Mental health and psychosocial support emergency response for conflict-

affected and internally displaced populations in North Showa, Ethiopia

2024/25

1. Abayneh Shewangzaw (Mental Health Specialist) (Principal

Investigator)
2. Nigus Alemnew (Mental Health Specialist) (Principal Investigator)
3. Dr. Mohammed demssie (PhD)(Psychologist) (Principal Investigator)
4. Getahun Sahile (PHD) (Psychologist)
5. Fikadu Gebeyehu (PHD fellow) (Psychologist)

February 2024
Debre Berhan University, Ethiopia
General Information or Project Profile

Mental health and psychosocial support emergency response for conflict-affected residents and
Title of award
internally displaced populations in North Showa, Amhara, Ethiopia.

Donor Debre Berhan University

To contribute towards reduced mentally illness, substance use, and neurological problem and
Project objective
treat individuals who have the illness in the war-affected area of north Shewa zone and IDP
center in Debre Berhan town and to ensure that host communities and IDPs have support to their
immediate mental illness perpetuating and aggravating factors alleviation.

Project activities Mental health, substance use, and neurological screening, MHPSS service mapping, rapid
MHPSS needs and resources assessment , Awareness campaigns, key messaging,
provide mental health education and promotion programs, provide psychological first aid, and
linkage to health facility to take medication Lay counseling services, Provision of
specialized psychotherapy, Establishment of MHPSS mobile teams, Establishment of
conflict mediation teams, “peace cooperatives”, Establishment of MHPSS resource
center, Training on psychological first aid and Para counseling, MHPSS, PSS of mobile
teams, volunteers, community key person, HEW, and health professionals from North Showa
Selected Woredas & IDP to educate the host community & IDPs, and conduct action research

Award start date Start date 15/2/2024 End date 15/2/2025 1 year

Budget 3,516,198 Ethiopian Birr

Target groups and The main target beneficiaries are men, women and youths school counselors, health
beneficiaries extension workers, health post workers, health center workers, Hospital staffs who have
been affected by the conflict in North Showa Zone and IDPS. Direct beneficiary =
22,000 North Showa Woreda residents and IDPs will be targeted under the project. A
specific focus will be on people directly affected with conflicts women, female
adolescents and girls, and people living with disabilities.

Award location Ataye, Shewarobit, Debresina, and China camp, Woinshet and Bakelo IDP sites in Debre
Berhan Town
Department of Nursing, Psychiatry unit, Aserat Woldeyesis Health Science Campus (AWHSC),
Project owner or
holder and Department of psychology, Debre Berhan University (DBU)

Cooperating Bureau of Health, Bureau of Education, Bureau of Water and Energy, Bureau of Women, child
government sector and social affair, Bureau of humanitarian emergency affairs

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 It will be implemented with the involvement of health offices, hospitals, health centers and
education offices in each Woreda, IDPs, Debre Berhan Specialized Comprehensive Hospital,
Project DBU, NGOs, zonal health bureau and different stakeholders. It will be monitored by the project
implementation and
members by regular meeting using the project indicators as a measurement. The overall
evaluation
achievement of the project will be evaluated by the project members, NGOs, Zonal non-
communicable diseases focal person, IDPs and community core process of the University.

Contact address Name Email Tel

Abayneh Shewangzaw [email protected] +251912038798
Nigus Alemnew [email protected] +2519 10211536
Getahun Sahile (PHD) @gmail.com +2519 13666693
Fikadu Gebeyehu [email protected] +2519 12066508
Mohammed [email protected] +251910352440
Demssie(PhD)

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Contents
Acknowledgments ......................................................................................................................................... 5
Acronyms and abbreviations ......................................................................................................................... 6
List of tables .................................................................................................................................................. 7
Summary of the project ................................................................................................................................. 8
Introduction ............................................................................................................................................... 10
Organizational background ..................................................................................................................... 11
Problem justification ................................................................................................................................. 12
Project approach and Strategy of intervention ...................................................................................... 14
Project beneficiaries and its selection ...................................................................................................... 16
Project Goals and Objectives/General objectives and Specific Objectives................................................. 16
General Objective.................................................................................................................................... 16
Specific objectives .................................................................................................................................. 16
Project Interventions: Outputs and Activities ............................................................................................. 16
Output 1: Enhanced mental health capacity of non-mental health professional’s partners who work at IDPs. 18
Project outcomes ....................................................................................................................................... 19
Input ........................................................................................................................................................... 20
Monitoring and Evaluation ...................................................................................................................... 21
Monitoring .............................................................................................................................................. 22
Evaluation ............................................................................................................................................... 22
SWOT analysis .......................................................................................................................................... 23
Sustainability and Phase out strategy...................................................................................................... 24
Work schedule/Plan .................................................................................................................................. 25
Budget plan ................................................................................................................................................ 30
Annex:-Screening tools for different mental illnesses and substance use ................................................... 38

4
Acknowledgments
We would like to thanks representatives of the internal displaced people in the three IDP sites, north Shewa
administrative bodies and Debre Berhan University for their collaboration and providing valuable information
regarding to the IDPs.

5
Acronyms and abbreviations
MHPSS Mental Health and Psycho Social Support
AWHSC Aserat Woldeye Health Science Campus
DBU Debre Berhan University
IDP Internally Displaced Population
PTSD Post Traumatic Stress Disorder
UNHCR United Nations Human Rights Commission

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List of tables
Table 1. Work schedule of mental health, substance and neurological problems project at north Shewa zone war-affected
areas and IDPs in Debre Berhan, Ethiopia, 2024 ...................................................................................................................... 25
Table 2 Summary of costs per activity to be used to provide MHPSS services Efrata ena Gidim, Kewot and Tarma ber
Woredas, North Shewa, Amhara, Ethiopia, 2024/25 ................................................................................................................ 30
Table 3 Summary of Costs expected to be used provide the services Efrata ena Gidim, Kewot and Tarma ber Woredas,
North Shewa, Amhara, Ethiopia, 2024/25 ................................................................................................................................ 31
Table 4 Budget plan of mental health, substance and neurological problems project at IDPs of Debre Berhan, Ethiopia,
2024/25...................................................................................................................................................................................... 32
Table 5 Budget breakdown for stationary of the project Debre Berhan, Ethiopia, 2024/25 ..................................................... 34
Table 6 Budget break down for equipment of the project Debre Berhan, Ethiopia 2024/25 .................................................... 34
Table 7 budget breakdown for food and tea break of the project Debre Berhan, Ethiopia 2024/25 ......................................... 34
Table 8 Grand total budget plan of mental health, substance and neurological problems project at IDPs of Debre Berhan,
Ethiopia, 2024/25 ...................................................................................................................................................................... 35

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Summary of the project
Title of the project: - Mental health and psychosocial support emergency response for conflict affected people
and internally displaced populations in North Showa, Amhara, Ethiopia.

Goal: - To provide MHPSS services, improve their resilience and protection, and equip them with better coping
strategies for conflict-affected populations. In general, the project will contribute towards reduced mental illness,
substance use, and neurological problems and treat individuals who have the illness in the conflict-affected hos
community in the North Shewa zone and IDP center in Debre Berhan town, ensuring that IDPs and host
communities have support for their immediate mental illness in the Debre Berhan town IDP centers and North
Showa zone war-affected communities, Amhara region, Ethiopia, 2024/25.

Activities:- Mental health, substance use, and neurological screening; MHPSS service mapping; rapid MHPSS needs and
resources assessment; Awareness campaigns, key messaging, providing mental health education and promotion programs,
providing psychological first aid, and linking to a health facility to take medication Lay counseling services, Provision of
specialized psychotherapy, Establishment of MHPSS mobile teams, establishment of conflict mediation teams, “peace
cooperatives," Establishment of the MHPSS resource center, Training on psychological first aid and para-counseloring,
MHPSS, PSS of mobile teams, volunteers, community key persons, HEW, and health professionals from North Showa
Selected Woredas and IDPs to educate the host community and IDPs and conduct action research.
Outputs: - Increase and improve beneficiaries access to quality critical mental health services, enhance the mental
health capacity of non-mental health professional partners who work at IDPs, increase IDPs access to substance
and related addictive disorder treatment services; and increase inclusive neurological problem management
services for crisis-affected individuals.
Project site: - The project will be implemented in the North Showa Zone, selected Woredas, and the IDP center
found in Debre Berhan Town, North Showa. Ethiopia
Project owner: - The project owner is Department of Nursing, Psychiatry unit, Aserat Woldeyes Health Science
Campus (AWHSC), and Department of psychology, Debre Berhan University (DBU)
Project beneficiaries: - The main target beneficiaries are men, women, and youth-school counselors, health
extension workers, health post workers, health center workers, and hospital staff who have been affected by the
conflict in the North Showa Zone. The project will benefit people who reside in Efratana gidim, Tarmaber, Kewot
Woredas, and IDP centers found in Debre Berhan town.
Budget and duration of the project: - A total of 3,516,198Birr is needed to implement the project from Feb 15,
2024 to Feb 15, 2025.
Project implementation and evaluation: - The project will be implemented with the involvement of health
8
offices, hospitals, health centers, and education offices in each Woreda, IDPs, Debre Berhan Specialized
Comprehensive Hospital, DBU, NGOs, the zonal health bureau, and different stakeholders. It will be monitored by
the project members at regular meetings using the project indicators as a measurement. The overall achievement
of the project will be evaluated by the project members, NGOs, zonal non-communicable diseases focal person,
IDPs, and community core processes of the university.

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Introduction
Humanitarian Context Analysis:

Both fighters and non-combatants suffer physical and mental consequences as a result of war. The physical costs
of war include death, injury, sexual violence, hunger, disease, and disability, while the mental consequences
include post-traumatic stress disorder (PTSD), despair, and anxiety. Individuals and communities are emotionally
upset as a result of the terror and horror caused by war violence, which disrupts lives and shatters relationships and
families.

Non-combatant civilians are commonly affected by the combined consequences of war, torture, and repression;
particularly those captured in conflict zones or forced to participate in war-related activities such as murder or rape
against their will. According to Elbedour, Bensel, and Bastien (1993), the hapless victimized individuals caught up
in the experience of war were dubbed the collaterally injured population. Furthermore, war-related emotional
suffering can occur not only as a result of direct exposure to life-threatening situations and violence, but also as a
result of indirect stressors such as the injury or death of relatives or caregivers, economic hardships, geographic
displacement, and on-going disruptions of daily life (Jensen & Shaw, 1993).

According to the United Nations, internally displaced people (IDP) are “persons or groups of persons who have
been forced or obliged to flee or to leave their homes or places of habitual residence, in particular as a result of or
in order to avoid the effects of armed conflict, situations of generalized violence, violations of human rights or
natural or human-made disasters. Unlike refugees, they have not crossed an internationally recognized State border
(1).

There are now more than 55 million internally displaced people worldwide, of whom more than 87.2% have been
displaced by conflict and violence, and 12.8% were displaced by disasters. The combined forecasts for the 26
countries covered by the Foresight model suggest that the total

number of people displaced will have increased by 5.4 million in 2024 (1.9 million in 2023 and 3.5 million in
2024) from an estimated 95 million at the end of 2022. This means that by 2024, the number of displaced people
will have doubled since 2015 and increased by over 50 million. Of the 5.4 million people forecasted to be
displaced by the end of 2024, 3 million are estimated to be living in sub-Saharan Africa. Furthermore,
approximately 70% of the 5.4 million are estimated to be internally displaced. According to United Nations
Human Rights Commission (UNHCR), 42% of all IDP worldwide lived in Africa(2).

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Ethiopia has one of the world’s largest internally displaced populations, with displacement risks remaining high in
2023. Accordingly, Ethiopia had 4.2 million IDP, which is the second highest number in Africa. An estimated
358,000 people have been internally displaced in Amhara region as a result of ethnic based conflict in neighboring
regions and war in the northern part of Ethiopia along Amhara and Tigray Regional borders and are in urgent need
of humanitarian assistance, including many children and women who have been exposed to significant stress as a
result of physical and psychological trauma. Since August 2023, a new conflict has been started between the Fano
militants and the Ethiopian national defense forces in almost all districts of Amhara regional state. Due to this
reason, the number people who leave their habitual area is expected to increase(3).

According to WHO, Mental health is defined as “a state of well-being enabling individuals to realize their
abilities, cope with the normal stresses of life, work productively and fruitfully, and make a contribution to their
communities(4, 5).

Internal displacement is emerging as one of the greatest challenges facing humanity. The displacement of people
from their home or habitual area leads to various mental health problems such as post-traumatic stress disorder
(PTSD), depression, substance use and anxiety in these groups of people(6). Conflict exposes displaced
populations to violence and high levels of stress, causing dramatic rises in mental illness that can continue even
for long time after conflict has ceased. Displacement also disrupts social support structures and exposes civilian
populations to high levels of stress(7, 8).
The conflict in North Showa affected thousands of people and many of them have endured enormous distress,
subjected to different forms of psychosocial trauma, long term hardship and very strenuous circumstances. The
task of addressing the mental health and psychosocial needs of the affected people is enormous, and it has only
been addressed so far in a very limited way. This project aims to pave the way for wider scope.

Organizational background
The project is conducted in Efratana gidim, Tarmaber, Kewot Woredas, and IDP centers, which are found in
Debre Berhan city. There are 425,585 people in Efratana Gidim, Tarmaber, and Kewot Woredas, and also 22,579
internally displaced populations from Wolega and west Showa zones of Oromia regional state in the 3 IDP centers
(China camp, Woyinshet, and Baklo). The majority (64%) of them are women’s and children's. Based on age
category, 2,025 are children aged 0–4 years, 3554 are aged 5–14 years, 1600 are aged 15–17 years, 14000 are aged
18–59 years, and 1400 are aged >60 years. The project will be implemented from Feb 15, 2024 to Feb 15, 2025.

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Debre Berhan is the capital city of North Showa Zone, Amara regional state, located 130 km from Addis Ababa
(the capital city of Ethiopia) and 695 km from Bahir Dar (the capital city of the Amhara Region) on the main
highway to Dessie. North Shewa Zone has three hospitals, namely Debre Berhan Comprehensive Specialized
Hospital, Ataye Secondary Hospital, and Shewarobit Primary Hospital, which are the only health facilities in the
target area that provide mental health services.

Problem justification

When individuals and families seek safety by leaving their homes, cultures, and habitual communities
because of the threat of violence and persecution, emotional distress can be heightened. Studies have
indicated that mental health and psychosocial problems are extremely common in major crises like conflict -
affected incidences(9, 10).

About one third of displaced persons will experience high rates of depression, anxiety, substance use,
and post-traumatic stress disorders (PTSD) as a result of the circumstances they faced during their
displacement, which can significantly affect the quality of their life(11, 12). A systematic reviews and meta-
analysis study has shown that, the prevalence estimates of mental health disorders vary widely from 4% to
80%(13, 14). From this, anxiety accounts 4 to 40%, 5 to 44% for depression, and 9 to 36% for PTSD (14-
18). Displaced people are frequently subjected to a wide range of traumatic and violent events, as well as
poor living conditions, impoverishment, loss of self-esteem, and cultural and social disarray(19).

IDPs may resort to substance use to cope with these stressors. As studies have shown, IDPs use different
substances to mitigate the effects of stress, depression, and traumatic experiences. Also, IDPs are frequently
subjected to traumatic events, making them vulnerable to using different substances(20).

It is critical to comprehend the impact of people's early experiences on their mental health and long-term
development, as well as the societal implications. Many persons fleeing violence have been traumatized and have
lost loved ones; others have been caught in the crossfire. Individuals who are exposed to conflict and violence are
at a higher risk of developing mental illnesses. Posttraumatic stress disorder (PTSD) is the most common
condition in war-affected areas, according to research, followed by depression. People who have been affected by
war have a higher rate of behavioral or emotional difficulties, such as aggressiveness and other affective
disorders.

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Mental illness on IDPs and among host communities have a profound effect at different level. At the individual
level, victims of this disorder often experience substance abuse, depression, anxiety, personality disorders,
suicide, psychosis, cognitive disorders and many other mental health issues. At a societal level, the possible
consequences can be separation from families, homelessness, poverty and imprisonment(21). These mental health
issues might have long-term detrimental implications for those who are impacted. Individuals suffering from
PTSD or depression, as well as those who show challenging behaviors, must discover ways to manage with their
symptoms while in a combat zone, where there is little, if any, help for dealing with such issues.
These mental health issues have a substantial societal cost. Mentally ill students and those transitioning to
employment demand greater resources in school and during the transition. They are more prone to leave
occupations and be unemployed as adults. Persistent mental health issues may consequently impair the
educational achievement and employability of war-affected persons, impeding their recovery once the war is
ended.
Mental health and psychosocial problems in IDPs and host communities are highly interconnected, yet may be
predominantly social or psychological in nature(22, 23).

Significant problems of a predominantly social nature include:

 Pre-existing (pre-emergency) social problems (e.g. belonging to a group that is discriminated against or
marginalized; political oppression);
 Emergency-induced social problems (e.g. family separation; safety; stigma; disruption of social networks;
destruction of livelihoods, community structures, resources and trust; involvement in sex work); and
 Humanitarian aid-induced social problems (e.g. overcrowding and lack of privacy in camps; undermining
of community structures or traditional support mechanisms; aid dependency)

Problems of a predominantly psychological nature include:

 Pre-existing problems (e.g. severe mental disorder; depression; alcohol abuse);

 Emergency-induced problems (e.g. grief; non-pathological distress; alcohol and other substance abuse;
depression and anxiety disorders, including PTSD); and
 Humanitarian aid-related problems (e.g. anxiety due to a lack of information about food distribution).

From November 7th through December 30th, Debrebirhan University conducted a needs assessment. 591 people
from the North Showa war-affected districts took part in the process. The overwhelming majority of the
participants (96%) stated that there is widespread distress in the community, with 86 percent stating that they are

13
 experiencing severe emotional anguish. "Killings" is the first source of distress mentioned: sexual violence, fear
of death, witnessing murders, and loss of loved ones. Most participants said they were afraid in their families. In
addition, households reported being split up and felt unable to appropriately care for the people they were
responsible for. Insecurity and the threat of renewed violence are cited as the most distressing issues at a
community level. The results show that people are feeling overwhelmed on an individual, family, and
community level. Most respondents reported not knowing how to cope with the situation, or what to do help
improve their psychosocial wellbeing. The majority of distress indicators spontaneously reported was sleeping
problems, tiredness, anxiety and aggressiveness/anger. According to the assessment, PSS activities should focus
on assisting families and the community in coping with feelings of overwhelms and fears. Families are finding it
difficult to provide assistance to their members. Participants indicated that they don't know their neighbors and
that the people they used to rely on are no longer available. It is necessary to rebuild support networks.
Beneficiaries will reclaim control and be able to make decisions about their futures as a result of this. At least 23
incidences of acute emotional distress and suspected mental health issues were discovered throughout the
assessment. Given the multiple reports of high levels of violence, including SGBV and psychological problems
such as sorrow, sexual abuse, physical abuse, PTSD, stress, suicide attempt, sleeping disorder, despair, and loss
of hope, it's critical to get specialist help.

Some stakeholders and non-governmental organizations have been doing mental illness prevention and risk
mitigation awareness-raising sessions and sensitization activities, but this has not been satisfactory. Despite the
response by the stakeholders, the sheer scale of the crisis means that more mental health support is needed for
IDPs and host communities. The scale of the crisis also means that, for many, their needs or complex
vulnerabilities may not be adequately addressed. Other notable areas needing to be addressed are community-
based services to strengthen the community's ability to provide support to people affected by conflict and violence.
Considering the cycle of the escalation of violence, it would be appropriate to include conflict transformation and
reconciliation activities, especially as anger and aggression were listed as common spontaneous distress indicators.
Therefore, this project will fill the gap by contributing towards reduced mental illness, substance use, and
neurological problems and treating individuals who have mental illness in the IDP centers in Debre Berhan town
and war-affected areas in north Shewa Zone, Amhara, Ethiopia.

Project approach and Strategy of intervention

The proposed project contributes to addressing unmet and, unfortunately, constantly increasing needs in three
targeted areas. The intervention was mainly implemented to deliver a rapid, effective, and well-coordinated

14
response to targeted populations affected by conflict. The proposed interventions will be aligned with and comply
with the government's efforts to support the targeted group and assist in the government's capacity.

The project extends the integrated, multi-sectoral approach to prevent and manage mental health, substance,
neurological, and related problems. Due to the current context of war and crisis survival, the project strategy
places particular emphasis on responding to SGBV and psychological trauma across several of its outcomes. All
outcomes will be implemented by ensuring the integration of the different sectors to maximize the impact of the
project. The project will directly involve the targeted areas in the planning and implementation processes. It will
focus on the capacity building of IDP communities, who in turn will provide skills and information.

The project also focuses on capacity building on issues of the organization and its members for effective and
efficient delivery of services to beneficiaries.

Strategy of intervention;

• Working closely with existing government partner structures at all level

• Implement participatory targeting process and implementation

• Working with NGOs partners.

• Emplace clear monitoring and evaluation mechanisms as well as compliant response mechanisms.

• Conducting review meeting, joint supportive supervision and couching.

• Reinforce referral mechanisms to health facilities

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Project beneficiaries and its selection
A participatory targeting process will be implemented to select beneficiaries in the targeted three sites according to
verified processes. Vulnerability criteria will be implemented to select the most vulnerable IDPs. The selection
will be based on needs analysis, vulnerability assessment, and considering age, gender, disabilities, and medical
illnesses. More vulnerable households whose livelihoods have been mostly affected, particularly women and
child-headed households; households with physical disabilities and ill members will be.

Project Goals and Objectives/General objectives and Specific Objectives

General Objective

The project will contribute towards reduced mental illness, substance use, and neurological problems and treat
individuals who have the illness in the North Showa zone war-affected communities and IDP centers in Debre
Berhan town, ensuring that IDPs have support for their immediate mental illness in Debre Berhan town IDP
centers and North Showa zone war-affected communities, Amhara region, Ethiopia, 2024/25.

Specific objectives
 To provide quality mental health services for at least 12,750 IDPS

 To provide substance and related addictive disorder treatment services for at least 1,000 IDPs.

 To provide inclusive neurological management services for at least 800 crisis-affected individuals.

 To provide mental health, substance use and neurological health education and promotion programs
targeting all IDPs

 To provide MHPSS services for at least 6,000 beneficiaries in North Shewa, Amhara region.

 To conduct action research related to mental illness

Project Interventions: Outputs and Activities

Output I: MHPSS services delivered to beneficiaries in North Showa, Amhara region.

Activities:
 Assessment: MHPSS service mapping, rapid MHPSS needs and resources assessment in North Showa,
Amhara region.
 Lay counseling services
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  Provision of specialized psychotherapy
 Establishment of PSS mobile teams: the mobile teams will establish activities such as recreational
activities, discussion and support groups. Activities will include use of creative methodologies such as
theater, music, plastic arts. Specific groups will be developed to address the needs of women, men, male
and female youth.
 Training of PSS mobile teams: PSS mobile teams will consist of selected IDPs. The PSS mobile team
members will be provided with intensive training to build their capacity in provision of basic PSS services.
This will encourage a sustainable approach, as once the population moves from the site, they will still be
able to use to acquired knowledge and skills within their community.
 Establishment of conflict mediation teams, “peace cooperatives”: as per the assessment conducted, there is
a need to address peace building issues. A conflict mediation officer will assess the best structures to
implement to encourage community participation and build its capacity in implementing positive conflict
resolution mechanisms.
 Establishment of MHPSS resource center: the MHPSS resource center will act as a focal point and safe
space for beneficiaries to access services, for partners to refer cases or access MHPSS resources and as
well as a training venue for MHPSS capacity building. In addition, the center will be open to be used by
other actors implementing activities aiming at improving psychosocial wellbeing.
 Training on psychological first aid and Para counseling
 Awareness campaigns, key messaging: in order to raise awareness on MHPSS services available and how
to access them. The awareness campaigns will also provide information on stress reactions, how to cope
with them, and what can the community do to provide support to each other.

Output 2:- Increase and improve IDP’s access to quality critical mental health services

Activities:
In order to respond to growing needs on mental health in the target areas we will:
 Screen all targeted IDPs for mental health problem and put appropriate diagnosis
 Assess predisposing, precipitating, perpetuating and protective factors of mental illness
 Identify victims of GBV and/or people with PTDS
 Provide psychological first aid, counselling, psych-education and mental health promotion
 Link individuals who need psychiatric medication and those who need further investigation to health
facilities

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  Work in collaboration with other stakeholders
 Rebuild social network within the IDPs and other concerned individuals and groups.
 Give training for caretakers and volunteers to provide preventive, treatment and rehabilitative care of
mentally ill individuals.
 Protect, promote and support people with mental illness.

Output 3: Enhanced mental health capacity of non-mental health professional’s partners who work at
IDPs.
Activities:
 Providing training on mental health and psychosocial support service for non-psychiatric health
professionals.

Output 4: Increase IDP’s access to substance and related addictive disorder treatment service.

Activities:
In order to abstain of substance use and gambling disorder in the target areas we will:

 Screen all targeted IDPs for substance use and related gambling disorder

 Assess predisposing, precipitating, perpetuating and protective factors of substance use

 Provide substance withdrawal treatment

 Provide motivational interview and psychotherapy (especially group, family and supportive therapy)

 Work in collaboration with other stakeholders

 Rebuild social network within the IDPs and other concerned individuals and groups.

 Give training for caretakers and volunteers to provide preventive, treatment and rehabilitative care of
substance users.

Output 5: Increase inclusive neurological problem management service for crisis-affected individuals

Activities:

In order to provide inclusive neurological problem treatment service for crisis-affected individuals, we will

 Screen all targeted IDPs for neurological disease especially epilepsy and headache

18
  Assess predisposing, precipitating, perpetuating and protective factors of neurological diseases

 Strength referral system to health facilities

 Give training for caretakers and volunteers to provide preventive, and treatment of neurological diseases.

Output 6: Provide mental health, substance use and neurological health education and promotion programs
targeting the risky groups

Activities:

 We will perform continuous community mobilization, sensitization and mental health education activities.

 Prepare different leaflets and disseminate in the IDPs

 Prepare poster and post in visible area

 Perform advocacy

Output 7: Conduct action research related with mental illness

The generation of knowledge in related with magnitude of different mental illness among individuals in IDPS and
it’s an essential element in strategies to improve mental health promotion and care in the IDP. Staffs of the project
will be conduct different action research to improve upon and strengthen the capacity to establish a sound
knowledge basis for practice in related to mental health and neurological diseases.

Project outcomes
If we conduct the above activities we can find the following results
 Increase awareness on mental health, substance use and related addictive disorders and neurological
diseases cause, presentation and management modalities
 Able to prevent different mental health problems, substance use and related addictive disorders and
neurological diseases
 Strength social network
 Reduce mental illness, substance users and neurological diseases
 Increase mental health seeking behavior and treatment
 Implementation of suggested recommendations from action research
 Request NGOs and other stakeholders for intervention of mental illness

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Input
Project coordinator:

The coordinator will spend time and assist in providing administrative and logistic support to the project. And also
will summon a regular meeting with the project members, key personnel and review the progress of work, check
records and carry out spot verification of the project’s monthly performance. Coordinates the program and make
sure that the project is sustained. The project coordinator submits the report to the concerned body.

Project team members

They will be actively involved in all activities of the project. Involve in the training. Submit progress report to the
project coordinator.

Financial input

The project will be implemented to achieve the objectives and a total of 3,516,198 Ethiopian birr will be needed
for implementations.

Engagement of Stakeholders, Roll and Responsibility

We and consortium partners work closely with all level authorities and enjoys good relationships with
Governmental and non-governmental organizations at all levels. On the coordination of humanitarian activities,
partners will specifically work closely with Health Bureaus, emergency humanitarian coordination Units,
education Bureaus and WASH teams. To facilitate MoUs, joint project visits (supportive supervision) and
evaluations. The nature of our collaboration and coordination with different level authorities involves information
exchange as well coordination of activities and capacity building efforts.

Consortium partners maintain close coordination and efficient communication with clusters and UN agencies in
country including the UN-led Ethiopia Humanitarian Coordination Team (EHCT), Disaster Risk Management
Technical Working Group (DRM-TWG) and are active participants in the Nutrition, WASH, Health, Protection,
Emergency Shelter/NFIs, and Education in Emergencies clusters.

Department of Nursing, Psychiatry unit, AWHSC, and Department of psychology, DBU

 Take permission from concerned government bodies and make partnership agreement with other partners
timely
 Cover all the budget/costs for implementation, monitoring and evaluation as per approved budget

20
 Implement and coordinate the project activities at all level of project cycle in collaboration with relevant
stakeholders
 Recruit proper volunteers
 Manage properly the project implementation, monitoring and evaluation
 participate all cluster meetings at all level
 Link /integrate the project activities with different organization
 Prepare and submit monthly activity and financial report for respective bodies.
Bureau of Health (BoH)
 Facilitate and participate actively in planning, implementation, monitoring, evaluation of the project
 Supervise/follow up and support the progress of the project
 Provide relevant documents; policy, strategies, guidelines,
 Provide technical support at all level of project cycle particularly how to use existing government structure
 Provide timely feedback for the report and monitoring visits
Bureau of Education (BoE)
 Provide technical support
 Support linking projects to the school
 Provide timely feedback for the report and monitoring visits
Bureau of Water & Energy (BoWE)
 Lead and participate WASH need assessment
 Prepare suitable WASH facilities especially for Individuals with disabilities
NGOs

Work in collaboration

Monitoring and Evaluation

This project is designed to prevent and manage mental illness, substance use and related gambling disorders and
neurological diseases and its impacts, raise awareness about its prevention and promote mental health seeing
behaviours. Hence managing the project resources and delivering the promised intervention, and determining the
success, are indispensable management functions for which monitoring and evaluation are necessary tools.

21
Monitoring
Monitoring tools will be used to monitor the progress of the project as an ongoing process. The project
team will be the responsible bodies to monitor the progress of the project. To monitor the ongoing process
of the project the team of the project will have a meeting twice a month to discuss about the different issue.
One responsible body will be assigned at each site who able to report daily to the project team. Depending
on the report the project team will give immediate response to the situation.

Quality Benchmark monitoring (QBM): To monitor the quality of key activities, quality benchmarks
will be used, which will in turn ensure the delivery is in line with agreed technical standards. Findings
drawn from the assessment will have specific action points and an associated timeline for completion to
hold project staff accountable.

The project will organize review meetings to evaluate achievement, document lessons learned, and to
discuss on challenges encountered for future learning. Moreover, the project will build the capacity of
project members to increase their knowledge and skill in monitoring and ensuring the quality of program
implementation.

Monitoring tools will be used to track the implementation of the action’s activities against work plans and
to report against results’ achievements and beneficiary targets.

Monitoring data will be generated through various methods depending on the type of indicators and
period for data collection. For outcome level indicators, these are planned to be generated through surveys
at the beginning and end of the project. The output and process indicators monitoring data will be
generated through various methods including direct observations/visits, project records and checklists.

Evaluation
As it is the case with any evaluation, it will be critical to determine not only the output but also if the
made a difference in practical activities of all the beneficial. For this evaluation, it is important to
determine not only if objectives are met, but how much and how well a combination of approaches will
be used to determine project out comes. The survey will be again conducted at the end of the project
period for the comparison purpose to evaluate the effectiveness of the project.

Reporting and communication

22
The day-to-day project activities implemented by the project will be collected through reporting formats. Based on
the data collected, progress report will be compiled by the project members and submitted to DBU and
government on quarterly basis using monthly reporting format of DBU and government respectively. Similarly,
final/ terminal evaluation reports will be compiled, documented by DBU and disseminated /reported to respective
bodies timely.

Finally it will be used for managerial decision. Moreover, regular financial reports shall be made and shared with
DBU.

As mentioned in the above, the methods/techniques that will be employed for collecting data at the time of
monitoring, and evaluation are observation, survey, interview, and case stories/studies.

SWOT analysis
Opportunity of the project

The project is focused on vulnerable groups which is the top priority agenda of the Ethiopian government

There is different NGOs working on IDPs

Threats

Unpredictable security environment results in further displacements, and operational limitations/ restrictions to
access which may impact programme activities, cause delays and affecting market functionality and ability of
government stakeholders to carry out their respective functions/ duties. Prolonged conflict and displacement
could lead to heightened protection concerns including of SGBV; As a result of movement restrictions and
security situation, the cost of food items may continuously increase.

Crosscutting issues

Child safeguarding: Safeguarding issue is a responsibility of every individuals who participat in IDPs.
Safeguarding operations are overseen by project coordinator.

Safeguarding measures will be prioritized to ensure the safety and protection of children and adults who come into
contact with this project; and will work to prevent risks of harm from deliberate or inadvertent actions and failings
that place them at risk of abuse, sexual exploitation, injury and any other harm.

23
Child participation: Child participation is not only a way of working, but an essential programme principle
within different organization programs. We recognize the child’s right to be heard and the need to invest in
structures, approaches, capabilities and systems to ensure their contribution. In this project, we will facilitate the
safe, ethical and meaningful participation of children across the implementation of the project activities.

Gender and disability: Gender dynamics influence the personal experiences of boys, girls, young men and
women in situation of migration/ return and in conflict settings and related displacements. These groups are
exposed to different types of vulnerability, including boys are more likely to engage in hazardous physical work
and be victims of bullying; whilst girls are usually having poorer access to information, and they are at higher risk
of sexual exploitation and abuse. The project will therefore be critical in ensuring that girls and boys equitably
access, participate in and benefit from the project activities.

Sustainability and Phase out strategy

The approach of this project is to focus more on IDP participation. The sustainability of the project will be the
primary responsibility of all beneficiaries. Since most of the concerns the project addresses pertain to IDPs, it is
expected that the active involvement of the youth, women's, and first aiders themselves will sustain the project.

The project focuses on quality, rapid, and efficient response. The action of the consortium and its members will
allow beneficiaries to limit the use of negative adaptation strategies through quick action. The action will also
increase local knowledge in social support, health-seeking activity, risk of protection, and gender equality, which
will have a positive influence long after the completion of the project. By creating detailed awareness about
mental health and the factors that lead to its disturbance, the project will contribute to the improvement of mental
health.

Advocacy for mental health promotion by emphasizing the prevention, treatment modalities, and rehabilitation, as
well as the cause, psychopathology, and intervention strategies of mental health problems and neurological
diseases, and mainstreaming mental health in different service sectors, will promote mental health and reduce
future risks. Strengthening the existing referral and case management system will promote the sustainability of
public social services to support the wellbeing and resilience of IDPs. We will also collaborate with local and
international organizations and local authorities to build capacities in humanitarian relief and recovery phases to
allow them to continue operating after the project phases out. The selected partners will be provided with training

24
on mental health substance use, related gambling disorders, and neurological diseases. These competencies
contribute to building resilience.

Work schedule/Plan
Table 1. Work schedule of mental health, substance and neurological problems project at north Shewa zone war-
affected areas and IDPs in Debre Berhan, Ethiopia, 2024

S Site
/ U
Activity Tar M A M Sep Oc N De Ja
N ni get Chi Wo
Ba Feb
ar pr ay Jun Jul Aug 202 t ob c n
Description ke 202
t na yin 20 20 20 2024 2024 2024 4 20 20 20 20
lo 4
shet 24 24 24 24 24 24 25

1. 17 13 1
Incentives for
pa 0
volunteers and
rti
health professionals
ci 40
attend the mass
pa
screening
nt

2. Assess cause,
presentation,
diagnose and
treatment
modalities of
mental illness,
All
substance related
cas
and addictive
es
disorders and
neurological
diseases and refer
patients who need
medication and
other investigations

3. Purchase necessary 12 50 3
material (T-shirt, 0 0
banners, leaflets
20
etc) for ensuring the
0
proper
dissemination of P
the messages cs

25
S Site
/ U
Activity Tar M A M Sep Oc N De Ja
N ni get Chi Wo
Ba Feb
ar pr ay Jun Jul Aug 202 t ob c n
Description ke 202
t na yin 20 20 20 2024 2024 2024 4 20 20 20 20
lo 4
shet 24 24 24 24 24 24 25

4. Provide psycho pa
education on rti
Fo
mental health, ci
r
substance and pa
all
neurological nt
problems s

5. Provide counselling
service (individual,
Ba
family and group),
sed
group therapy,
on
family therapy,
the
couple therapy, pa
cas
interpersonal rti
e
therapy, cognitive ci
sta
behavioural therapy pa
tus
and narrative nt
exposure therapy s

6. pa 40 30 3
rti 0
Teaching Recovery
ci 10
Techniques for
pa 0
Ages 8+
nt
s

7. Celebration of 1 1 1
mental health,
abstain of substance
use and free from
epilepsy day with
themes/mottos #e
targeting mental ve
health messages nt 3

8. Conduct biweekly 12 12 1
#
meeting to discuss 2
w
on the challenges, 12
ee
progress of the
k
project

26
S Site
/ U
Activity Tar M A M Sep Oc N De Ja
N ni get Chi Wo
Ba Feb
ar pr ay Jun Jul Aug 202 t ob c n
Description ke 202
t na yin 20 20 20 2024 2024 2024 4 20 20 20 20
lo 4
shet 24 24 24 24 24 24 25

9. P 60 25 1
Provide ar 5
Psychosocial ti
10
Support one day ci
0
training to teachers pa
and parents nt
s

10. Conduct three days 25 20 1

PFA, MHPSS, 5
substance abuse P
and epilepsy ar
training for health ti
extension workers, ci 60
and humanitarian pa
actors especially nt
non-psychiatry s
health
professionals.

11. A 12 99 7
Provide s 60 0 5
Psychological First pe 0
30
Aid (PFA) services r
00
for children and B
their caregivers. O
Q

12. Provide IDPs with L 25 15 1

updated ea 0 0 0
information fl 0
regarding mental et
health, substance s 50
abuse, and epilepsy & 0
survivors and ba
disseminate its n
prevention key ne
messages. r

13. Two days training P 30 12 99 7

for community ar 0 6 5
members such as ti
27
S Site
/ U
Activity Tar M A M Sep Oc N De Ja
N ni get Chi Wo
Ba Feb
ar pr ay Jun Jul Aug 202 t ob c n
Description ke 202
t na yin 20 20 20 2024 2024 2024 4 20 20 20 20
lo 4
shet 24 24 24 24 24 24 25

religious leaders, ci
and community pa
influential persons nt
on MHPSS, s
substance abuse,
epilepsy and basic
child protection
issues including
identification,
reporting and
referral of GBV

14. Provide 10 6 4
communities with
updated
information
#
regarding main
ba
support services for
n 20
CP concerns
ne
including GBV
r
survivors and
disseminate CP and
GBV prevention
key messages.

15. Support with

referral/provision of
A
support for
s Fo
identified mental
pe r
illness and
r all
neurological
B cas
diseases
O es
(transportation
Q
support to access
services)

16. Set up well #s 3 2 1

understood u
mechanisms for g. 6
suggestion and b
compliant o
28
S Site
/ U
Activity Tar M A M Sep Oc N De Ja
N ni get Chi Wo
Ba Feb
ar pr ay Jun Jul Aug 202 t ob c n
Description ke 202
t na yin 20 20 20 2024 2024 2024 4 20 20 20 20
lo 4
shet 24 24 24 24 24 24 25

17. 21 17 1
P 3
Provide training on
ar
mental health and
ti
Psychosocial
ci 50
support (MHPSS)
pa
for health workers
nt
s

18. Fr 1 1 1
eq
Quality Benchmark
ue
Monitoring (QBM) 3
nc
y

19. Joint Supportive Fr 2 2 2

Supervision/on site eq
monitoring/Visit ue
2
with government nc
Partners y

20. R 1 1 1
ev
ie
Review Meeting w
and Learning M
2
Session ee
ti
n
gs

21. Conduct action

research on IDPs

29
Budget plan
The below table depicts the total budget allocated for each physical activity

Table 2 Summary of costs per activity to be used to provide MHPSS services Efrata ena Gidim, Kewot and Tarma
ber Woredas, North Shewa, Amhara, Ethiopia, 2024/25

No Activities Place Number of Number of Numb

profession days for er of
als the Traine
activity e
1 Assessment: MHPSS service mapping, rapid woredas 5 10
MHPSS needs and resources assessment in North
Showa, Amhara region.
2 Establishment of PSS mobile teams Three Woredas
3 Lay counseling services Three Woredas 5 90
4 Provision of specialized psychotherapy Three Woredas
5 Training on MHPSS for volunteers, community key Three Woredas 5 15 750
person, health extension workers, health
professionals, religious leaders and key
administrative bodies
6 Training of PSS mobile teams Three Woredas 5 10 30
7 Establishment of MHPSS resource center Shewarobit
8 Training on psychological first aid and Para Three Woredas 5 15 180
counseling
9 Awareness campaigns, key messaging: in order to Three Woredas 5 25
raise awareness on MHPSS services available and
how to access them.
Grand Total

30
Table 3 Summary of Costs expected to be used provide the services Efrata ena Gidim, Kewot and Tarma ber
Woredas, North Shewa, Amhara, Ethiopia, 2024/25

S/N Description of Activities Total cost/ETB

1. Professional Fee for trainers 240,000

2. Trainees’ meal and lodging allowance 380,000

3. Transport allowance (round trip) 130,000

5 Stationary cost (Small Spiral Note Book , Ball Point Pen, Flip 140,000
Charts, Markers of Different Colours, Vinyl Tapes, Record Books)

6 Professional fee for seminar presenters 60,000

7 Refreshment cost 180,000

8 Professional fee for Developing/ Adapting training manuals 250,000

Facilitators’ perdiem 60,200

9 Professional fee for Technical backstopping for the school-based 120,00

training for counsellors, nurses, medical doctors

10 Lump cost for project coordinator/ focal persons (3) 290,000

Sub total 1,850,200

Contingency (5%) 92,510

Grand total 1,942,710

31
Table 4 Budget plan of mental health, substance and neurological problems project at IDPs of Debre Berhan,
Ethiopia, 2024/25

S/ Number
N of Number Per
Activity of day dim/day
Total
participa
nts

1. Incentives for volunteers and health professionals attend 3 500 60,000

40
the mass screening
2. Assess cause, presentation, diagnose and treatment 80 500 200,000
modalities of mental illness, substance related and
addictive disorders and neurological diseases and refer
patients who need medication and other investigations 5

3. Purchase necessary material (50 T-shirt, 3 banners, 147 -

leaflets etc) for ensuring the proper dissemination of the
messages Pcs

4. Provide psycho education on mental health, substance 1 500 2500

and neurological problems 5

5. Provide counselling service (individual, family and 25 500 62,500

group), group therapy, family therapy, couple therapy,
interpersonal therapy, cognitive behavioural therapy and
narrative exposure therapy 5

6. Teaching Recovery Techniques for Ages 8+ 5 8 500 20,000

7. Celebration of mental health, abstain of substance use 1 500 2,500

and free from epilepsy day with themes/mottos targeting
mental health messages 5

8. Conduct biweekly meeting to discuss on the challenges, 12 300 18,000

5
progress of the project

9. Provide Psychosocial Support one day training to 1 500 52,000

104
teachers and parents

10. 3 500 96,000

Conduct three days PFA, MHPSS, substance abuse and
epilepsy training for health extension workers, and
64
humanitarian actors especially non-psychiatry health
professionals.

11. Provide Psychological First Aid (PFA) services for 100 - -

5
children and their caregivers.

32
S/ Number
N of Number Per
Activity of day dim/day
Total
participa
nts

12. Provide IDPs with updated information regarding mental

health, substance abuse, and epilepsy survivors and -
disseminate its prevention key messages.

13. Two days training for community members such as 2 500 305,000
religious leaders, and community influential persons on
MHPSS, substance abuse, epilepsy and basic child 305
protection issues including identification, reporting and
referral of GBV

14. Provide communities with updated information regarding - - -

main support services for CP concerns including GBV
-
survivors and disseminate CP and GBV prevention key
messages.

15. Support with referral/provision of support for identified 40 40,000

mental illness and neurological diseases (transportation 1000
support to access services)

16. Set up well understood mechanisms for suggestion and

-
compliant

17. Quality Benchmark Monitoring (QBM) 5 1 - -

18. Joint Supportive Supervision/on site monitoring/Visit - 2 - -

with government Partners

19. Review Meeting and Learning Session 5 2 - -

20. Conduct action research on IDPs 5 6 500 15,000

Total 873,500

33
Table 5 Budget breakdown for stationary of the project Debre Berhan, Ethiopia, 2024/25

Budgets for stationary

Ser.no Materials Unit price Quantity Total price
1 Pen 30 670 20100
3 Flip chart 300 10 3000
4 Marker 360 5 1800
5 Note book 70 670 46900
6 Printing of leaflet 10 700 7000
Sub tot 78,800

Table 6 Budget break down for equipment of the project Debre Berhan, Ethiopia 2024/25

Ser.no Equipment Unit price Quantity Total price

1 T-shirt 400 50 20000

2 Banner 300 6 1800

3 Plaster 250 2 500

Sub total 22,300

Table 7 budget breakdown for food and tea break of the project Debre Berhan, Ethiopia 2024/25

Training/therapy Costs for Food and tea break

PSS Item Number Cost/person Duration of Total
of person in birr training birr
Tea break before launch 105 200 1 21000
Tea break after launch 105 100 1 10,500
PFA & MHPSS Tea break before launch 65 200 3 39000
for humanitarian Tea break after launch 65 100 3 19500
actors
MHPSS, Tea break before launch 305 200 2 122,000
substance & Tea break after launch 305 100 2 61,000
epilepsy
Group therapy Refresher 202 50 20 202,000
Teaching Refresher 102 60 8 48,960
Recovery
Techniques
Sub Total 523,960
34
Table 8 Grand total budget plan of mental health, substance and neurological problems project at IDPs of Debre
Berhan, Ethiopia, 2024/25

S/N Type of cost Total birr

1 Personal 873,500
2 Stationary 78,800
3 Equipment 22,300
4 Refreshment 523,960
Sub-total 1,498,560
Contingency (5%) 74,928
Grand total 1573488

Grand total budget for the Project 1,942,710 +

1,573,488=3,516,198

35
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14. Keyes EF. Mental health status in refugees: an integrative review of current research. Issues in mental
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37
Annex:-Screening tools for different mental illnesses and substance use
PTSD Checklist
This part contains questions related to emotional changes after peoples face hard and traumaticevents. Choose the best
alternative that describes your situation.

S.No Questions Yes No

1 Do you have repeated, disturbing,and unwanted memories of the stressful
experience?
2 Do you have repeated, and disturbing dreams of the stressful experience?
3 Do you suddenly feel or acting as if the stressful experience were actually
happening again (as if you were actually back there reliving it)?
4 Do you feel very upset when something reminded you of thestressful
experience?
5 Do you have a strong physical reactions when something reminded you of the
stressful experience (for example, heart pounding, trouble breathing, sweating)?

6 Do you avoid memories, thoughts, or feelings related to thestressful

experience?
7 Do you avoid external reminders of the stressful experience (for example, people,
places, conversations, activities, objects, or situations)?
8 Do you have trouble remembering important parts ofthe stressful
experience?
9 Do you have strong negative beliefs about yourself, other people, or the world (for
example, having thoughts such as: I am bad, there is something seriously
wrong with me, no one can be trusted, and the world is completely dangerous)?
10 Do you blame yourself or someone else for the stressful experience or what
happened after it?
11 Do you have a strong negativefeelings such as fear, horror, anger, guilt, or
shame?
12 Do you have Loss of interest in activities that you used to enjoy?
13 Do you feel distant or cut off from other people?
14 Do you have trouble experiencing positive feelings (for example, being unable to
feel happiness or have loving feelings for people close to you)?

38
 15 Do you have irritable behaviour, angry outbursts, or acting
aggressively?
16 Do you take too many risks ordoing things that could cause you harm?
17 Are you “super alert” or watchful or on guard?
18 Do you feel jumpy or easily startled?
19 Do you have difficulty concentrating?
20 Do you have troubling falling or staying asleep?

HSCL-25 Hopkins Symptom Checklist for depression

Choose the best answer for how you felt over the past week

Questions Yes No
1 Do you feel low in energy?
2 Do you blame yourself for things?
3 Do you cry easily?
4 Do you loss sexual interest or pleasure?
5 Do you have Poor appetite?
6 Do you encounter difficulty falling asleep, staying asleep??
7 Do you feel hopeless about the future?
8 Do you Feel blue?
9 Do you feel lonely?
10 Do you Think of ending one’s life?
11 Do you Feel trapped or caught?
12 Do you worry too much about things?
13 Do you feel no interest in things?
14 Do you feel that everything is an effort?
15 Feeling of Worthless?

Substance use screening tools

I will ask you a few questions about your experience of using alcohol, tobacco, and Khat
substances throughout your life and over the past three months. It is important that you try to
answer each question as honestly and accurately as possible.

In your life, have you ever tried the following listed substances? Please circle a response for each
substance

39
A. Alcoholic beverages (beer, wine, etc.) 1. Yes 2. No
B. Tobacco products (cigarettes) 1. Yes 2. No
C. Khat 1. Yes 2. No

40
1