Overview

ESSENCE involved two sequential randomized controlled trials. The Training trial conducted training of rural ASHAs on delivering evidence-based brief psychological treatment for depression (the Healthy Activity Program) and aimed to determine whether digital training is an effective, cost-effective, and scalable approach for building the capacity of ASHAs for primary depression care. The Implementation trial integrated evidence-based depression treatments (based on WHO’s mental health gap action program) into routine primary care in rural Health and Wellness Centers (HWCs) in Sehore district, Madhya Pradesh, to determine if Enhanced Implementation Support was superior to routine district team support in improving depression screening at HWCs.

Rationale

More than 50 million people live with depression in India, with the majority in lower-resource settings, which have an acute scarcity of mental health professionals. However, despite the knowledge of evidence-based clinical treatments (EBT) treatment gaps exceed 90% in rural areas. ESSENCE will address the critical knowledge gap regarding the training and implementation support strategies necessary to scale up evidence-based delivery strategies for treatments for depression in a low-resource setting. The innovations in the study are focused on developing and testing strategies for the effective delivery of evidence-based treatments in low-income settings.

Progress till date

The ESSENCE team completed a three-arm, parallel-group randomized controlled trial comparing three ways of training ASHAs to deliver the Healthy Activity Program (HAP), a brief manualized psychotherapy for depression, in primary care. The arms were digital training (DGT); digital training combined with individualized coaching support (DGT+); and conventional face-to-face training (F2F). The target sample comprised 336 ASHAs. The Implementation trial team integrated evidence-based depression care services in 14 rural Health and Wellness Centers with half of the clinics receiving Enhanced Implementation Support for delivering depression care. Both the trials are completed and the results are being analysed.

Partner/s

• Harvard Medical School, USA

• National Health Mission, Madhya Pradesh, India

• National Health Systems Resource Centre, Government of India