Training of front-line health workers in Somalia on mental health: A mixed-methods effectiveness study on the implementation of mental health gap action programme (mhGAP)

Background: In 2020, The Federal Ministry of Health, the World Health Organization and the Somali National University rolled out a capacity-building programme called mental health gap action programme (mhGAP). An eight-day training was delivered to 24 front-line health workers serving local communities and internally displaced persons in five regions across south-central Somalia. This study assessed the effectiveness of mhGAP-training in improving participants’ knowledge, understanding and management of priority mental health conditions. Methods: A mixed-methods sequential design was applied to collect and analyze quantitative and qualitative data. Participants responded to pre- and post-tests with 16 multiple-choice questions, tailored to the content of the training. Quantitative data was analyzed using median scores. Four interviews were conducted five months after the mhGAP-training to collect data on value and effectiveness. Qualitative data were thematically analyzed. Results: Median scores were higher in the post-test compared with the pre-test, with 11 (IQR: 9.5-13) in the post-test and 7 (IQR: 4-9.5) in the pre-test. A Wilcoxon signed-ranked test revealed that the post-test score was significantly higher (MD =11, n =24) compared to the pre-test score (Md =7, n =24), z=-3.82, p =0.001, with a large effect size, r =0.5. The participants believed that their new knowledge and clinical skills-set gained had improved readiness for managing mental, neurological and substance use conditions. Conclusion: The findings indicate effectiveness of mhGAP-training for integrating mental health in primary health care. Given the limited human resources capacity and conditions in Somalia, the study has identified a way to expand mental health care to hard-to-reach communities. Training community health workers using a tailor-made training package of mhGAP can establish a continuum of care for marginalized people living with mental health conditions. This may contribute to reducing the substantial treatment gap for mental health care in Somalia.