Speaker
Description
Background and Objectives:
Despite a higher burden of mental health problems, especially depression and anxiety among perinatal mothers in Kenya, access to care remains fragmented and insufficient due to inadequate funding, lack of trained mental health workers at the primary health care level, and community-level stigma. To address this urgent gap, HealthRight Kenya implemented a community-based task-shifting approach to improve mental health outcomes for perinatal mothers in Nairobi’s informal settlements. The primary objectives were to: 1) improve individual and community knowledge, attitudes, and practices regarding mental health and Gender-Based Violence (GBV); 2) strengthen the integration of quality mental health services, including screening and Interpersonal Group Therapy (IPT-G), into the primary level of care; 3) build the capacity of Community Health Promoters (CHPs) and Healthcare Workers (HCWs) to deliver mental health services through a task-shifting model; and 4) enhance facility-level mental health information systems for better data management and decision-making.
Study Design and Methodology:
A pre-post cross-sectional study design was utilized to evaluate the intervention's impact across three informal settlements: Mathare North, Mukuru Kwa Reuben, and Mukuru Kwa Njenga. The project, which ran from 2020 to 2023, employed a multi-faceted approach grounded in community engagement and health system strengthening. Key interventions included training 137 CHPs and 53 HCWs on the WHO mhGAP toolkit and intervention guides, facilitating mental health screenings using tools like the PHQ-2 and PHQ-9, conducting community dialogue days, and rolling out facility-based IPT-G sessions for perinatal women. Data was collected through baseline, midterm, and endline surveys, complemented by routine monitoring data.
Results:
The project demonstrated significant positive outcomes. Awareness of mental disorders among beneficiaries increased from 31% at baseline to 94% at endline. Health-seeking behavior surged, with 82% seeking services at endline compared to 3% at baseline. A total of 37,044 community members were reached through health talks, and 943 participated in community dialogue days. Over 2,500 women were screened for mental health conditions; 281 enrolled in IPT-G sessions and 197 completed the program. Diagnoses of mental health conditions among women dropped from 70% to 50%. Satisfaction with services was high, with 99% of beneficiaries expressing satisfaction at endline.
Conclusion and Recommendations:
This project confirms that a community-based, task-shifting approach is effective in improving perinatal mental health awareness, access, and outcomes in resource-limited urban settings. Integrating evidence-based interventions like IPT-G with existing primary care and community structures, led by trained CHPs, is a scalable model. Key learnings emphasize the importance of multi-sectoral collaboration, capacity building, and adaptive program design. Future recommendations include scaling the model with a livelihoods component, integrating mental health indicators into DHIS2, digitizing screening and referral tools, and developing national guidelines for community-based mental health interventions.
