REDRESS’ mid-term review meeting held 28th February to 2nd March 2023 in Margibi County provided a valuable opportunity to review progress made after almost six months of implementing the REDRESS intervention package. Just as importantly, it allowed us to identify areas for strengthening the intervention moving forward.
This was an opportunity to celebrate – with over 3400 persons (including health workers, community health workers, informal providers, affected persons) trained in the new integrated case management (which includes mental health support) for people with skin neglected tropical diseases (NTDs). This has been the largest known roll out at scale of integrated case management training which includes mental health support. Observations shared by the research team and from MOH County and National NTD and mental health supervisors, highlighted new learnings are starting to embed and change the care practices of health workers and informal providers.
We also took time to reflect on some of the challenges experienced so far, for example, record keeping has been challenging across health systems levels. There are also differences in the coverage of community health workers between public and private facilities which creates challenges to increasing awareness and identification of patients within the community in private facility catchment areas. Finally, supervision has to date included NTD and mental health practitioners, but community health have not so far been involved. These reflections led to discussions within county teams to discuss and plan the next steps needed to strengthen services, within their county during a collaborative workplanning session. This led to action plans tailored to each unique county context, including suggestions for inclusion of the county community health focal person within the supervision team, radio campaigns to increase awareness among others.
Advance planning for the mid-term review meeting purposely set out to ensure that the various communities critical to the care of people affected by skin NTDs were present. This meant there were over 60 participants who attended the meeting, including people affected, community health workers, frontline health workers, informal providers including faith and traditional healers, representatives for community advisory boards, MOH representatives from county and national level for NTD, mental health, community health and laboratory divisions, Liberian and UK based researchers as well as REDRESS affiliated (Carter Centre) and collaborating partners (Effect Hope, American Leprosy Mission). Not only this, but the meeting set out to ensure that all persons present had the opportunity to actively participate and join discussions, in order to shape the remaining six months of intervention. This led to a varied programme during the meeting which was designed to create spaces for discussion and to promote participation.
The first morning of the meeting saw typical dissemination of progress and challenges from county and national NTD teams, and the REDRESS research team via powerpoint and plenary discussion. During this session much of the discussion and questions raised in the room were from MOH actors at national and county levels. Fortunately by the afternoon of day 1 we had pivoted to a world café, with discussion groups around critical intervention areas (e.g. supervision, peer support group). This led to in depth and lively discussions within these small groups. By day 2 and day 3 of the meeting, the dynamics within the room had shifted. Questions and comments were raised, and challenged, by participants representing all groups, allowing us all to learn from the varied perspectives and experiences within the room. For example, while many MOH staff and health workers were familiar with working together with patient representatives at meeting, it was a novel experience for many to discuss health and care with traditional and faith healers. Since they are often the first source of care seeking and often continue to play a role after a patient has sought care at a facility, there were useful lessons and negotiations made together. As one national MOH service provider reflected;
“Often you will see health workers cowering away from affected persons when the sore is smelling bad, but a traditional healer would hold them close and sometimes even suck the wound to provide traditional treatment….no matter what you think about traditional health practices….there is something about that physical connection and desire to help or reduce stigma that makes people feel human…that supports mental health too…with or without the addition of counselling.”
The mid-term review meeting was an opportunity for engagement, promoting greater understanding and building collaboration between participants, which we hope will lead to strengthening of the intervention, and ultimately more holistic care for persons affected by skin NTDs.