Afghanistan has a traumatized past; hundreds of thousands of Afghans have died and most have witnessed of horrendous violence and atrocities at one point or another in their lives. As a consequence, mental health problems in Afghanistan are far more profound than seen in almost all other countries. Even those with good physical health and living in ‘secure’ places are constantly barraged by bad news. Many of the mental disorders are connected to these experiences. Experts estimate that 60% of the Afghan populace suffers from mild to severe mental illness. Mental health, and treatment of mental health disorders, has been identified by the Afghan government main priorities for health system improvement. These mental health issues are more common in remote areas of Afghanistan. Regular screenings with appropriate referrals and treatments are very much essential for the people of such remote areas in order to start living a healthy life.
Tech4life Enterprises in order to improve mental health in Afghanistan and is currently implementing Blended Learning technology/application for frontline health workers in mental health. The idea is to improve knowledge of health workers about common mental health problems and their treatments. The main objective of the Mental Health Blended Learning application is to empower the health workers based in the communities for:
- Collecting information regarding mental health.
- Providing services to youth suffering from four major mental health issues, i.e. depression, psychosis, substance abuse and post-traumatic stress disorder.
- Referring these cases to the appropriate health provided, where necessary.
Mental health Blended learning project contains information for facility based health workers. Blended learning is a combination of (1) face-to-face interaction with a teacher/guider in order to get knowledge about the specific dieses and its treatments with additional instruction. (2) Live and or recorded sessions conducted in an online learning environment that allows for digital content, personalized learning, screening and collaboration with fellow learners.
The information of these mental health issues primarily develops on the basis of pre and post-evaluations which is takes place at the start and in the end of every each module. In the end of May, 2015, we completed our first and second module, called on ‘Depression’ and ‘Psychosis’.
Activities performed in these module includes:
- Online learning material which includes recorded lectures, videos, supporting articles, pictorial and animated presentation. This material has been uploaded on an e-learning website Moodle and also provided in a form of memory cards so that every health worker who can have the smart phone and or have a Moodle ID can easily excess the material.
- Face to face sessions which are conducted by doctors to facility-based health providers at the primary health care centers and then these facility-based health provides visit their case sites and convey that information to the community based health workers. In this session, doctors deliver information in the form of power-point presentation.
- Weekly skype sessions on different topics, conducted by the doctor based at Faizabad hospital to the facility-based health providers in their case area. The session is followed by a question & answer session, where relevant cases are discussed.
Two assessments have been conducted at different times; pre-assessment in the beginning of the project in order to get familiar about the initial knowledge of facility-based health providers and a post-assessment in the end of the module. Results of these assessments have been analyzed using t-tests in order to evaluate the statistical significance of changes in knowledge on the specified module.
Analysis results of depression module from four case sites (Baharak, Ishkashem, Shughnan, Nusai) shows knowledge improvement. Correct answers have been increases from 45% to 63% among the healthcare providers from pre to post-assessment.
Comments from Learners & Facilitators about Blended Learning Project
Dr Mahjabeen Sarahat – specialist psychiatrist of Faizabad Provincial Hospital, working as a facilitator for Blended Learning program says,
“blended learning program is running very well” she found it very quick and cost effective as a leaning program. She also quoted “I encourage the staff to join this blended learning program to get awareness about mental health issues that most of the afghans are facing nowadays”. In her last words she suggested that “we should work more on Dari translation (of all the material) for better understanding”.
Gul Mohammad Shaiq – Head Nurse of Baharak District Hospital AKHS’A facilitates blended learning project. He says,
“blended learning is going very well, Before using blended learning, most of our staff were unaware about the four mental health problems, like Depression, psychosis, PTSD and Drug abuse. Now all of our staff is able to diagnose these four problems easily”. In his words he highlighted that “before involving in blended learning project he had tried ministry of public health guidelines to learn about mental health problems, but blended learning program shows easy way of learning such material”.
He also appreciate the memory cards distribution process. In his words he encourage that “the material is very effective, useful, easy to understand and portable; you can learn any time anywhere”.
Ali Nazar – Teacher and admin in Bahshar CHC+ works as a trainer for Blended learning. He says about blended learning project that,
“before using this program I could not find any resources to solve mental health related problems”. He also highlighted, ” the program is running very well and fortunately there are no major obstacles during this project” He appreciated the material ‘”about 90% material is very easy to learn”. In his comments he also suggested that “this program could be very useful if the approach continues for the other topics”.