AKU researchers will collaborate with the Government of Sindh to increase access to mental health services by training community health workers to provide basic counselling during household visits with the help of a mobile phone app. Given that Pakistan has just one psychiatrist for every 500,000 people, such innovative efforts to expand access to counselling are urgently necessary. AKU’s project will be conducted in the Badin District of Sindh, which has the second-highest suicide rate in the province. Trained data collectors will survey approximately 350 households to identify individuals suffering from anxiety or depression who are willing to participate in the study. Approximately 80 Lady Health Workers (LHWs) and their supervisors will be trained using the World Health Organization’s Mental Health Gap intervention guide, which is designed to enable non-specialists to provide basic mental health services.
The LHWs will then use a mobile phone app that includes scripts, video and audio to provide monthly counselling sessions for six months to individuals who screen positive for anxiety or depression. Among other things, sessions will educate participants on the causes of depression and anxiety and the steps they can take to alleviate symptoms, and provide breathing and coping exercises.
The app will also assist LHWs in tracking cases and in determining if someone should be referred to a specialist. Lady Health Workers are government employed community health workers. There are roughly 90,000 of them across the country. Each makes monthly visits to households in her community to provide basic primary care. The app, known as mPareshan, is being developed by the research team and the Aga Khan Development Network’s Digital Health Resource Centre, which is based on AKU’s Karachi campus and which previously developed a mobile phone app for LHWs that is being used in Gilgit-Baltistan. Pareshan means worried or distressed in Urdu.
“This will be a pioneering study that generates evidence on whether community health workers can help to address anxiety and depression in vulnerable communities,” said Professor Fauziah Rabbani, Associate Vice Provost, Research and the project’s principal investigator. “Given the lack of mental health professionals in resource-limited countries around the world, such evidence is badly needed not only in Pakistan but globally.”
Researchers will evaluate changes in participants’ depression and anxiety scores, and in the knowledge and skills of LHWs and their supervisors. Discussions with stakeholders will help identify factors that could facilitate or hinder expansion of the intervention. The study is being conducted by faculty in the Community Health Sciences Department in collaboration with the University’s new Brain and Mind Institute. It is one of numerous interventions involving the Lady Health Worker Programme that AKU has carried out over the last two decades.