The realities of implementing Self-Help Plus – what have we learnt so far?

The realities of implementing Self-Help Plus – what have we learnt so far?

In HealthRight International’s first blog, we introduced our strategy for scaling an innovative mental health and psychosocial support intervention called Self-Help Plus (SH+) amongst South Sudanese refugees in Uganda. It has been a year and a half since we started on our journey to scale – a year and a half of initiating and developing partnerships, building relationships and co-creating pathways to scale together with our partners. In this second blog, we share key learnings and experiences which have shaped how we at HealthRight are implementing SH+ together with partners from different sectors.

Initially, we had planned on scaling SH+ in Uganda with three partners – the first, a large international Non-Governmental Organization (INGO) involved in safety during humanitarian crises, the second; another large INGO involved in livelihoods programming, and the third, the Ministry of Health in Uganda. We had progressed significantly with our first partner, which was also our largest partner at the time, but unfortunately experienced one major challenge of budget reformatting which led to a termination of the partnership. Although the outcome was unfavourable, we learnt that large humanitarian INGOs might not be able to be flexible in reformatting their budget to accommodate integrating SH+ into their programming, as they sometimes have prior formatting requirements that they have to adhere to. Such INGOs also have several layers of approval and decision making which makes it difficult to be flexible.

On the other hand, our experiences with another INGO has been quite different. In this partnership, we initially signed a teaming agreement under which we intended to learn, through research activities, how to integrate SH+ within one of their ongoing projects (financing for refugees). After our largest partner withdrew from the project, this partner stepped in to play a larger implementation role as they had the capacity and will to support integrating SH+ into not just one, but two of their ongoing projects. We were then able to negotiate a subcontract agreement, co-create an implementation plan and a timeline of activities. All these changes in our journey to scale, although reflecting how we are willing to learn and adapt to maximise impact, meant that we had to request for amendment from our funders. Our funders were quite supportive throughout the amendment process, but it also meant that we had to pause some of the activities while waiting for the outcome. This has caused a delay in our project, but, together with our partner, we have agreed on ways to reach more people in the short period of time we have left.

Experiences from these two large INGOs have informed us that each partner, although similar in structure, is unique and their needs are also unique. We have developed an ability to communicate to different partners and organisations, and allowed ourselves to take time to engage with partners and get to know them well, and understand their organizational ways of working. We have also taken time to understand how to tailor implementation of SH+ according to what each partner, and the communities that they work in, needs. Implementing SH+ in a manner that meets the needs of the communities allows for greater impact.

We have previously worked with our third partner, the Ministry of Health, on other projects in Uganda. The journey to scale project has strengthened our partnership, and we have widened our network in the Ministry. Building on previous experiences, and considering that the Ministry of Health’s reach covers the entire country, the main aim of the partnership is to develop SH+ to be implemented in such a way that the Ministry will continue to deliver SH+ past the duration of the journey to scale grant. The Ministry has been very forthcoming with ideas on how to sustainably deliver SH+ within their context, such as building capacity within their own staff to be able to not only deliver SH+, but train SH+ facilitators as well. The Ministry has also prioritised healthcare workers who have been in the frontlines during the COVID-19 pandemic to be the beneficiaries of SH+. Although our model of scaling was developed to be generic, there is a need to adjust based on needs and we have been able to learn how to communicate with partners, understand their needs and tailor SH+ to meet specific needs of the partner such as with the Ministry of Health in Uganda.

After all these partnership development processes, contracting and signing, we are excited to be piloting integration of SH+ into the Ministry’s COVID-19 programming, and into the financing for refugees and reproductive health project with our INGO partner. This has involved a full week of training SH+ facilitators from each partner – 33 SH+ facilitators from the Ministry of Health and 20 SH+ facilitators from the INGO. The SH+ facilitators from the Ministry include psychologists, social workers, psychiatric nurses and counsellors who have experience in running community health programs. Because of the Ministry of Health SH+ facilitators’ background and experience, the SH+ facilitators will also collect monitoring and evaluation data as enumerators. On the other hand, the INGO SH+ facilitators are community volunteers who are currently involved in the financing for refugees and reproductive health project. To support these SH+ facilitators to collect monitoring and evaluation data, 8 enumerators with experience in data collection have been trained. 

The implementation phase has officially started with both partners and we will share all the exciting details in our next blog. HealthRight is looking forward to learning how we can add value to our partners programs through our scaling strategy in this implementation phase, and as we work together, we aim to be meaningfully impactful to each and every person involved in SH+.