KAP Survey on Perception of Mental Health Disorders and Access to Mental Health Services Tender

Procurement Summary

Country : Libya

Summary : KAP Survey on Perception of Mental Health Disorders and Access to Mental Health Services

Deadline : 21 Apr 2019

Other Information

Notice Type : Tender

TOT Ref.No.: 31910599

Document Ref. No. :

Competition : ICB

Financier : World Health Organization (WHO)

Purchaser Ownership : -

Tender Value : Refer Document

Purchaser's Detail

Purchaser : HANDICAP INTERNATIONAL - HUMANITY & INCLUSION
8757 Georgia Avenue Suite 420 Silver Spring MD 20910 recruitment@Libya.hi.org
Libya
Email :recruitment@Libya.hi.org

Tender Details

Tenders are invited for Libya: KAP Survey on Perception of Mental Health Disorders and Access to Mental Health Services in Libya.

ToR – KAP survey on perception of mental health disorders
and access to mental health services in Libya
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:
http://www.handicap-international.fr/en/s/index.html
1- Presentation of the context
1-1- Mental Health in Libya
Since the fall of the regime of Gaddafi in 2011 and renewed conflict since 2014, the political and
economic situation in Libya has become extremely fragile. Health services in Libya have
gradually collapsed due to depleting human resources, equipment and medicine as well as a
lack of investment in the sector. Returnees were reported by REACH to be the group with the
highest difficulties to access adequate healthcare (54%)1. Furthermore, 24.9% of all assessed
households reported at least one member displaying two or more signs of psychological
distresses, 46.7% of IDP households and 39% of returnee households (compared to 23.5% of
non-displaced households).2
The Mental Health/Psychosocial Support (MHPSS) 4W assessment conducted in Libya in 2017
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.
1 201709 reach_lby_report_2017_multi-sector_needs_assessment_september_2017
2 Ibid.
Mental health service provision is highly centralized in Benghazi, Tripoli and Misrata, difficult to
access and of limited quality. In addition to the two mental health hospitals, Al Razy Psychiatric
Hospital in Tripoli and Benghazi Psychiatric Hospital, there are 6 mental health outpatient
facilities (one in Al Wahat/Ajdabia, two in Misrata, two in Tripoli and one in Al Jabal Al Gharbi)3.
Two are in mental health hospitals, two are in general hospitals and two are in polyclinics. In
parallel there are a number of private clinics, often run by professionals working in the public
hospitals, but that are not accessible to the most vulnerable part of the population primarily due
to financial barriers. All in-patients from the two mental health hospitals were discharged in 2014
mainly because of the lack of qualified health professionals (psychiatrics, psychologists, and
nurses). 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. In addition, psychotropic
medicines are not always available and often not affordable to people with low income.
There is no mental health policy in Libya nor updated mental health legislation. In 2012, an
inter-ministerial mental health meeting was conducted with various representatives, proposing
to develop a coherent and comprehensive mental health policy focused on six core
components: organization of services by developing community mental health services; capacity
development of human resources; involvement of users and families; human rights protection of
users; equity of access to mental health services across different groups; and quality of services
(WHO, 2015).
Stigma and 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. In 2012 the Ministry of Health’s annual budget provided 13 million Libyan Dinars for
the two mental health hospitals in Tripoli and Benghazi, accounting for 0.45% of total public
health budget.
There are no published data on the prevalence of mental health disorders in Libya prior to the
2011 conflict. The WHO estimates that rates of common mental disorders such as anxiety
disorders and depression double in the context of humanitarian emergencies from a baseline of
around 10% to 20% while people with severe mental health disorders (2-3%) are especially
vulnerable in such contexts and require access to care4.
According to Charleston’s5 predictions on mental health impacts after the 2011 conflict in Libya,
the estimated prevalence of depression and Post Traumatic Stress Disorder (PTSD) varies
according to levels of population-level political terror, trauma exposure and recurrence of
conflict. The study suggests that the prevalence of depression is higher than the prevalence of
PTSD and may be as high as 30-40% of the population in areas that are severely affected by
3 Libya 2017 – Service Availability and Readiness Assessment (SARA) Report – p 145
4 WHO & UNHCR (2012). Assessing Mental Health and Psychosocial Needs and Resources: Toolkit for Major
Humanitarian Settings. Geneva: WHO
5 Charlson, F.J., Steel, Z., Degenhardt, L., Chey, T., Silove, D., Whiteford, H.A. (2012). Predicting the Impact of the
2011 Conflict in Libya on Population Mental Health: PTSD and Depression Prevalence and Mental Health Service
Requirements. PLOS ONE 7(7): e40593.
conflict. Although the ongoing and recurrent conflict in the country is expected to further
increase the proportion of the population in need of mental health and psychosocial support,
there is no study revealing the actual mental health impacts of Libya’s population since the
upheaval from 2011 began.
A survey amongst 2, 692 households conducted by the Danish Institute Against Torture and the
Benghazi University in 2013 revealed that 29% of individuals reported anxiety, 30% depression
and 6% reported PTSD. Stress levels showed a preoccupation with political instability (63.6%)
followed by the collapse of the country (61.2%), insecurity about “life right now” (56.6%) and
insecurity about the future (46.4%). Nearly 30% of respondents reported being exposed to
violence during demonstrations6.
There is an increasing trend of substance use among young people as well as amongst women
in Libya7. Unsafe opioid injections have led to HIV infections among drug users8. Accounts from
outreach workers, doctors and the media9 reveal Libya’s drug-related problems stem from
painkiller use, especially Tramadol, and increased alcohol abuse.
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.
International Medical Corps (IMC) conducted a MHPSS need assessment showing that severe
social stigma exists towards psychiatric patients10. The stigma prevents individuals with mental
illness, especially people who have been treated in psychiatric hospitals, from integrating into
the community. People prefer private clinics, if they can afford them, to reduce or avoid the
stigma. Some informants reported an increase of local, traditional healers dealing with MHPSS
issues in recent years, especially in the city of Misrata, Libya’s third largest city.
In 2016 Handicap International conducted an assessment11 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 an integrated rehabilitation
6 Danish Institute Against Torture. (2014). Consequences of Torture and Organized Violence | Libya Needs
Assessment Survey.
7 JUSOOR Center for Studies and Development. (2015). The situation of women in Libya.
8 Hanna, F.B. (2017). Alcohol and substance use in humanitarian and post-conflict situations. Eastern
Mediterranean Health Journal. 23(3).
9 Media as IRIN News, 2013 and Voa News (Dettmer, 2013) revealed Libya´s drug problems.
10 International Medical Corps (IMC). (2011). IMC Libya Mental Health and Psychosocial Support Assessment
Report.
11https://www.humanitarianresponse.info/sites/www.humanitarianresponse.info/files/assessments/handicap_internati
onal_health_assessment_report_libya_june_2016.pdf
system, integrating physical and psychosocial rehabilitation, as well as including health structure
departments, coordination, and a referral system.
The Ministry of Health (MoH) and other stakeholders have identified MHPSS as a priority area
in Libya. A new mental health program based within Libya’s National Centre for Disease Control
(NCDC) was set to transform the institution-based approach to a community-based approach to
mental health care, to be made available in all areas of the country. In 2013, a 4-year (2015-
2019) mental health strategy to improve the services was launched. However, strategy
implementation has been impacted by ongoing conflict and political crisis in Libya.
1-2- AMAL – Action for Mental Health Assistance in Libya
The AMAL project (Action for Mental Health Assistance in Libya) is part of a general project to
Improve Access and Quality of Health Care Services in Libya, funded by the European
Commission.
According to the World Health Organization’s (WHO) 2015 Health Profile for Libya12, in order to
improve mental health in the country, a combination of immediate and long term interventions is
needed:
• The immediate actions should consist of assessment of mental health and psychosocial
support needs and system’s existing capacities, strengthening coordination among
actors working in the field of mental health and improving the supply of essential
psychotropic medicines.
• 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 evidencebased
practices and human rights.
As a response to these needs, Handicap International (HI), together with Nebras, a Tunisian
partner, propose the following Action for Mental Health Assistance in Libya consisting 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);
12 WHO - Libya health profile 2015 - WHO Regional Office for the Eastern Mediterranean
• 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)
2- Presentation of the KAP survey – A socio-anthropological study on
perception of mental health disorders and access to mental health
services
2-1- Why this research?
The research is resulting from a will to promote innovative knowledge management. The
research will help in defining the content of the awareness campaign on mental health disorders
(media campaign and sensitization session in the community), adjusting and adapting the
project interventions in line with the findings. This study will support the HI teams and their
partners in delivering our actions relating to the public understanding, identification and
acceptance of people with mental disorders in consistence with the perceptions and traditions of
the country. It will also help in correct and effective identification of people having mental health
problems and referring them to appropriate services respectful of their rights. The study would
help in knowing the good and bad practices in the community, services providers and local
authorities, language which community use or understands, what they mean by mental health
problems, what do they think about causes and whom they go if they identify person has mental
health problems. It should also describe the dynamic of the relations that is built between people
with mental health problems and the different stakeholders. It should highlight the negative and
positive interactions that can lead either to the empowerment of people with mental health
problem through a proper care and support or the deterioration of the wellbeing and ultimately
the abuse of their human rights. Finally, it should bring the light to the current referral pathway
that people with mental health problems and their caregivers take to seek support.
2-2- Research objectives
• General objective of the research
To bring an in-depth understanding on perceptions of mental health disorders among various
groups of communities, the dynamic of the interaction between people with mental health
disorders, the community, the different stakeholders and the traditional means of approaching
the issues of mental health in Libya.
• Specific objectives
• To know what are considered signs of mental health disorders and how mental health
disorders are described in the community
• To know the perceptions toward mental health by the families, various community
members, leaders, services providers and the local authorities and identify myths and
belief rooted in the society and among service providers.
• To describe the dynamic of the interaction between the person with a mental health
problem and the family, the community, the service provider and the local authority.
• To understand and analyze the referral pathway for people with mental illness
• To analyze the understanding of traditions, practices and skills among community
members related to mental health.
2-3- Location
Briefing to take place in Tunis before travel to Libya.
Field visits in Tripoli and Misrata. Remote interviews with stakeholders in Benghazi.
2-4- Target Population
• General community members, community leaders, traditional healers, local authorities
• Users of mental health and psychosocial services and their caregivers
• Existing basic and specific service providers addressing the needs of persons living with
psychosocial disabilities;
• Authorities ruling over the mental health.
2-5- Methodology
This is qualitative anthropological study that will use different methods such as the participant
observation, group and individual interviews with relevant stakeholders in order to capture the
understanding and social perception regarding the mental health problems and meet the
expected outcomes. A literature review regarding the subject is expected in order to enrich the
study. Data collection tools can be an observation grid and a grid of semi directive interview,
adapted to different profiles to query. The data collection tools should be subject to a validation
of Handicap International.
2-6- Ethics
The expected technical offer shall include mechanisms to be implemented so as to ensure:
• the protection & safety of HI teams and participants in the research
• informed consent of all respondents
• the confidentiality of sensitive and personal data
• the scientific validity of the research
• the possibility to use and exploit the information contained in the research
• the adoption of a comprehensive and participatory approach
2-7- Specific survey constraints
The research protocol will be validated by HI committee composed by technical focal points and
Libya program team. The proposed methodology in the technical offer should be participationoriented
in line with the requested qualitative approach.
2-8- Security
The consultant will recieve a security brieifng from HI upon arrival to the mission. The consultant
will be expected to respect HI’s security rules when conducting the mission in Tunis and Libya.
3- Presentation of the mission
3-1- General objective of the expert mission
The expert will ensure the implementation (final protocol), the realization (collection, processing
& analysis), the monitoring and the exploitation of the research results.
3-2- Expected results of the mission
(1) A written protocol is finalized. From the technical proposal and in collaboration with the
reference person of Handicap International, a protocol is written. This document provides key
elements of the implementation of the research and contains, a minima: introduction with
background of the research, state of art, interest of the research ; presentation of the objectives
(general & specific), with target population, location; presentation of the methodological
framework: study design, selection of participants, data collection, data treatment, data analysis,
quality monitoring mechanisms; responsibilities of the expert; time schedule; budget; ethics
considerations.
(2) Field visit consisting of 3 weeks
(3) Report writing and finalization for 1 week
3-3- Deliverables

Final Protocol
Final data collection tool (interview guides, questionnaires)
Final data base
Research report including recommendations
3-4- Time Schedule & budget
The research will be conducted during the 2nd quarter of 2019. 1 month of mission will be
required for the study. Exact dates will be agreed during the recruitment.
The budget for the research will be approx. 7, 000 Euros. This amount is to cover the
consultancy fees, international return air fare to Tunisia, local expenses whilst on mission,
insurance and taxes if any.
Flights from Tunisia to Libya and Libyan visa will be covered by HI. Accommodation in Tunis
and Libya and local transportation will be covered by HI.
4- Requested profile
• Mandatory:
o Minimum Diploma: Master in Socio Anthropology or sociology with at least 5
years of experience in conducting socio-anthropology related researches
o Experience in the mental health sector
o Proven and recognized experience in methods of data collection, treatment and
analysis (particularly qualitative data)
o Experience in participatory research approaches
o Analysis, synthesis and writing demonstrated capacity (provide a list of
publications)
o Knowledge of the working languages (written &oral): English
• Desired:
o Recommended experience in conducting surveys/researches
o Ability to work in collaboration with public and associative actors
o Familiar with the North African context

How to apply:
Applications must include:
• About the consultant:
o A curriculum vitae (training, experience in the areas mentioned above, lists of key
publications)
o References
o A letter of motivation
• About the technical proposal:
o A methodological proposal to conduct this research, including, a minima:
Understanding of the issues of the research and of the terms of reference;
background of the research; presentation of the objectives (general & specific);
location; target population; presentation of the methodological framework: study
design, selection of participants, data collection, data treatment, data analysis,
quality monitoring mechanisms; ethical considerations
o A financial proposal including, a minima, details of consultancy fees and
operational costs of the research.
o Decision about the methodology will be made upon proposal of the applicant in
his/her technical offer and subsequent discussions and validations with HI
technical unit.
Please, send all required documents before April 21 2019 to the following address:
recruitment@Libya.hi.org

Documents

 Tender Notice