WHO Certified mhGAP Trainer - Akkar

The International Rescue Committee (IRC) responds to the world’s worst humanitarian crises and helps people whose lives and livelihoods are shattered by conflict and disaster to survive, recover, and gain control of their future. In more than 40 countries and over 20 U.S. cities, IRC teams provide clean water, shelter, health care, education and empowerment support to refugees and displaced people.

In Lebanon, IRC started its work in 2012. The IRC provides emergency aid and long-term services for Syrians and the struggling Lebanese communities hosting them. Currently, the IRC implements Education, Economic Recovery and Development, Protection, Child Protection programs, early childhood development and works to respond to and prevent Gender Based Violence (GBV) in the North, Akkar, Bekaa, Beirut and Mount Lebanon.

In view of the emerging needs in the health sector, IRC has started up a Health program to meet the health needs of the vulnerable population, through supporting PHCCs along with a system strengthening approach.

The mental health gap action programme (mhGAP)

Mental, neurological and substance use (MNS) disorders are highly prevalent and burdensome worldwide. The gap between what is urgently needed and what is available to reduce the burden is still very wide.

The World Health Organization (WHO) has recognized the need for action to reduce the burden, and to enhance the capacity of Member States to respond to this growing challenge.

Subsequently, the WHO mental health Global Action Programme was endorsed by the 55th World health Assembly in 2002. As a next phase, the WHO Mental Health Gap Action Programme (mhGAP) was launched by WHO in 2008 with the objective of scaling up care for mental, neurological and substance use (MNS) disorders. mhGAP is the WHO action programme developed for countries especially with low and lower middle incomes to achieve this objective.

This programme is grounded on the best available scientific and epidemiological evidence about MNS conditions that have been identified as priorities. It attempts to deliver an integrated package of interventions and takes into account existing and possible barriers for scaling up care. Priority conditions were identified on the basis that they represented a high burden (in terms of mortality, morbidity, and disability); caused large economic costs; or were associated with violations of human rights. These priority conditions are depression, schizophrenia and other psychotic disorders, suicide, epilepsy, dementia, disorders due to use of alcohol, disorders due to use of illicit drugs, and mental disorders in children.

The mhGAP package consists of interventions for prevention and management for each of these priority conditions, based on evidence about the effectiveness and feasibility of scaling up these interventions. mhGAP provides a template for an intervention package that will need to be adapted for countries, or regions within countries, based on local context.

Description of the Consultancy

The mhGAP Intervention Guide (mhGAP-IG) was published in 2010 as a clinical decision-making tool for the assessment and management of priority MNS conditions using evidence-based guidance for non-specialist healthcare providers. Five years after the initial launch of the guide, updates to the mhGAP guidelines based on emerging literature was performed and revised mhGAP guidelines were published in 2015 as mhGAP-IG version 2.0.

The consultant through the mhGAP training will aim to teach non-specialist healthcare providers on how to assess, manage, and follow-up on priority MNS conditions using the evidence-based mhGAP-IG 2.0 in non-specialized health settings. In addition, it aims to ensure that participants attain the 12 core competencies in delivering care for people with MNS conditions outlined in WHO’s mhGAP training manuals.

Thus, the target audience will be IRC’s local primary healthcare (PHC) partners, specifically PHC centers’ (PHCC) staff mostly general practitioners, pediatricians, obstetricians/ gynecologists, midwives, nurses, assistant pharmacists, and social workers.

The management should be involved in the training to ensure that there are adequate resources made available to primary healthcare providers to deliver mhGAP interventions.

Through this consultancy, the main responsibilities of the consultant will be to:

• Provide training of non-specialist healthcare providers on mhGAP-IG 2.0.
• Ensure attainment of the necessary attitude, knowledge, and skills by healthcare providers to implement the assessment and management guidelines for priority MNS conditions.
• Provide mhGAP implementation supervision training to relevant IRC staff.
• The training of non-specialist healthcare providers will be competency-based and will aim to ensure that participants develop the attitude, knowledge and skills required to use the mhGAP-IG 2.0.
• Attitude change will be assessed by role plays and observations from supervision; knowledge will be assessed by written tests (multiple choice questions [MCQs]); and skills will be assessed through practical sessions (peer- and facilitator-assessed role plays).

Deliverables

The consultant, when selected, is expected to:

• Prepare the WHO’s mhGAP training and adapt it to the local context based on the information gathered from a training needs assessment conducted prior to the training. The assessment will allow to define the available time, modules to be prioritized, strengths and weaknesses in mental health knowledge amongst participants, and level of support to be offered. Translation of the training material to local language, Arabic, is expected. The trainer should refer to the trainer checklist when preparing for the training and develop a clear training agenda
• Deliver the training in accordance to WHO’s mhGAP training manuals and national guidelines such as Guide for the Rational Prescription of Medications for Priority Mental and Neurological Conditions and Maternal Mental Health Guidelines for Healthcare Providers while adhering by the training guidelines and using different specific training techniques, mainly person stories, group discussion, role plays, video demonstrations, and facilitator demonstrations.
• Prepare and present the write-up of the training material adapted to the target audience and local context including the training forms for each module, mainly pre- and post- test multiple choice questions (MCQs), competency assessment forms, evaluation forms, and participant’s logbook.
• Prepare a detailed report about the training including the pre- and post-assessment analysis with constructive qualitative feedback based on the evaluation of the training through formal and informal responses collected from participants.
• Prepare mhGAP supervision tools and guidelines including a detailed training on implementation.

The training topics are:

• Introduction to mhGAP.
• Essential care and practice.
• Depression
• Anxiety
• Psychoses
• Epilepsy
• Child and adolescent mental and behavioral disorders.
• Dementia
• Disorders due to substance use.
• Self-harm/ suicide.
• Other significant mental health complaints.
• Use of valproic acid (sodium valproate) in women and adolescent girls of reproductive age (Addendum, March 2022).
• mhGAP implementation supervision.

Payment Rate and Schedule

Payments will be settled upon the completion of the above-mentioned deliverables in monthly instalments.

Number of participants

Four members from IRC’s Health program and 20 staff form the supported PHCCs.

Requirements of the Consultant

The consultant should have the following characteristics:

• Be a specialist in mental neurological and substance use disorders (MNS) health care (psychiatrist, psychiatric nurse, neurologist, etc.).
• Have clinical skills and experience in mental health and/or management of MNS conditions.
• Have skills and experience with administrative aspects of managing MNS conditions, including record keeping, follow-up, and referral.
• Have experience in delivering the mhGAP training
• Have a certification from WHO to deliver the mhGAP training.

​​​​​​​Dates and locations of training

The consultant is expected to deliver the training over the period of five days in Akkar (training will take place between October and November 2022 - dates to be confirmed later).

Language of the Material

The training material should be presented and delivered in Arabic. The consultant can provide the guidance material (training manual) in English or Arabic language and is expected to contextualize the translation of the terms used and/or translated to and from the languages mentioned earlier.