Implementing the mhGAP-HIG: The process and outcome of supervising trained primary health care workers in Khyber Pakhtunkhwa, Pakistan

BackgroundThe province of Khyber Pakhtunkhwa (KP), grappling with frequent humanitarian and conflict challenges, faces significant gaps in mental health services marked by limited resources and inequitable distribution of services. To strengthen these services in nine districts in the province, 105 PHCWs were trained to identify and treat psychological conditions and were subsequently supervised for three months. This study examined the efficacy of remote supervision and analyzed the clinical data gathered during the supervision period. MethodsA mixed-method approach was used to collect clinical data during supervision. Supervision covered assessment, management (including pharmacological and psychosocial interventions), and referral needs in all cases. Both qualitative and quantitative feedback were analyzed. Additionally, clinical data were examined to identify reported stressors and clinical presentations. ResultsOut of 105 registered trainees, 53 (50.34%) participants (including 38 PCPs and 15 CPs) submitted 413 cases through the application during three months of supervision following the initial training. The most frequently reported condition was depression (56.9%). Commonly reported stressors include health challenges or caregiver burden, marital or domestic challenges, bereavement, and socio-economic difficulties. Supervision was crucial in adjusting diagnoses in nearly a quarter of cases and management plans in 38.25% of cases. Participants expressed a preference for remote supervision and found it beneficial for assessment/diagnosis (61.1%), management interventions (72.2%), and referral guidance (44.4%). ConclusionEffective capacity building of PHCWs depends on remote supervision for an extended period, continuous monitoring of assessment and intervention skills, and the establishment of structured referral pathways. The collection of clinical data is crucial for improving the training programs. Systematic support from provincial governments is essential to scale up this initiative.