Consultancy For Carrying Out A Situation Analysis On Mental Health And Psychosocial Support In The Hodh El Chargui Region At Land of men

1. Presentation of Terre des hommes – Lausanne

Terre des hommes – Lausanne is an independent, neutral and impartial Swiss organization, founded in 1960, dedicated to bringing about meaningful and lasting change in the lives of children and young people, particularly those most at risk [ 1] . We ensure their well-being and the effective implementation of their rights as defined in the Convention on the Rights of the Child and other human rights instruments. To make a difference, we focus our efforts on maternal and child health, children and young people in migration situations, and access to justice.

Tdh-L operates in 32 different countries around the world, in humanitarian and development contexts. In its interventions, Tdh-L promotes an approach based on human rights, as well as general progress in quality and responsibility by ensuring meaningful access to services for all, in safety and dignity. Tdh-L has adopted the Core Humanitarian Standard as its quality and accountability framework, which is fully integrated with widely recognized industry standards, including the Sphere Handbook, the Minimum Standards for the Protection of Children in Humanitarian Action and the Accountability Principles towards the affected populations of the IASC.

Tdh-L’s work is structured around the following principles [2] :

• Act in the best interests of the child;
• Promote the participation and empowerment of children, young people, their families and communities;
• Work in partnership to strengthen local capacities, dynamics and systems;
• Act for humanitarian interest, development and peace;
• Promote constant improvement, collaboration and learning;
• Be transparent and accountable to beneficiaries, partners, donors and ourselves.

Tdh-L has been present in Mauritania since 1984, and operates in three main areas:

• Access to justice for children and young people in contact with the law.
• Supporting migrant and refugee children and young people to improve their living conditions.
• Strengthening child protection systems.

As such, Tdh-L benefits from broad recognition and credibility with state authorities (Ministry of Social Action for Children and the Family, Ministry of Justice, Directorate of Judicial Protection of Children, …) and also donors, notably the European Union, the French Development Agency (AFD), UNICEF, the Spanish Agency for International Development Cooperation, Monegasque Cooperation, and the Andalusian Agency for International Cooperation for Development (AACID).

Tdh-L intervenes in nine regions of Mauritania, including Hodh El Chargui, through support to the Ministry of Justice for the application of justice for all and the coordination of customary and formal justice, thanks to funding of AFD for the period 2022-2026. As part of a larger project, which will be carried out in Consortium with other INGOs, Tdh-L is preparing to start activities on strengthening the child protection system in this region. Mental health will also be a strategic area of ​​intervention aimed at meeting the needs for mental support and mental accompaniment of host and refugee communities.

These terms of reference serve to describe the objectives, duration and mandate of the consultants in charge of piloting this study, the results of which will serve as a basis for building the intervention strategy in the field of MHPSS in the Hod El region. Charghi.

1. Context and rationale

Mauritania and its people in Hodh Chargui have welcomed Malian refugees fleeing violence in their country for years. As of February 2024, UNHCR estimated that more than 187,000 refugees are currently in Hodh Chargui, representing 20% ​​of the total population in the region. UNHCR and other partners are trying to respond quickly and effectively to emerging challenges, ensuring that displaced people have access to shelter, food, water and essential protection services, such as psychosocial support.

In Hodh El Chargui, as of January 31, 2024, the number of new arrivals from Mali was estimated at 71,301 refugees outside the camp, including 14,410 new arrivals for the month of January 2024 alone. This massive influx creates strong pressure on the natural resources and basic services already fragile in the few localities where they are available. The majority of actors and services are concentrated in the commune of Bassikounou, at the Mbera refugee reception camp. With the exception of certain one-off interventions, there are few services provided in other municipalities that accommodate these populations. The actors (NGOs, United Nations agencies, local authorities) seem to be in a phase of analyzing needs and planning the first responses outside the camps. The registration campaign for new arrivals established outside the Mberra camp will probably begin before the end of the first half of the year.

In the Hodh El Chargui region, Psychosocial Support and Mental Health are not systematically taken into consideration in the majority of interventions. Institutional and humanitarian actors have very little information and data on the psychosocial needs of affected communities, because the theme is not often included in community needs assessments. However, all stakeholders are unanimous on the fact that access to psychosocial support services is an absolute necessity and one of the priorities for communities.

Indeed, during all the evaluations carried out by actors from different sectors, new arrivals shared their difficulties in overcoming the events they experienced, in coping with their new living conditions and in finding a feeling of peace and serenity. This has a strong impact on their well-being and manifests itself mainly through social isolation, sleep-related disorders (nightmares, insomnia), anxiety, psychosis, feelings of insecurity linked to events experienced and intense stress linked to to the lack of resources and opportunities. These signs fade in the weeks following their arrival, in particular thanks to the welcome of the host communities, but a significant proportion of men, women, young people and children need specific support.

If refugees in the camp have access to a continuum of psychosocial services ranging from access to basic services adapted and respectful of their dignity to individualized psychological/psychiatric care, new arrivals established outside the camp do not have access to these services. Furthermore, in the area concerned, there is a dissociation between Mental Health support services, provided by actors involved in the health sector, and psychosocial support [3] , generally managed by protection actors. Collaboration between the two sectors is limited.

This study is part of the desire of the French Development Agency and Terre des hommes – Lausanne to support the Ministry of Health in its efforts to improve the integration of mental health and psychosocial support in the Hod El Charghi region, in complementarity with other players operating in the sector in this same area. It aims to assess the mental health state of recently arrived displaced Malians as well as the psychosocial support needs of the vulnerable population in the region.

1. Objectives and fields of application

Scope of situation analysis

The scope of the analysis is the Hodh El Chargui Region (Mauritania), notably the urban centers and villages welcoming new arrivals (around 100 villages), equivalent to a population of around 187,000 refugees outside the camp as of 31 January 2024, including 14,410 new arrivals for the month of January 2024 alone. The number of refugees represents 20% of the host population of approximately 37,400 individuals in the wilaya of Hodh El Chargui.

Displaced populations in Mali have fled due to attacks by armed groups. They have suffered or witnessed multiple acts of violence such as killings, rape, abuse, etc.

• The refugees were moved with a large number of livestock into villages to which the population had very limited access. The needs in terms of shelter, food, water and health care as well as the challenges in terms of integration and protection reinforce their vulnerability. An analysis of the MHPSS of newly displaced people from Mali would be crucial given the trauma they have suffered. Forced displacement, violence and loss of family ties can have significant impacts on their psychological well-being.
• This study will make it possible to know the approaches developed by the communities for psychosocial support, so that the project strategy can be developed on the basis of what exists. An in-depth analysis could also examine the responses of the authorities and PTF for long-term prospects for these displaced people.

Main objective

The general objective of the consultancy is to deepen the understanding of the context and needs relating to the mental health and psychosocial needs of refugee, returnee and host populations in the Hodh El Chargui region. Concretely this will involve:

• Assess the prevalence of common mental disorders among displaced populations;
• Identify risk factors, social determinants and mental health of displaced people;
• Evaluate the accessibility and effectiveness of existing psychosocial support services at the institutional or community level;
• Formulate recommendations to improve the humanitarian response in terms of mental health and psychosocial support;
• Develop an action plan based on the recommendations which will serve as a basis for the formulation of a project on MHPSS in the Hodh El Chargui region.

Proposed specific objectives and study questions:

Specifically, the objectives envisaged for this consultancy will be:

1. Understand the context in terms of mental health and psychosocial support in Mauritania:

• Is there a policy in the field of mental health and psychosocial support in Mauritania?
• What are the prospects at the national level in terms of mental health and psychosocial support?
• What is its variation at the wilaya and moughataa level?

1. Analysis of socio-cultural perception at the community level. This will involve identifying and analyzing:

• What are the cultural conceptions and characteristics of psychosocial distress and mental disorders for the community? How does the community view psychosocial distress and mental illness?
• How do refugee, returnee and host communities define, identify and treat people with mental or psychosocial disorders?
  • What are the signs of cultural manifestations of well-being, psychosocial distress or mental disorders?
  • What cultural/traditional care have been put in place by communities to help these people?
  • What are the adaptation mechanisms to manifestations of psychosocial distress and individual and collective mental disorders before/following displacement?

1. Identify the actors and services contributing to the prevention/response to cases of psychosocial distress and assess their technical and operational capacities to provide quality services. This will involve:

Analyze the functioning of actors in the formal mental health and psychosocial support system in the HeC region across the entire scale of the health pyramid, starting with Community Health Workers;

• List the available MHPSS activities/services as well as the gaps in terms of response (on levels 1 to 4 of the IASC pyramid);
• List the non-formal actors playing a role in the care of people suffering from psychosocial distress and mental illness;
• Identify formal/informal referencing mechanisms and analyze their limits;
• Identify barriers to access to services for host, displaced and returnee populations;
• Identify and analyze the capacities and skills of front-line actors (health, education, security, etc.) and community actors in terms of prevention, guidance and provision of psychological first aid as well as the limits in terms of skills

1. An accurate assessment of the mental health and psychosocial support needs and resources of the host community and refugees/returnees. This will involve identifying and analyzing in particular:

• What situations do people who have suffered trauma experience? And their families? What are their recourses? Deduce the differentiated needs of communities in terms of mental health and psychosocial support, particularly those of children, young people and ethnic minorities where applicable.
• What are the stress factors and specific needs of children and young people on the move (refugees, returnees) and their families before and during their migratory journey and during their settlement?
• Which groups are most affected or at risk of psychosocial distress and mental disorders?
• What are the community and family support systems for host and refugee populations to preserve their mental health and psychosocial well-being?
• What are the means that facilitate access to formal and non-formal mental health services and psychosocial support (ie information, referral, etc.)? What are the obstacles ?
• What are the needs of host and refugee populations regarding the types of support/services needed?

1. Formulate recommendations for the benefit of sponsors and other stakeholders with a view to strengthening/improving the MHPSS service offering in Hodh El Chargui.
2. Methodology and technical approach

The consultation will be conducted following a six-step approach:

Steps

Launch of the consultancy after validation of the proposed methodology and the work plan by the Steering Committee (in particular in order to confirm the study questions selected).

• Secondary data review – conduct a literature review of existing information regarding MHPSS for people of all ages and genders (e.g. national system for MHPSS, policies and plans, country context, affected population, previous assessments and published reports ).

Understanding the Tdh-L SMSPS framework and the Mauritanian context.

• Quantitative survey of a representative sample of displaced people and host communities
• Qualitative interviews with displaced people, host communities, aid workers, government and community officials to understand challenges and gaps in available responses
• Data analysis and writing of a report including specific recommendations
• Recruitment and training of staff and investigators in charge of collecting data in the field, leading workshops and focus groups on ethical principles, the basic skills necessary for this type of activity and on the tools of collection.

Supports the translation of tools into Arabic and local languages.

• Manage the collection of primary data in the field in conjunction with the Tdh-L team and the investigators under the supervision of the Steering Committee.
• Workshop to analyze the data collected with the Steering Committee and local stakeholders.
• Development of specific recommendations adapted to the context.
• Writing of the 1st draft report and inputs from the Steering Committee as well as local stakeholders.

Governance

The consultant will work under the direct supervision of the “Children and Youth on Mobility” Coordinator.

A Steering Committee will be set up to monitor the process, align with the strategic reference documents, read the deliverables and monitor the quality of the deliverables. This committee will be composed of:

• Tdh-L team Mauritania :
  • Coordinator of the Tdh-L “Children and Young People on Mobility” Program
  • National Protection Coordinator of Tdh-L.
• Tdh-L regional team :
  • Regional Transversal Protection Advisor
  • Regional Advisor for the “Children and Youth on Mobility” Program
  • Technical Advisor Monitoring, Evaluation, Accountability and Learning.
• AFD:
  • Mental Health Referent at AFD headquarters;
  • Project manager of the AFD Agency in Nouakchott.
• EU:
  • Mental Health Manager Tawefoug Project
• WHO:
  • Non-communicable diseases focal point.
• State:
• MHPSS Focal Point within the Ministry of Health
• Director of Children or his representative

The team of consultants will be supported by the Tdh-L logistics department in Mauritania for the organization of workshops, ticket reservations or any other activity requiring their services.

1. Duration and deliverables:

The consultancy will be carried out over a maximum of 40 days, spread over a maximum period of 3 months from the signing of the contract.

The expected deliverables of the mission are as follows:

1. A scoping report including: the documentary review, the methodology and collection tools used, the analysis plan and the work plan.

2. A map of existing services and actors present in the HeC region on MHPSS.

3. A situation analysis report containing:

– An executive summary not exceeding 5 pages containing the main conclusions of the evaluation as well as the recommendations;

– An in-depth presentation of the context including the needs identified in terms of MHPSS and the capacities of the actors;

– An analytical section that provides results and conclusions regarding the research questions ;

– A section of operational recommendations with a view to strengthening and improving the offer of MHPSS services in Houd El Chargui (in accordance with section II of these Terms of Reference), which will serve as a basis for defining the MHPSS strategy and implementing implementing activities in the Hod El Charghi region.

4. A PPT presentation with the main results of the consultancy.

1. Recipients and uses of analysis results:

• Tdh-L Delegation of Mauritania: Inform the development of intervention implementation strategies and inform the MHPSS project which will be formulated based on the results of this study.
• Donor and Ministries of Health/MASEF: Have tangible elements to validate their positions and intervention strategies.
• Humanitarian actors: Inform actors about the needs and the MHPSS context in order to encourage broader consideration of issues related to MHPSS, improve coordination and strengthen the response service offering.

Communities: Have recommendations to improve prevention/response at the community level.

1. Profiles sought

• The consultant (or team of consultants) sought to carry out this mission must have a higher degree (minimum BAC + 5) in psychology, psychiatry or any other related fields such as health or human sciences.
• Have at least 5 years of experience in the field of Psychosocial Support and Mental Health, preferably in North and/or West Africa.
• Proven experience in carrying out studies on the subject, with at least three similar exercises/mandates.
• Familiarity with the Minimum Child Protection Standards, MHPSS IASC framework, gender and diversity issues and intersectorality.
• Demonstrate proven experience in the development of research/study/situation analysis tools, evaluation methods adapted to children and young people and in the context of development/humanitarian projects.
• Excellent communication skills in French (oral, written). Good capacity for synthesis, analytical mind.
• Ability to produce analytical summaries accessible to diverse audiences.
• Perfect command of IT tools.
• Experience in facilitating workshops and joint work, with varied audiences.
• Experience in organizing training and popularizing technical/complex themes.
• Planning, organizational and management skills and proactive attitude, ability to manage potentially conflicting situations.
• Impeccable ethics, particularly on the principles of confidentiality, data protection, impartiality.

Knowledge of the Mauritanian and Malian context is a real asset.