Photo Credit: Alexandre Bonneau-Afroto/ALIMA

Integrating Mental Health into Maternal Care in Nepal

Perinatal depression (depression around the time of childbirth) affects up to 33% of women in Nepal. This condition can have severe consequences for both mother and baby: it is linked to poor maternal health, increased risk of suicide, low birth weights, and developmental problems in infants.
Despite its prevalence, treatment options in Nepal are extremely limited. The World Health Organization has recommended models for maternal mental health care, but these often require specialists or clinics that are out of reach for most communities. In practice, many Nepali women in rural areas never receive any mental health support during or after pregnancy.
The lack of mental health integration means that when community health workers or nurses visit new mothers, they focus only on physical health (like checking the baby’s weight or giving vaccinations). Signs of depression or anxiety often go unnoticed and unaddressed. This gap leaves thousands of mothers suffering in silence and can also impact their ability to care for their newborns.

Community Health Workers (CHWs) as a Solution: This project will integrate mental health services into routine perinatal care by training community health workers to provide basic mental health support to pregnant women and new mothers. An NGO called Possible Health has an established network of full-time, salaried CHWs in Nepal who have served over 33,000 households.
With our support, these workers will be trained to screen women for depression during prenatal and postnatal visits, offer counseling and problem-solving therapy, and refer severe cases to professionals. Essentially, the mental health of the mother will be addressed alongside physical health check-ups, rather than being treated as a separate, specialized service. (This initiative builds on a prior WAM Foundation grant, which laid the groundwork by expanding CHW services in these communities.)

Integration into National System: A key aspect of this effort is working hand-in-hand with Nepal’s government. The program is designed to plug into Nepal’s existing Community Health Program, which the government is already piloting in some districts. By aligning with national priorities and showing results, the project creates a clear path for the government to scale it up countrywide. The training curriculum, digital tools for tracking patients, and supervision methods are all being documented so they can be adopted as official policy if successful.
Evidence of Effectiveness: The approach of using lay health workers for mental health has been tested elsewhere and shows promise. In fact, even before adding the mental health component, Nepal’s community health worker model (implemented by Possible Health) had improved key outcomes like postpartum care access and influenced policy decisions. By demonstrating that CHWs can effectively deliver depression care (e.g., showing improvements in mothers’ mood, functionality, or infant health), the project will provide evidence that mental health support can be scaled in low-resource settings without requiring a large number of expensive specialists.

Low Ongoing Cost: This community-based model is very cost-efficient. It operates at an annual cost of about $3.05 per person in the covered population, primarily covering the salaries of the health workers. Because it uses existing personnel and infrastructure (rather than creating new clinics), expanding the service to more regions won’t significantly increase costs per capita. In other words, once CHWs are trained for mental health, they can serve many additional mothers with minimal extra funding.
Maximizing Resources: By integrating mental health into routine care rather than running a parallel mental health program, the project makes the most of every health worker’s visit. The nurse or CHW who is already seeing a mother for a check-up can also address her psychological well-being in the same visit. This maximizes impact without duplicate efforts. It’s a practical example of achieving more with the same resources.

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