Ministry of Planning, Development & Special Initiatives
Pilot testing of the digital tools
In 2021, the feasibility of the digital solution for MHPSS and the training tools across all tiers was successfully tested in ICT. The web portal (www.mhpss.pk) was developed and integrated with a LMS that offered online courses and other training resources. All three mobile applications were also integrated with the centralized MHPSS web portal, enabling real-time synchronization of data into a centralized database. In collaboration with the National Telecommunication Corporation (NTC), the system was also integrated with a fully functional telecom solution.
For the community intervention at Tier 1, and as part of the recruitment process, stakeholder mapping matrix of public and private organizations was conducted. Later, in collaboration with MoNHSRC (including the DHO), Federal Directorate of Education, Directorate of Special Education, Islamabad Capital Territory administration, academic institution (NUST), Saving 9, and relevant NGOs (Rozan, Down syndrome club, Pehli Kiran Schools), 758 CMHWs were registered in Hamdard Force. During the testing period of three weeks, a directory of frontline workers was prepared (2100 nominations), and bulk SMS invitations with the link for registration were sent. Out of which, a total of 758 participants registered as Hamdard Force Given the limited time available for model testing, only 40% completed the online courses. During the two-week of testing training resources, 17 participants submitted 30 cases through the app, and requested supervision for 20 of these cases.
Participants appreciated the well-structured content, highlighting the efficient presentation clear and concise language, and ease of understanding. They acknowledged its role in enhancing knowledge and awareness, particularly its usefulness regarding the referral mechanism and seamless accessibility through a mobile application. However, they also highlighted concerns regarding the program's duration and technological challenges.
At Tier 2, in collaboration with NUST, 18 clinical psychologists (CPs) were recruited and trained to supervise the use of the MyCare+ application to provide support to the users. Similarly, in collaboration with the district health office, 12 healthcare professionals including PCPs and CPs [1] were selected and trained on mhGAP-HIG to assess and manage common mental health conditions at Tier 3. Lastly, at Tier 4, a total of 10 experienced mental health specialists (8 Psychiatrists and 2 CPs) were selected as trainers and a Training of Trainers (ToT) was jointly conducted by a local and international master trainer.
Pilot testing of Tier 3 intervention
In 2023, the MoPD&SI provided technical support to the Directorate of Public Health in Khyber Pakhtunkhwa to conduct a pilot project for building the capacity of 105 primary health care workers (PHCWs), which included PCPs and CPs . The project was supported by the International Medical Corps (IMC) to strengthen mental healthcare services for Afghan refugees and host communities in nine districts of Khyber Pakhtunkhwa, including Chitral, Haripur, Kohat, Lower Dir, Mansehra, Mardan, Nowshera, Peshawar, and Swabi. The Directorate of Public Health engaged with the relevant district health authorities to nominate PCPs for the training program. Similarly, IMC nominated CPs from within their teams or those affiliated with partner agencies for participation. A total of six training workshops (5-day each) were held between August-December 2023.
The participants registered on the MHPSS web portal and the LMS. The training was evaluated using a pre-post design and demonstrated significant improvements in knowledge and skills, particularly in assessment and management of mental health conditions. The evaluation of these trainings revealed that the adapted mhGAP-HIG guide, supported by digital tools, is both feasible and effective in implementation and strengthening mental health service delivery in low-resource primary care settings.
Participants advocated for broadening the scope of mhGAP trainings, ensuring refresher courses and integrating the guide into the pre-service training of medical doctors and clinical psychologists.
Following these training workshops, the participants downloaded the mhGAP-HIG app and joined district-specific WhatsApp groups, created to facilitate remote supervision and peer support. The trained PHCWs were supervised remotely for three months to manage people with mental disorders in the primary care settings. During this period, a total of 413 cases were submitted through mobile application. Case-based supervision was provided through individual and group discussions via WhatsApp groups. The supervision data offered valuable insights about clinical trends and compliance with mhGAP protocols. Supervision was particularly helpful to guide assessment process, plan management (including both pharmacological and psychosocial interventions), and making decisions about referral, in accordance with mhGAP protocols. The majority of PHCWs preferred remote supervision over in-person support and expressed satisfaction with the supervision mechanism. The impact of supervision on the performance of trained PHCWs has been published [2].
In 2024, eight months after the initial training, three refresher training workshops were conducted for the same cohort. The evaluation of the refresher trainings confirmed knowledge retention from initial trainings and highly satisfactory feedback from the participants [3].
References
Humayun & Najmussaqib, 2024. doi. https://doi.org/10.1101/2024.11.21.24317704
Humayun et al., 2025. https://doi.org/10.1016/j.ssmmh.2025.100451
Humayun & Najmussaqib, 2024. doi. https://doi.org/10.1101/2024.11.21.24317704
Mental Health Strategic Planning & Coordination Unit Health Section Ministry of Planning, Development & Special Initiatives