HealthNet TPO is implementing mental health care for the Afghan population since 2002. A first programme started in Nangarhar province by training local health staff in basic psychiatry and has been expanded to 10 other provinces of Afghanistan in the meantime. Until 2010, HealthNet TPO mainly provided mental health services in public health centres (district level), but meanwhile a pilot project has been initiated for the provision of mental health care at a regional and provincial hospital level. The aim is to strengthen and intensify support for mental health services on the primary health care level, in six provinces (Nangarhar, Daikundi, Logar, Kunar, Laghman and Uruzgan).
The mental health programme in Afghanistan currently focuses on the integration of mental health components within the health care system, through both the Basic Package of Health Services (BPHS) and Essential Package of Hospital Services (EPHS). In close collaboration with the Ministry of Public Health (MoPH), HealthNet TPO drafted mental health training materials (reviewed by a committee, including WHO, EMRO, expert NGOs, expert psychiatrists from neighbouring countries and other qualified and experienced psychiatrists) for doctors working in the Essential Package of Hospital Services (EPHS). These materials have been tested and approved, and will be used as the basis for the development of a national curriculum.
HealthNet TPO is training employees in basic mental health care. Also doctors, nurses, midwives and general practitioners had a ‘basic training’ in the field of mental health. The method is based on local structures and practices. Especially key people within the communities are approached for this basic training in recognizing mental problems. This way, they can send potential patients to specialized health centres.
Psychosocial Care and Community development
For some six years, the entry point for implementing psychosocial services has been the health care system. Although the psychiatric and psychosocial programmes have always remained closely linked, six years later, the psychosocial component of the programme underwent a considerable development. The focus of psychosocial services now lays within the communities where problems can be diagnosed in a different way; the emphasis is on social determinants of health.
Frequently reported stressors among both males and females in Afghanistan are poverty, domestic violence, substance abuse, the effects of war and repression, and problems faced by children. The women and young girls have always been the stage for acts of violence that are typical to specific traditional lifestyle and cosmology, but the warfare of the past years has definitely had its impact on how violence is now embedded in daily routine. The aim is to enable people to cope with the stresses of life and to be able to determine culturally appropriate solutions for (re-)occurring problems.
Finding cultural acceptable and feasible solutions to these problems are major challenges and ask for a multi-sectoral approach. The approach should address the close ties between psychosocial and mental health status on the one hand, and issues of poverty reduction and other structural social issues (including education, community mobilization, empowerment of women, addressing Human and Women’s Rights) on the other hand. Therefore an important objective nowadays is the development and implementation of new activities in close collaboration with other successful stakeholders. Besides the involvement of relevant Ministries, the collaboration with other NGOs has proven to be successful.
To ensure local staff is able to execute activities effectively, several training courses are conducted. Also community health workers, teachers, key community figures, health committee members, provincial assembly members, relevant governmental staff and relevant NGO staff are trained in providing psychosocial support. In addition, many awareness raising activities take place.
Major counterparts for this programme are the Ministry of Public Health(MoPH) and the Ministry of Women Affairs (MoWA). Memorandum of Understandings have been signed with the MoPH and the MoWA which acknowledge the role of HealthNet TPO as an important body in the country on mental health and psychosocial services.
Aim: The development, implementation and evaluation of cost-effective, culturally appropriate, sustainable and community-based mental health care en psychosocial services. The aim is to integrate mental health care into existing health structures in Afghanistan.
Main donors: Dutch Ministry of Foreign Affairs, European Commission, Unifem, Save the Children.
These TV Spots are broadcasted in Afghanistan as part of the psychosocial programme for the empowerment of women.
TV spot 1: A woman who suffers from family violence tries to talk with her husband; unexpectedly she gets the support from het her mother-in-law which is quite unusual in Afghanistan; mothers-in-law are often the perpetrators of violence against their daughters-in-law. Having themselves been suppressed in their youth, they often encourage the repression of their son’s wives.
TV spot 2: A young girl hears that her family is planning to marry her to a rich man in return for money. The girl gets the support from her father who succeeds in convincing the other family members to abondon this idea. Selling women for monetary gain is not as common as years ago but is still frequently reported in Afghanistan.