Strategic framework for MHPSS coordination and implementation

This roadmap outlines the strategic areas of action required for the coordination and implementation of MHPSS services and is aligned with the MHPSS implementation framework. A similar roadmap can be applied to develop MHPSS services at the level of the provinces.

Phase 1: Inception and policy endorsement

a. Policy and strategic alignment
For effective implementation and sustainability of the MHPSS services, the foremost requirement is to secure formal policy endorsements from the relevant planning & coordination bodies (e.g., PC/MoPD&SI, MoNHSR&C, and Provincial Health Departments). The policy to develop MHPSS services must be aligned with the Prevalent Vision of Government ^[1] , National Health Policy frameworks (e.g., Universal Health Coverage (UHC) goals), upcoming social protection and insurance strategies; and Mental Health Act provisions.

b. Institutional setup for a steering and coordination mechanism
For an institutional set up, a National MHPSS Steering and Coordination Committee must be notified. Backed by a secretariat (a MHPSS Unit), the committee will coordinate between all key stakeholders, converge MHPSS initiatives and resources, and ensure effective deployment of MHPSS services. The committee should include representation from the Ministry of NHSR&C (focal persons for Mental Health, Primary Health Care, Digital Health), provincial health and P&D departments; line ministries/departments e.g., Education, Social Welfare, Human Rights; other entities e.g., NADRA, PTA, and other Telecommunication partners; and development partners, as needed. The committee may create technical working groups (TWGs) e.g., for digital system refinements and troubleshooting; address research and information gaps etc.

c. Resource mobilization and integration with ongoing programs
The third important strategic area is resource allocation and integration with the ongoing investments such as Sehat Sahulat Program (SSP), Primary Healthcare revamp (PHCPI ^[2], UHC-BP ^[3] ), Education sector teacher training programs, Social Registry / National Socio-Economic Registry (NSER) data platforms . Also, funding sources must be mapped for short and long-term services like public funds such as PC-1 or seek public-private partnerships by identifying external sources of funding from development partners such as World Bank, GIZ, iNGOs etc.

Phase 2: System readiness and preparedness

a. Capacity building
This phase comprises of developing training curricula for building the capacity of a mental health workforce (such as mental health specialists, PCPs, and community health workers), as well as revision and deployment of digital tools for implementing training and supervision mechanisms.

A National Training of Trainers (ToT) program should be implemented for healthcare providers in primary health care; and community health workers (LHWs, CMWs, teachers, and social workers etc.)

b. Digital Infrastructure and Interoperability
For effective deployment of scalable MHPSS services, it is essential to host a dedicated web portal and LMS on secure national ^[5] , NADRA cloud). Interoperability with existing DHIS2 (District Health Information Systems), Sehat Sahulat IT systems, and Health Management Information Systems (HMIS) must be ensured. Coordinated with PTA and telecom partners will also be required for integrating a helpline with the MHPSS digital solution.

c. Resource mobilization and integration with ongoing programs
The third important strategic area is resource allocation and integration with the ongoing investments such as Sehat Sahulat Program (SSP), Primary Healthcare revamp (PHCPI , UHC-BP ), Education sector teacher training programs, Social Registry / ^[4]. Also, funding sources must be mapped for short and long-term services like public funds such as PC-1 or seek public-private partnerships by identifying external sources of funding from development partners such as World Bank, GIZ, iNGOs etc.

Phase 3: Implementation and Evaluation

Following the key steps mentioned above, the pilot implementation may commence in ICT and at least one province (e.g., KP/Balochistan) to effectively operationalize service and referral mechanisms, The provinces preparing for pilot implementation need to be supported to adapt digital tools and service protocols, include MHPSS in their Annual Development Plans (ADPs), nominate local MHPSS coordinators and ensure linkages with mental health services (Public, private, NGOs).

The monitoring and evaluation dashboards (for collecting and analyzing baseline service utilization data) also need to be operationalized. For this, detailed national Key Performance Indices (KPI) must be defined with their reporting templates. In parallel to an effective pilot implementation, a public awareness and community engagement campaign must be launched. A mid-term review and adjustment of the program to ensure effectiveness and sustainability will guide the process.

Sustainability and Scalability

The pilot implementation will pave the way for incremental plan for phased scale-up across the country. For scale up, the unit will support provinces to adapt digital tools/courses and referral protocols, include MHPSS in their Annual Development Plans (ADPs) and nominate local MHPSS coordinators. The sustainability will be ensured with a smooth transition plan for the technical support from federal to provincial jurisdictions, commitment from provincial governments for scale-up. Finally plan for a national roll out needs to be formulated.