The Harvard Medical School Center for Global Health Delivery-Dubai hosted a three-day workshop in Dubai, UAE, bringing together academic, non-governmental, community, and government experts to catalyze consensus and ongoing collaboration on implementation and benchmarking of community-health worker-delivered service delivery packages for common mental disorders (CMDs) in low- and middle-income countries (LMICs).
The need for this meeting was clear – mental disorders are currently the leading cause of disability worldwide, and they most frequently remain unaddressed and untreated due to a lack of access to mental health care. It is estimated that up to 90% of persons with common mental disorders in LMICs receive no treatment for their mental health conditions. Research has now shown the effectiveness and feasibility of community health worker-delivered psychosocial and mental health support in LMICs, however, bottlenecks in health service delivery prevent these interventions from reaching those people who need them the most in low-resource settings. Grassroots and community-based organizations have increasingly been leveraging health care delivery platforms to deliver mental health services in sustained ways in these settings. This workshop seized the opportunity to accelerate progress by supporting the development of shared platforms and practices for delivery of innovative and sustainable community-based mental health care for common mental disorders, in particular through task-sharing by community and non-specialist providers.
The workshop aimed to generate recommendations on scaling up such interventions by: 1) Defining the specific tasks and related competencies for CHWs to increase contact and effective coverage for empirically supported interventions for CMDs; 2) Elaborating the training and supervision protocols and procedures for the delivery of such interventions; 3) Describing the system level strategies for enabling, sustaining and enhancing the effectiveness of such interventions; 4) Defining the role of stakeholder and community engagement for enabling, sustaining and enhancing the effectiveness of such interventions; and 4) Describing the metrics for impact assessment and evaluation designs for such programs. The first day of the workshop focused on synthesizing the evidence across these five objectives through a series of short plenary style lectures and panels. Over the second and third days, participants broke out into small groups to elaborate the best practices, barriers to delivery, and potential strategies for addressing barriers for each of the five areas.
The workshop concluded with participants building consensus around recommendations and knowledge gaps for scaling up CHW-delivered interventions for CMDs. Conversations were energetic and fruitful, and while time was too short to reach complete consensus at the end of the three days, participants committed to continuing these discussions and collaborations in pursuit of much-needed guidance on this issue. All those in attendance will provide iterative feedback on a consensus statement, which will inform a journal article and policy paper to be published in the next year.
Participants in the Scaling Up Community Health Worker-Delivered Interventions for Common Mental Disorders workshop represented a broad community of academics, researchers, policymakers and on-the-ground implementers – including community mental health workers themselves. The workshop was hosted in collaboration with the new Harvard initiative GlobalMentalHealth@Harvard, a cross-Harvard initiative which aims to transform global mental health through education, research, innovation and engagement, as well as the nongovernmental organizations Partners In Health and Sangath.
Number of Participants: 61
Number of Countries: 24
Countries Represented: Australia, Bangladesh, Canada, Ethiopia, Haiti, India, Indonesia, Lebanon, Lesotho, Liberia, Malawi, Mexico, Pakistan, Peru, Rwanda, Sierra Leone, South Africa, The Netherlands, UAE, Uganda, Ukraine, United Kingdom, USA, Zimbabwe