The District Project

In 2013 SMMHEP was awarded a three year Scottish Government Malawi Development Grant to increase the capacity of non-specialist healthcare workers to deliver mental health care in five Districts in Malawi. It also funded the development of an e-learning platform for postgraduate trainees in psychiatry, and continued to support the undergraduate and postgraduate teaching.  In 2008 the WHO launched the Mental Health Gap Action Programme (mhGAP) designed to scale up care for those with mental, neurological and substance use disorders and decrease the ‘treatment gap’ between the treatment needed and that available in low- and middle-income countries. This is estimated to be as large as 75% in some places.

As part of this programme the WHO developed a ‘train the trainers’ model for use in non-specialist settings. SMMHEP set out to implement and fully assess this training model in a project based at Zomba Mental Hospital and  run in collaboration with Associate Professor Chiwoza Bandawe, Clinical Psychologist in the College of Medicine (now the Kumuzu University of Health Sciences) in Blantyre.  Once a lead training team of experienced Malawian mental health professionals was appointed the teaching materials were contextualised for use in Malawi. The lead team delivered a 4-day training package to the District Mental Health Teams based in five Districts in southern Malawi. These Teams in turn delivered a 2-day training package and monthly supervision for three months to 500 primary healthcare workers and non-specialist clinicians in District Hospitals who rotate to primary care facilities.  Peer led support groups for users and carers were established in each District which did not already have one and community awareness events were held in all five Districts.  The knowledge, confidence and attitudes of those who were trained were measured, and an increase in knowledge and confidence was demonstrated. Focus group discussions illustrated the training programme’s acceptability. A full report of the project can be found in these two articles:

Kokota D, Lund C, Ahrens J, Breuer E, Gilfillan S. Evaluation of mhGAP training for primary healthcare workers in Mulanje, Malawi: a quasi-experimental and time series study. Int J Ment Health Syst. 2020;14:3. Published 2020 Jan 20. doi:10.1186/s13033-020-0337-0

Ahrens J, Kokota D, Mafuta C, et al. Implementing an mhGAP-based training and supervision package to improve healthcare workers' competencies and access to mental health care in Malawi. Int J Ment Health Syst. 2020;14:11. Published 2020 Feb 27. doi:10.1186/s13033-020-00345-y