are not salaried and they only get paid when they participate in health related activties. As such, CHWs had high expectations that could not be met by the project. Only about 60% of the trained CHWs participated in the project implementation.

Service user interest in treatment vs. material support

Service users are less motivated to participate in productive activities and raising funds for their treatment instead, they were more interested in receiving material support from the project. Levels of poverty were also very high.


Empowering service users to form groups, and engage in production and saving will be important at scale up. In addition the use of CHWs to engage people experiencing ongoing trauma is also very important in post conflict communities. The evidence from this study can be used to convince stakeholders and governments to invest in these two areas at the scale up stage.

The intervention has already been successfully piloted in two sub-counties before scaling it up to a total of seven sub-counties.

Evaluation methods

The project was evaluated at different levels: output related evaluations were integrated into the project implementation while outcome evaluations were conducted at different phases of the project.

Cluster randomised trials were used to evaluate the PFA component at six weeks and again at three months follow up. The improved quality of life of patients treated for mental illness was evaluated using WHO Quality of Life questionnaire after six months of follow up on treatment. The improved knowledge and attitudes of communities members will  also be evaluated at entry into the district again after one and half years of the project.

Cost of implementation

The total project cost is projected to be 270,000 CAD over the span of two years. A cost analysis has not been implemented.


  1. Musisi S, Kinyanda E. Liebling H., et al (2000) Post Traumatic Stress Disorders in Uganda.  A 3-year retrospective study of case records at a specialised torture treatment center, Kampala, Uganda. Torture Vol. 10 No. 3.
  2. Musisi S. (2004) : Mass Trauma and Mental Health in Africa. African Health Sciences Journal. Vol.4 No. 2 Aug 2004.
  3. Kinyanda E. and Musisi S, (2002) War traumatisation and its psychological             consequences in women of Gulu district – In Violence Against Women and       Children:  A Review of women’s studies, VOL XI Nos 1 and 2.  University Center   of Women’s studies, University of Philippines Press.
  4. Okello J, Onen TS and Musisi S (2005): Psychiatric Disorders Among War-abducted And Non-abducted Adolescents In Gulu District, Uganda: A Comparative Study. African Journal Of Psychiatry. 2005, 10:225-231.
  5. Bolton P, Betancourt T et al (2009): A Qualitative Study Of Mental Health Problems of children affected by war in Northern Uganda. Transcultural Psychiatry 46(2): 238-256.
  6. Akello  G, Richters A And Ovuga E (2010): Children’s Management Of Complaints Symptomatic Of Psychological Distress: A Critical Analysis Of The Different Approaches In Northern Uganda. African J Traumatic Stress Vol 1, No. 2, p70-79.
  7. Abbo C, Ekblad S, Waako P et al (2009): The prevalence and severity of mental illness handled by traditional healers in two districts of Eastern Uganda. African Health Science Journal Vol 9 Special Issue. 
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