Innovation summary

In Uganda, both traditional and biomedical treatment are sought by people suffering from mental disorders, yet clinicians are often reluctant to work with traditional healers— and vice-versa. Wayo-Nero is a community-led strategy using lay workers (Wayos and Neros) to liaise between biomedical and traditional healers and the local community. The Wayo-Nero strategy aims to:

  • Facilitate early case detection
  • Streamline the referral process
  • Support recovery from mental illness
  • Help change attitudes toward mental illness
  • Improve treatment-seeking behavior at the community level

The Wayo-Nero strategy has two main components:

  • Development of a bi-cultural therapeutic intervention model using the Wayo-Nero strategy
  • Use of cell phone technologies (SMS/voice) to communicate/share mental health information between biomedical practitioners, traditional healers and the community

Impact summary

  • Approximately 400 lay workers and 70-100  traditional healers will be trained
  • $985,155 USD funded over three years

"Before, we used think that the doctors in hospitals are our enemies who refuse to see and believe what our medicines can do in terms treating diseases. Now… they are not our competitors nor are they enemies, they are colleagues in providing care."

 

-Traditional Healer in a Wayo-Nero Workshop

This innovation is funded by Grand Challenges Canada.

Innovation details

Mental health service delivery is particularly challenging in post-conflict areas like northern Uganda. The burden is high, infrastructure has suffered, and specialist staff are limited. The Wayo-Nero strategy builds off of indigenous institutions to reduce the treatment gap, following in the footsteps of successful models of health promotion for HIV.1-3

Wayo-Nero is a bi-cultural, community-led strategy that revitalizes the roles of “uncles” (Wayos) and “aunties” (Neros), who traditionally help with child-rearing. These “aunties” and “uncles” are trained as lay mental health workers, assisting in community-level case-finding, referral, follow-up and stigma reduction.

Wayos and Neros provide a bridge between the traditional and biomedical healing communities. Wayo-Nero enables traditional healers and therapists to collaborate and partner with healthcare providers in the biomedical system. Both clinicians and traditional healers receive training to promote better collaboration and understanding.

This project includes a mobile health (mhealth) component, in order to address the isolation of many villages that resulted from the destruction of roads and infrastructure during periods of conflict. Cell phones are used to share mental health information; for example, a text message (SMS) system allows people with mental illness to be identified and request support from Wayos and Neros.

Key drivers

Community engagement
The project involves local governments, local communities through Community Advisory Boards, and non-governmental organizations in the implementation of the innovation to ensure sustainability and that sustainable targets are achieved.

Challenges

Inadequate resources

The overwhelming number of patients turning up at health facilities strains the supply of medicines and the availability of providers.

Continuation

The plan is to roll out the innovation in other parts of Uganda and countries in Sub-Saharan Africa. An international NGO has already expressed interest in scaling up the Wayo-Nero strategy to other districts in the Northern Region.

Partners

  • Child Health and Development Center, School of Medicine, Makerere College of Health Sciences (Uganda) is the main institutional partner delivering the innovation
  • District Health Officers of local governments provide the additional medicines required
  • District Advisory Boards of local governments assist the mobilization and monitoring of activities at the community level
Funder

 

Evaluation methods

The intervention will be evaluated through a controlled trial, which consists of three phases:

  • A baseline survey of 2,400 (1,200 in intervention and 1,200 in control) informants
  • A mid-term review to be conducted in month 20
  • An end-of-project evaluation to assess the impact of the intervention against baseline data

Cost of implementation

$985,155 USD has been invest over three years, October 2012 – October 2015.

Impact details

388 mental health uncles and aunties (Wayos and Neros) and 53 traditional healers have been trained, as of November 2013.

References

  1. Patel S et al. (2011) ’The Wayo programme in Northern Uganda: building on traditional assets in supporting Acholi young women and girls in the context of war and HIV’. Chapter 9 in Denov M et al. (eds.) Children’s Rights and International Development: Lessons and Challenges from the Field. London: Palgrave Macmillan.
  2. Williams DG et al. (2004) Malawi faith communities responding to HIV/AIDS: preliminary findings of a knowledge translation and participatory-action research (PAR) project. African Journal of AIDS Research, 3(1):23-32.
  3. Muyinda H et al. (2003)  Harnessing the Senga institution of adolescent sex education for the control of HIV and STDs in rural Uganda. AIDS Care, 15(2):159-167.

Research

Multimedia
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Country

Uganda

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