REDRESS Intervention Manual: Supporting health workers to identify, diagnose, treat and support persons affected by NTDs that affect the skin

This guide explains the integrated approach in Liberia and is designed to support health workers to identify, diagnose, treat and support persons affected by NTDs (specifically leprosy, Buruli ulcer, lymphedema, hydrocele, onchocerciasis and yaws) within the existing patient care pathway. It also includes a focus on how to help persons whose mental wellbeing is affected as a consequence of having (had) an NTD.

The Intervention manual details a collaboratively developed intervention (with affected persons, community health volunteers and assistants, frontline health workers, Ministry of Health national staff, laboratory personnel, researchers and international research and funding partners) to detect and refer skin NTDs through the use of integrated approaches at community level. This includes providing initial awareness and sensitisation about these conditions for faith and traditional healers, alongside established community level health workers, such as community health assistants (CHAs) and community health promoters (CHPs). This manual also seeks to ensure that people affected by these NTDs receive more person-centred and holistic care, through the integration of mental health care via basic psychological support (BPS-N) for the most commonly occurring mental health conditions among people affected by skin NTDs (depression, anxiety, suicide and self-harm and other conditions including Post Traumatic Stress Disorder and anxiety), a basic package of psychological support and peer support groups. 

The manual aims:

• To improve knowledge and awareness of mid-level healthcare workers on NTDs affecting the skin and basic psychological support.
• Support Liberia MOH (Ministry of Health), including officer in charge and second screener at primary healthcare facilities to diagnose, treat and manage NTDs affecting the skin, screen for mental illness, provide basic psychological support with links to mhGAP trained providers and refer complicated cases to secondary or tertiary healthcare facilities.
• Assist Liberia MOH supervisors at district, county, regional and national levels to carry out training, supportive supervision, referral, monitoring and reporting.
• Provide health workers at all levels with greater understanding of their job tasks and roles and responsibilities.
• Provide CHPs and CHAs with the knowledge to support case detection for NTDs, and to provide look listen link support and referral for psychological support where necessary.
• Assist Liberia MOH stakeholders in the training and implementation of an integrated case detection and referral system for skin NTDs, with integration of mental health screening and mhGAP.