Training of Trainers (ToT) on Problem Management -HI عودة إلى الفرص

Terms of Reference – Training of Trainers (ToT) on Problem Management + in Libya 2021 for AMAL Project

Handicap International (HI) is an independent and impartial international aid organization working in situations of poverty and exclusion, conflict and disaster. Working alongside persons with disabilities and other vulnerable groups, our action and testimony are focused on responding to their essential needs, improving their living conditions and promoting respect for their dignity and their fundamental rights. Handicap International is a not-for-profit organization with no religious or political affiliation. It operates as a federation made up of a network of associations that provide it with human and financial resources, manage its projects and implement its actions and social mission. For more details on the association visit www.hi.org 

1. Presentation of the context   

1. Mental Health in Libya 

The Mental Health/Psychosocial Support (MHPSS) 4W assessment conducted in Libya in 2017 by mhpss.net states that “Mental Health is a chronically neglected field in the country with many longstanding problems that predate the conflict that started in 2011, including underdeveloped community and specialized services, shortage of qualified workforce, lack of facilities, social stigma towards people with mental illness and funding marginalization”. In addition, the current and long-lasting violence in the country is believed to further increase the proportion of the population in need of mental health and psychosocial support, requiring a combination of immediate and longer-term interventions.

Mental health service provision is highly centralized in the main urban centers of Benghazi, Tripoli and Misrata, difficult to access and of limited quality. In addition to the two mental health hospitals, one in Tripoli and one in Benghazi there are 6 mental health outpatient facilities in Libya.Two are in mental health hospitals, two are in general hospitals and two are in polyclinics.. A high number of qualified foreign health professionals left the country during the 2014/2015 conflict. Provision of mental health care in Libya is essentially based on prescription of drugs, and counselling and psychotherapy services are rare..

Stigma and a lack of awareness about the real extent of mental health needs in Libya, as well as the absence of mental health policy or legislation, have led to limited financing of mental health services. 

The situation of non-Libyans in the country (migrants, refugees and people on the move) is also of great concern. It is widely reported in the media of refugees and migrants facing kidnapping, slavery, torture and organized violence, and sexual violence along the migration route.

In 2016 HI conducted an assessment on the availability, capacity and range of services delivered in health structures in Western Libya. The findings of the assessment stressed that the MHPSS sector is undeveloped with a lack of a harmonized statistical system shared by health structures, and the absence of systematic data collection on inpatient flow and pathologies;  a lack of trained and experienced MHPSS human resources; an over-medicalization of psychological distress; only a few civil society organisations are active in the field of psychosocial support; and there is a lack of capacity to advocate efficiently for the cause of MHPSS. Moreover, the assessment reported a lack of  a comprehensive rehabilitation system, integrating physical and psychosocial rehabilitation, as well as including health structure departments, coordination, and a referral system. 

1. AMAL – Action for Mental Health Assistance in Libya

According to the World Health Organization’s (WHO) 2015 Health Profile for Libya, in order to improve mental health in the country, a combination of immediate and long-term interventions is needed

Long-term actions should include: integrating mental health and substance use services at the community and primary health care levels; building the capacity of health professionals to deliver evidence-based interventions for priority mental and substance use disorders; enhancing access to evidence-based psychosocial interventions; developing a national mental health strategy and plan; and increasing awareness of mental health and the rights of people with mental disabilities based on best evidence-based practices and human rights.

In response to these recommendations and based on evidenced needs, the 3-year Action for Mental Health Assistance in Libya (AMAL) project, implemented by HI and its Tunisian partner Nebras() is part of a wider initiative to Improve Access and Quality of Health Care Services in Libya, funded by the European Commission.

The project consists of:

• Increasing awareness about the risks and manifestations of mental illness and substance abuse (including awareness campaigns and awareness sessions in the community)
• Expanding access, availability and acceptability to quality psychosocial support and mental health care (including delivery of mental health services through outreach teams, primary health care clinics, psychiatric departments of general hospitals and/or in psychiatric hospitals); 
• Training and upskilling of mental health staff (including ToT and university diplomas in mental health for several categories of specialized as well as non specialized staff) 

1. Presentation of ToT on  PM+

1. Why this training?

Mental health services in Libya are highly centralized and there is very little integration of mental health into primary health care and no community approach. Given the stigma related to mental health disorders as described above, patients can be reluctant to consult with a professional and remain untreated. As a response to this gap, through the AMAL project HI plans to develop the provision of mental health care at community level on adults suffering from mild and moderate mental health disorders.

In early 2021, as part of the implementation of the project “Mental health and psychosocial support” supported by the United Nations Development Programme (UNDP), HI has identified, selected, trained and supported 2 CSOs for the delivery of MHPSS services at community level. Psychosocial workers of these two CSOs have been trained on PM+ in March and April 2021, since then they have been applying the PM+ to their service users.

The results of this collaboration are encouraging so far but more support is needed, essentially to broaden the scope of capacity-building provided through training them to become themselves trainers and supervisors for other CSOs. This approach aims at enlarging the geographical scope of MHPSS activities provided at community level and reach communities more adequately and in the long term. 

The already trained PSWs of the two CSOs, will now receive a training of trainers (ToT) for PM+ in order to provide them with skills to duplicate the trainings at the benefits of other CSOs and supervise –with the support of HI- MHPSS interventions at community level. 

1. Training objectives 

General objective of the training

The general objective of the ToT is to provide trainees with:

• Lessons learnt about the good practice and challenges on applying PM+ in the given context drawn from the practice of application by the PSWs.  f
• The provision of a ToT on the basis of the PM+ manual modifying or amending PM+ activities where necessary based on the lessons learnt. 

Specific objectives 

The specific objectives will be to develop the ToT skills of trainees with:

• The reflection of their PM+ practice by the PSWs on criteria for successful application of PM+ and needs of improvement and expansion
• Development of a ToT curriculum including the modifications and amendment needed. 
• Provision of a training about the modifications and amendments
• Provision of skills to provide PM+ trainings for other PSWs

1. Training content

In the form of a Training of Trainers, the training should be in Arabic and cover the following topics.

• Modifications and amendments needed (for example flexible application of the PM+ according to the needs of the BN, more elements for stress management and stabilization etc.. This depends on the results of the lessons learnt.)
• Training skills for the PM+ following the PM+ TOT manual. 

1. Location, dates and duration

The activities and the training should take place in presence in Tripoli or in Tunis,

Activities to develop the lessons learnt (3 days) 

The trainings: 4 days

1. Target Population 

The target population of the ToT is the PSWs of the above mentioned CSOs who have received a PM+ training and are practicing the approach since then.

Number of trainees will be approximatively 10 trainees 

1. Methodology 

Elaboration of lessons learnt: FGD, case discussions, clinical supervision.

The training should include: Participatory methods to develop the needs skills and knowledge  

• Roleplays
• ToT tools
• Cultural adaptation

1. Presentation of the mission 

1. General objective of the trainer’s mission 

The trainer will ensure: 

• Elaboration and documentation of the lessons learnt (4 days)
• Preparation of training material and handouts (3 days)
• Delivery of training (in Arabic) in Libya or Tunisia (4 week)
• Final report and recommendation (1 day)

3-2- Deliverables  

1. Documentation of the elaboration of the lesson learnt (process and results)
2. The final training curriculum and final training material 
3. Training report including recommendations 
4. Pre and posttest for the training 
5. Satisfaction assessments for the training 
6. Final report on the training and its results including  feedback on training, recommendations

All training materials (PPT, manuals and handouts) should be in Arabic with a summary of content in English reports, and results on pre and post-test and satisfaction assessments in English

1. Requested profile 

• Mandatory: 
  • Minimum Diploma: Master in psychology with at least 5 years of experience in clinical psychology
  • Experience in the humanitarian field, preferably in the MENA region
  • Good knowledge of the PM+ and other approaches of psychosocial counseling
  • Good knowledge of participatory methodology 
  • Experience in delivering ToT
  • Arabic and English language skills mandatory

• Desired: 
  • Ability to work in collaboration with public and associative actors 
  • Familiarity with the North Africa context and Libya in specific