Public-Private Partnerships for Mental Health in Post-Conflict Countries

Public-Private Partnerships for Mental Health in Post-Conflict Countries

UgandaBedford, United States
Organization type: 
nonprofit/ngo/citizen sector
Project Stage:
Established
Budget: 
$500,000 - $1 million
Project Summary
Elevator Pitch

Concise Summary: Help us pitch this solution! Provide an explanation within 3-4 short sentences.

PCAF heals emotional wounds of victims of mass violence by training health workers and establishing trauma treatment systems in post-conflict countries.

About Project

Problem: What problem is this project trying to address?

One billion people, one-sixth of humanity, have directly experienced torture, terrorism or mass violence. The majority of survivors of mass violence develop traumatic depression, often so severe that victims are unable to work, care for themselves or tend to their families. With proper treatment, 90% of these people can be returned to function: to work, to child rearing and to school. In Africa, the incidence of traumatic depression exceeds the incidence of HIV/AIDS and TB combined; yet in most post-conflict countries mental health services are scarce and there is no system for access to mental healthcare. PCAF partners with government to heal the emotional wounds of victims of terrorism and mass violence by training indigenous health workers and establishing trauma treatment systems.

Solution: What is the proposed solution? Please be specific!

PCAF works in public private partnership with governments to create capacity, sustainability, scalability and community acceptance. PCAF partners with government to provide multi-disciplinary mental health clinics at government district hospitals, the government contributing space and drugs (and the participation of the Ministry of Health), PCAF providing training, salaries and community outreach expense. PCAF provides expert professional training in mental health, building capacity for indigenous caregivers through trainings and workshops, relying on local experts trained in culturally appropriate treatment. Because of government's contribution, not only are PCAF's costs kept low (each clinic costs an average of $30,000 annually), but PCAF is fostering government acceptance and support of mental health services. PCAF commits to run each clinic for a period of ten years before turning the clinic over to government.
Impact: How does it Work

Example: Walk us through a specific example(s) of how this solution makes a difference; include its primary activities.

An example at one of our seven clinics: PCAF's multidisciplinary staff in Gulu treats former child soldiers and other victims of war trauma through a combination of counseling, medication, group therapy, spiritual healing and psychosocial support. Patients come to the Gulu district hospital or are referred to the PCAF clinic by local NGOs or religious institutions with complaints due to nightmares, persistent pain, substance abuse or depression. PCAF's Gulu staff screens the general patient population for psychotrauma and mental illness and provides psychoeducation to reduce stigma. Patients then choose to be treated at the PCAF clinic or are referred by hospital personnel. Once a patient is screened at the PCAF clinic by the psychiatric clinical officer, they embark on a schedule of bi-weekly counseling and drug therapy, and in some cases, group therapy. Patients are evaluated at each visit using validated psychiatric assessment tools. Patients who do not return for appointments are tracked by phone where possible and receive social worker visits to determine the resion for non-adherence. PCAF social workers also go to the home, workplace or school to address issues and educate the patient's family, co-workers or teachers about the patient's needs. HIV/AIDS screening, testing and counseling are also offered. A year-long study of 113 patients receiving psychotropic treatments and trauma counseling at the Peter C. Alderman Foundation Trauma Clinic in Gulu had excellent sustained decline in depression and PTSD symptom load for up to one year of follow-up.
Sustainability

Marketplace: Who else is addressing the problem outlined here? How does the proposed project differ from these approaches?

In Uganda, both Basic Needs, a UK-based NGO, and TPO work on a community level to address mental illness in the community setting. They do not have the ability to provide clinical care for patients. Both organizations are reducing their presence in Uganda. In Cambodia, PCAF is the only group to our knowledge addressing mental health care in Siem Riep Province, where we work. In Liberia, the Carter Center and Medicins du Monde are working to build capacity by training psychiatric nurses. Neither organization has a psychiatrist on-site for training, or offers any clinical training. Since opening our training clinic in Bong county on January, 2011 PCAF is the only organization offering clinical training for health workers, under the direct supervision of a Ugandan psychiatrist.
Team

Founding Story

Liz and Steve Alderman lost their son Peter in the attacks on the World Trade Center on September 11, 2001. He was 25 years old when he died. Looking for a way to honor Peter, Liz saw a Nightline broadcast featuring the work of Richard Mollica, a Harvard psychiatric working to address the legacy of traumatic depression and PTSD in post-conflict countries. The Aldermans decided to honor Peter by helping those who had also been emotionally scarred by terrorism and violence but who had little chance of access to health care to help them return to productive lives. Peter had been killed in an act of mass violence, but survivors of mass violence across the globe could be returned to function in his name. The initial plan to help train mental health workers grew into an effort to create health systems in which these workers could treat patients, and partnerships with governments to ensure that these systems will be sustainable into the future.
About You
Organization:
Peter C. Alderman Foundation
About You
First Name

Alison

Last Name

Pavia

About Your Organization
Organization Name

Peter C. Alderman Foundation

Organization Country

, NY, Bedford, Westchester County

Country where this project is creating social impact

, GUL

How long has your organization been operating?

More than 5 years

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Innovation
How long have you been in operation?

Operating for more than 5 years

Which of the following best describes the barrier(s) your innovation addresses? Choose up to two

Access, Quality.

Social Impact
Please describe the goal of your initiative; outline what you are trying to achieve

PCAF is working to create a scaleable, low-cost model for providing mental health care in low-resource settings to those who need it the most. Working with some of the best minds in global mental health to inform its model and delivery of care, PCAF is putting words and research into action, working to return victims of traumatic depression and PTSD to function: to work, to child-rearing and to school. By partnering with government and civil society, building human resource capacity in mental health, and working only with indigenous health care workers, PCAF hopes to leave a legacy of government and community acceptance of the necessity of mental health care that becomes intrinsic to the health care structure of each country it works in.

What has been the impact of your solution to date?

PCAF has trained over 1,000 health workers to date, who have gone on to treat over 100,000. Our clinics saw 11,000 patients in 2011. Early results on these patients show a marked and sustained reduction of symptoms and a return to productivity.

PCAF's fourth annual pan-African conference on psychotrauma in Nairobi in July, 2011 was attended by nearly 600 participants. The conferences are written up in the African Journal of Traumatic Stress, now in it third edition. PCAF has supported and created a forum for the exchange of ideas, research and information on global mental health.

PCAF has provided care for the mentally ill where none would exist. Cambodia has no healthcare infrastructure. Uganda has a severe shortage of mental health care workers, and no funds to pay salaries. Liberia has neither a healthcare infrastructure nor human resource capacity. Without PCAF, thousands would go without any possibility of treatment, and would likely be unable to return to function.

What is your projected impact over the next five years?

In Uganda, PCAF is now extending its community outreach program, providing care and psychoeducation in community health centers. This will likely increase patients treated by more than 25%.
In Cambodia, PCAF is partnering with the Applied Mental Health Research Group of the Bloomberg School of Public Health to improve its treatment delivery systems and patient outcomes at its two clinics.
In Liberia, PCAF plans to train and supervise a cadre of psychiatric nurses who will staff the country's planned network of menatl health Wellness Clinics.
In Kenya, PCAF plans to add mental health services to a maternal child health clinic in Kibera, Nairobi.
In the US, PCAF is working with a partner on a plan for a global mental health research network.

What barriers might hinder the success of your project? How do you plan to overcome them?

PCAF is working to ensure its sustainability after the Aldermans are no longer able to guide the organization. An Executive Director was hired three years ago to consolidate and direct the organization and review strategy and operations. A Director of Programs was hired in the US, as well as a Director of Programs for Africa.This latter position is vital. A development associate and program associate has been added to the NY staff. The board has added three new members in this time frame, and is looking to expand further. WIth this plan for sustainability in process,the next barrier to success is funding. PCAF now has a number of foundation funders, and has expanded its individual giving program. It is working on establishing an endowment, and is looking to government funding sources.

Winning entries present a strong plan for how they will achieve and track growth. Identify your six-month milestone for growing your impact

Community outreach programs in Uganda will increase patient visits by 25%.

Identify three major tasks you will have to complete to reach your six-month milestone
Task 1

Institute regular outreach visits to community health centers

Task 2

COnduct all needed follow-up and home visits to patients

Task 3

Document and evaluate all patient contacts to follow outcomes

Now think bigger! Identify your 12-month impact milestone

Add Kibera, Nairobi Kenya clinic service, and see 500 patients in the first 12months of operations

Identify three major tasks you will have to complete to reach your 12-month milestone
Task 1

Complete MOU with Ministry of Health

Task 2

Finish hiring psychiatric nurses

Task 3

Train nurses in PCAF model, and Open service

Sustainability
Tell us about your partnerships

PCAF's most important partners are the ministries of health of the countries it works in. SIgnificant partners include: Makerere University and Butabika National Mental Referral Hospital of Uganda, who provide the local psychiatric expertise necessary forprograms in Uganda, Liberia and Kenya; the Harvard Program in Refugee Trauma, which provided the basis for the treatment and health worker training model; the Africa Mental Health Foundation, co-sponsor of the last two summer conferences and partner on the Kibera Clinic; the Bloomberg School of Public Health and NYU School School of Medicine.

Are you currently targeting other specific populations, locations, or markets for your innovation? If so, where and why?

PCAF has been approached by the governments of Kenya, Tanzania and Sierra Leone to work specifically with refugee populations. Working with refugee trauma is a natural outgrowth of PCAF's current work, and a number of our patients in Northwest Uganda are refugees. PCAF will site visit several locations in Tanzania this summer after its conference on psychotrauma, and will explore the Kenya option once the Kibera clinic is off the ground.

What type of operating environment and internal organizational factors make your innovation successful?

There are three factors that have contributed to PCAF's success: First, PCAF's partnerships with governments ensures low cost, sustainability and scalability. PCAF works in post-conflict countries where few services are available, government is eager to receive NGO assistance, and PCAF requires government to participate in its clinics and carry its share. The countries are equal "owners" of the mental health clinics, and will go on to operate them.

Second, the organization is "lean and mean." PCAF is small and communications are paramount: it works efficiently and with flexibility.

Third, the Aldermans, who are visionary founders driven by a passion to help others in their son's memory. They lead by example, consistently putting the needs of the organization above their own.

Please elaborate on any needs or offers you have mentioned above and/or suggest categories of support that aren't specified within the list

Strategic planning; funds development; board development.