40 community health workers in Gujarat, India complete training to deliver evidence-based psychological treatment


Written by: Udita Joshi, Research Coordinator, Sangath Bhopal Hub
Edited by: Juliana Restivo, Program Coordinator, Harvard Medical School

According to the latest survey by WHO, COVID-19 pandemic has disrupted critical mental health services in 93% of the countries worldwide. This has led to a prolonged exposure and upsurge in mental health conditions and exposed the deficiencies of India’s mental health care system which reaches less than 5% of the population and is under-resourced. This burden of mental health conditions is expected to rise as the socio-economic ramifications of the pandemic unfolds. 

EMPOWER is a priority work-stream of the GMH@Harvard Initiative with the goal of increasing health system capacity for the prevention and care of mental health problems across the life course, globally. Using digital training, supervision, and quality assurance tools for specific evidence-based psychosocial interventions EMPOWER will train frontline health workers to deliver these interventions with assured quality. Learn more about EMPOWER’s mission and programs at EMPOWER.care.

The relationship between mental health and COVID-19 has led to increasing demand but due to inadequate resource allocation, staggering gaps in the workforce capacity, service provision is suffering. Growing evidence from Low-and Middle-Income Countries (LMICs) demonstrates that frontline healthcare providers, with appropriate training and supervision, can effectively deliver brief psychological treatments for depression. However, scaling up this evidence is hampered by reliance on face to face methods for training, supervision, and quality assurance barriers. One of GlobalMentalHealth@Harvard’s effector arm implementing partners in India, Sangathhas sought to address these barriers efficiently and at scale, by using digital approaches to train and support by building on extensive formative work with the target participants, and developing learner-centered and focused content. ESSENCE is a National Institute of Mental Health funded U19 Scale Up Hubs research project which is one of the foundational research projects to inform the EMPOWER program. ESSENCE developed and evaluated digital approaches to train non-specialist providers (in India these are government accredited community health workers, also known as Accredited Social Health Activists) in Madhya Pradesh, India. 

The Sangath Bhopal Hub are the leading implementers for EMPOWER India. The Sangath Bhopal team has now recently expanded on the ESSENCE project with the recently concluded Project EMPOWER in Gujarat. The project led by Dr. Vikram Patel, Principal Investigator, Harvard Medical School and Dr. Anant Bhan, Principal Investigator, Sangath Bhopal Hub has successfully trained 43 community health workers in the Health Activity Program, an evidence-based psychological treatment for mental health issues like depression, anxiety and substance use or alcoholism. The pilot phase of the project was initiated in August 2020 and was implemented in the tribal district of Jhagadia in the Bharuch district of Gujarat. 

Participants and project partners during a project dissemination event at Gujarat Institute of Mental Health (GIMH), Ahmedabad.

The objective of the project was to engage the frontline health workers in digital training and build capacities for delivering mental health treatment at the grassroots. The frontline health workers were trained in providing evidence-based psychological treatment in rural communities that are underserved. 

The pilot phase was implemented with 29 Accredited Social Health Activists (ASHAs) and 14 Community Health Officers (CHOs) of Jhagadia block in selected primary healthcare settings of Gujarat (7 Primary Healthcare Centers and 2 Community Healthcare Centers). The training was delivered in the Gujarati language to all the participants with the help of an online learning management system (LMS) nested within the TeCHO platform which is used across the state by the health system as per the advice of local partners. The LMS contained educational content in various forms such as audio, video and PDF files. The audio and video content made it easy for the participants to learn and understand the training modules. The project team also conducted focused group discussions (FGDs) and competency assessment tests to understand the level of knowledge and awareness the frontline health workers acquired from the program. 

The Sangath Bhopal team took the opportunity to discuss the findings and appraise the work with State officials in Gujarat and discussed opportunities for future work.

The findings of the pilot were presented by Dr. Udita Joshi, Research Coordinator, Sangath Bhopal Hub and Aakrushi Brahmbhatt, Research Assistant, Sangath Bhopal Hub with the participants and project partners during a project dissemination event at Gujarat Institute of Mental Health (GIMH), Ahmedabad. The team also presented the success stories from the field and a project dissemination report.  Experiences were also shared by the participants of the digital training from Jhagadia during this presentation. 

The pilot was implemented by Sangath Bhopal Hub in collaboration with SEWA Rural, Harvard Medical School, and the National Health Mission, Government of Gujarat. The project was funded by the Tata Trusts via The Lakshmi Mittal and Family South Asia Institute Harvard University

For any further updates contact: Dr. Udita Joshi udita.joshi@sangath.in

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