Abstract

Background The 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.

Methods A 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.

Results Out 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%).

Conclusion Effective 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.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This study did not receive any funding

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

This study was conducted as part of the Mental Health and Psychosocial Support Project, approved by the Ministry of Planning, Development & Special Initiatives in compliance with ethical standards and consent protocols under letter no. 6(262) HPC/2020. The Ministry of Planning, Development & Special Initiatives is an independent research and development institution and acted in the role of an ethics committee to approve the project.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Availability of data and materials

The data that support the findings of this study are available from the Health Section at the Ministry of Planning, Development & Special Initiatives, Government of Pakistan. Confidentiality restrictions apply to the availability of the data used under the license for the current study and so are not publicly available. However, the data can be available from the authors upon reasonable request after formal approval from the Ministry of Planning, Development & Special Initiatives, Pakistan.

List of abbreviationsKPKhyber PakhtunkhwaUNHCRUnited Nations High Commissioner for Refugees; UNHCRUNOCHAUnited Nations Office for the Coordination of Humanitarian AffairsIMCInternational Medical CorpsPHCWsPrimary Health Care WorkersPCPsPrimary Care PhysiciansCPsClinical PsychologistsPSIPsychological InterventionEMROWHO Regional Office for the Eastern MediterraneanLMICsLow and Middle Income CountriesMHPSSMental Health and Psychosocial SupportMoPD&SIMinistry of Planning, Development & Special InitiativemhGAP-HIGmental health Gap Action Program-Humanitarian Intervention GuidemhGAP-HIG-PKmental health Gap Action Program-Humanitarian Intervention Guide adapted for PakistanCOPCommunities of PracticeMHCsMental Health ConditionsACUAcute stressGRIGriefIDIntellectual DisabilityEPIEpilepsy/seizuresSUBHarmful use of substancesPSYPsychosisPTSDPost-traumatic Stress DisorderDEPDepressionOTHOther significant mental health complaintsCBTCognitive Behavioral TherapyOPDsOutpatient Departments