Heal by hair - Mental health hairdressers ambassadors

Mental health problems account for 14% of the global burden of disease; 75% of this burden is in low- and middle-income countries. In Africa, mental health is a taboo that affects 110 million people - 60% of them are women under 25 who suffer from depression and anxiety. Of these 66 million young women, 85% do not have access to treatment. An alarming situation, aggravated by the low funding rate for Mental health: less than a dollar a year inhabitant, according to the WHO. Besides, the majority of African countries have on average one psychiatrist for 500,000 inhabitants, instead of one for 5,000 people in accordance with WHO recommendations. For example, Côte d'Ivoire has about fifty therapists for more than 25 million inhabitants. In Togo, the ratio is 1:1,600 000 i.e. 5 therapists for 8 million inhabitants. In Cameroon, has 10 therapists for 26 million of inhabitants, i.e. one therapist for every 2 600,000 inhabitants5.

The World Bank considers it to be the "single biggest thief of productive economic life", costing the economy around $5 billion a year.

Objects of fears, fantasies and clichés, mental health disorders arouse rejection and lead to stigmatization. Stigmatized, mental illnesses are also neglected. Only one in five African countries has a mental health policy and everywhere, the budgets dedicated to mental health are insignificant. Indeed, most low- and middle-income countries devote less than 1% of their health budget to the treatment of mental disorders. If the Covid19 pandemic has allowed us to become more aware of the importance of mental health as a major individual and collective issue, no African country has made mental health a national cause and none raises awareness on a large scale. scale on the "evil of the century". Meanwhile, more than 700,000 people die by suicide each year - with suicide being the fourth leading cause of death among 15-29 year olds.

Experience from past pandemics has shown that once the physical health hazards subside, the mental health effects persist. In this context, innovation is not an option, but an imperative necessity.

Research shows that poor mental health limits:

• Health

• Education

• Livelihoods

• Building positive relationships and communities

Indeed, an African woman suffering from depression is less productive, her income is lower, her physical health is poorer and she may become the target of criticism or even social exclusion. If she is a mother, the negative impact extends to her children and her entire family. Research shows that children of depressed mothers are more likely to be in poor health, to miss school or have academic difficulties, and to suffer from depression themselves.

For an African woman, being accompanied and cured of depression means (re) becoming more economically productive, allowing the community to prosper, improving the life and educational and socio-emotional follow-up of her children. Furthermore, improving the mental health and well-being of African women will better position the global community to achieve the Sustainable Development Goals.

Heal by Hair is a short and innovative training of three (3)
days, which includes the basic principles active listening and mental health; including recommendations Programme of Action Scientists Addressing mental health gaps of the World Health Organization ((mhGAP-GI-WHO-2010). The mhGAPGI is used in more than 90 countries.

Anxious to base our action on Cultural and social realities specific to the African context, the Heal by programme Hair offers an innovative approach in mental health, consisting of mobilizing a network of hairdressing professionals.

Like first-party training somatic rescue, Heal training by Hair, will allow hairdressers Mental Health Ambassadors for Become the first link in the chain of care and not of professionals of health. 

By learning to recognize the first signs of mental disorders, or
worsening of a pre-existing condition, they will be able to listen Active and caring, they will be equipped to adopt a behaviour and adapted language. And above all, they will be able to accompany and refer their suffering clients to therapists.

The mental state of the person is often denied in Africa - because stigmatized -, or hidden in a restricted circle, or it is entrusted to the leaders of monotheistic and/or esoteric cults. Often for the worse. There is a lack of information and treatment offers on mental health and the stigma kills.

Due to social and cultural assignments, African women, regardless of their social status and age, regularly see a hairdresser for services whose duration allows exchanges and confidences. With Heal by Hair we are going to find women where they already are and where they will not be victims of any negative prejudice to talk about mental health disorders: the hairdressing salon.

By 2035, the training of 1000 hairdressers could lead to raising awareness and support up to 5 million women in 20 cities. These are as many children, families and communities sensitized.

According to the World Health Organization (WHO), 110 million people, including 60% of women suffer from disorders mental health on the Continent. 66 million women suffer today of mental health disorders in Africa. 66 million people who need our help. The women we aim at addressing through our Program are in the vast majority self taught hairdressers, owners of their saloon, mother and wifes.

Heal by Hair training will allow mental health ambassadors to become the first link in the chain of care and not health professionals. By learning to recognize the first signs of mental disorders, or the aggravation of a pre-existing disorder, they will be able to show active and benevolent listening, they will be equipped to adopt appropriate behavior and language; and, above all, they will be able to refer their suffering clients to therapists.

Thanks to the program, the Heal by Hair mental health ambassadors can be stimulated regarding the mental health issues, they are equipped and sensitize to break stigma and silence. By making serious mental health information available and accessible- adapted to the local context, it is also about giving women back their "power to act" over their mental health and their ability to exercise choices and transform their lives and those of their communities.

Therefore, by the end of the training, the women are aware of the fact that "Mental health is Health" and that starts with their selves and then goes on to their surroundings.

Heal by Hair also aims at training and increasing the creation of socio-economic value of these hairdressing entrepreneurs.

As part of the impact study of the Heal by Hair program, the

Bluemind investigators Foundation went to the meeting different hairdressers in order to have a better understanding of their realities, and be able to help them better in their role as ambassadors in Mental Health. This process allowed the identification of a set of brakes, but also the identification of needs to be able to contribute to cover so that the ambassador hairdressers can be able to practice in better terms.

The main needs identified are related to the low financial means of which they have and the health of their household (83% participants are not insured, and have very little concept of operation of insurance. They do care for their home at their own expense.); and the main development objective of their activity. The hairdressers interviewed are unanimous as to their needs in financial means to develop their projects. In fact, achieve their goals professionals represents the main concerns of hairdressers. The social incentives we provide to ambassadors are : Health insurance, Accident insurance, Micro credit, Beauty products, Visibility, Vocational training.

This project was born from Marie-Alix De Putter's personal experience of depression, post-traumatic stress disorder and anxiety after the assassination of her husband in Cameroon when she was pregnant with 4 months. She is the Founder and President of the Bluemind Foundation.

She is indeed very sensitive to mental health issues, their impact on daily life and wishes through this social innovation to provide young girls and women with mechanisms enabling them to deal with them.

After the hairdressers have been certified as mental health ambassadors, a monthly follow-up is carried out with them by psychiatrists, which allows feedback from the field to be used to better identify the expectations of these women in terms of relates to this innovation.  

Moreover, we have a strong organization consisting of a leadership team (15 members) and a governance committee consisting of a Scientific committee(4 members), an Audit Committee (3 members), a Stakeholder Committee (6 members) and a Board of Directors (5 members).

Our scientific council is composed of psychiatrists who are responsible for writing the curriculum of the Heal by Hair trainings.

Research and solid data from the field guide our actions and honor the communities where we work. Thus, we went to the field and interviewed 714 women and 148 hairdressers in seven (7) countries (including Togo, Cameroon and Côte d'Ivoire) and in the diaspora (France). Women's plural voices were synthesized in our "Cross-Study Report between African Women and their Hairdressers" published in November 2021.

As part of the impact study of the Heal by Hair program, the Bluemind Foundation's investigators went to meet the different hairdressers in order to have a better understanding of their realities, and to be able to best help them in their role as mental health ambassadors.

This approach has made it possible to identify a set of obstacles, but also to identify needs that must be able to help cover so that hairdressing ambassadors can be able to practice in better conditions.

Bluemind foundation working above all for the well-being of women in Africa, it was important to have a diversified response which explains the presence of our teams everywhere in Africa (Togo, Cameroon, Ivory Coast ...) and in Europe (diaspora) with a team of volunteers and institutional partners including in each countries, such as Dalberg, the Development Innovation Fund (FID in France, attached to Agence Française pour le Développement - AFD), the PNSM (National Mental Health Program) in Ivory Coast.

Thanks to the Heal by Hair program, ambassador hairdressers now have:

- Tools and techniques for active listening and first aid psychological

- Confidence in their interactions with people living with a Mental Health

- Tools to establish a better relationship of trust with their clients and the possibility of supporting them and directing them to therapists

- Media exposure

- The strength of a network of hairdressing professionals

- A social incentive package

Below the main figures of the inaugural session that was held in Abidjan (Côte d'Ivoire) in April 2022 : 

- 250 applications received in 7 days

- 22 hairdressers certified as ambassadors mental health Heal by Hair

- 14 partners including Dalberg, CNPS (National Provident Fund Social) and the PNSM (Programme National Mental Health)

- 100% customer satisfaction participants

- 8,000 women sensitized in the course of the year (2022-2023) thanks to our ambassadors Regular participation of hairdressers ambassadors trained for six months at monthly follow-up meetings and assessment.

Below the main figures of the inaugural session that was held in Abidjan (Côte d'Ivoire) in January 2023 : 

- 989 applications received in 7 days

- 73 hairdressers certified as ambassadors mental health Heal by Hair

A hairdresser has the ability to sensitize an average of 360 women in per year. Following the two editions in Abidjan, 95 ambassadors were certified who will sensitize not less than 35 200 women in the coming year, to be added to the 8 000 women already sensitized the first year.

The 3rd edition was held in Douala from April 24 to 26, 2023 with the training of 16 hairdressers who are now Heal by Hair ambassadors. A fourth edition that will take place in Lomé from 16 to 19 July 2023 with the objective of training 80 mental health ambassadors. 

Besides from raising funds that will certainly help us accelerate the growth of the program, our goal while applying to Solve is also to be able to overcome a few challenges :

- Monitoring and Impact evaluation is a key in our activities. Therefore, we will need to have the proper information, partners, that could help us be more specific regarding our studies. We already have an adavanced Research Departement, with mental health reseachers that work with and within the Bluemind Foundation step by step. However, any partners that could give us some keys is welcome.

- Technology is another challenge we face, because we intend to scale up as much as possible and to extend the Program to more countries to have a greater impact. However, we are currently facing the lack of a stable internet accessibility of african population and african women. Therefore, we are trying to find what solutions could be developed to reach out to more women, through technology.

- Regarding the institutions in african countries, we indeed face some cultural barriers, but the fact that our program aims at improving mental health perception and treatment and a larger scale, we tend to have a positive attention from the authorities. However, we need to have a greater visibility and a high level management that can deal with the institutions.

Finally, we are looking for endorsement and support of the project, for a greater visibility and impact, in Africa and worldwide.

The three-day training given through the program aims to enable hair-dressers to observe and recognize the first manifestations of mental health problems
in their customers, and if needed, be able to orient them towards mental health professionals. The rationale of the project lies in the fact that hair-dressers spend
a lot of time with their customers, who often share stories from their personal lives.
A non-representative survey run by the Bluemind foundation (Bluemind Foundation 2021) on 714 women in six African countries showed that 64% of interviewed women at least sometimes confide in their hair-dresser, and 86% believe that other women do so. The duration and repetition of interactions, added to the neutral status of the hair-dresser, could in combination with training constitute a powerful first line of defense against depression and anxiety.

Our missions: 

• To raise awareness of mental health issues, promote wellness and prevent risky situations. By opening the debate on mental health concerns, we enable people to take the first step towards recovery. 

• Mobilize to enable access to mental health support and care for young women and men in Africa. 

• In addition to communication and awareness-raising actions on digital platforms and in the field, to defend the rights of patients and to question the public authorities on the challenges of mental health.

A hairdresser dresses an average of 7 women a day, or 360 women a year. In view of these observations, the training of 1,000 hairdressers in mental health by 2035 could lead to awareness and support up to 5 million women in 20 cities. These are all children, families and communities that are aware.

In addition to the massive social impact for women and their communities, we know how important it is for the certified ambassadors of the “Heal by Hair” Program to be supported in their professional activities. Therefore, social incentives and set for them to thrive in their finances. Those incentives are the access of a social protection, microcredit, and assistance in their projects.

Our main hypothesis is that due to a certain proximity maintained with their clients during their service, the hairdressers regularly collect their confidences. Unfortunately, due to a lack of appropriate tools and the legitimacy required to exercise effective listening, the action of hairdressers is of limited scope. Training of these essential and yet invisible intermediaries not addressed by the public authorities (or by other structures), can play an important role in raising awareness and providing first aid to the many women they see every day.

The training of 1,000 hairdressers could lead to sensitizing and supporting 3 to 5 million women by 2035. These are as many children, families, and communities sensitized and impacted.

Currently (Spring 2023): 111 women have already been trained. About 40 000 african women will be sensitized by these ambassadors, each year.

Our goal is to train 210 ambassadors in 2023 (Côte d'Ivoire, Cameroun, Togo), that could reach out to 75 240 women in a year.

By 2024, we intend to train 1,000 hairdressers between Côte d'Ivoire, Cameroon and Togo, with 2 training sessions per country. 80 women would be certified per session. That would be 480 ambassadors. However, we are also developing an alternative training, mainly online, a digital training for the other half.

By 2025, we intend to train 1,960 hairdressers between Côte d'Ivoire, Cameroon, Togo, and an additional country, with 3 training sessions per country. 80 women would be certified per session. That would be 980 ambassadors. However, we would also administer digital training for at least the equivalent.

The ambition of the Heal by Hair program is to reach and educate 2 million women, train 1,000 hairdressers (working-class neighborhoods) in 20 African cities by 2035.

=> 3-phase strategy with a half-yearly impact measurement implemented with performance indicators measured barometrically.

Knowing that a hairdressing service lasts on average 2 hours, and assuming that the working time of a hairdresser is at least 10 hours a day; knowing that she receives on average 7 people including 5 women minimum per day. In one week, 30 customers can be registered in this way and in two weeks 60. However, cultural experience shows that after two weeks, the same customers return to the same hairdressing salon. Our hypothesis is therefore that the last two weeks of the month, it is mainly the same customers who come back.

 However, the hairdresser also receives new clients, of which we estimate the number at 10 over the last two weeks of the first month. Estimated total of 70 clients for the first month (N)

The number of new clients for the following months would be 20 clients due to 10 new clients every two weeks. Thus, the minimum total number of clients for a hairdresser is 70 + 20*11=290 women/year

Phase 1 (2022 – 2025): objective = 1 million women sensitized at a rate of 250,000/year. To reach these 250,000 women/year, it would take: 250,000 / 290 = 862 trained hairdressers

 Target of the survey: clients of Heal by Hair Ambassadors Hairdressers (HbHAH)

 Type of survey and sampling: quantitative study conducted among women clients of HbHAH

Two-stage cluster sample household survey :

 1st degree: random draw of 50 hairdressers from the CSHbH database

•  2nd degree: Interview of 20 female HbHFAH clients using the random step method

Sample size

 To estimate the sample size, the following formula was use : 

Where P represents the estimated result indicator, Z represents the Z value corresponding to the desired level of confidence. In the analyses, z=1.96 corresponding to the 95% confidence level; represents the desired margin of error in this case 3%. The final sample size obtained after calculation is 1,000 women to be surveyed per country

Mode of administration of the questionnaire

• Face-to-face questionnaires (via specialized tablets)
• phoning
• Focus groups

Collection monitoring: daily

Processing and analysis

• Daily recovery of data from the mass data collection platform, ONA, synthesis and export to Stata data analysis software for processing preparation
• Data cleansing
• Calculation of the key indicators of the survey through codes on the Stata software (do files) 

Some impact measurement indicators for the “women” target

• Level of effort to find a certified Heal by Hair stylist
• Performance of the Ambassador hairdresser
• Trust, respect for confidentiality and improved well-being

The underlying theory of change is that access to mental health care for women in African societies can be improved by developing the listening skills of service providers, here hairdressers. Thanks to the existing social structures, the Heal-by-Hair initiative will allow women to have better access to information and advice for their mental health. Hairdressers are not intended to provide medical care but to become “active listeners” via three mechanisms: (1) by creating an accessible discussion framework conducive to discussions on mental health; (2) providing information on how to contact mental health professionals; (3) fighting the stigma around mental health. Hypotheses : 

- Hypothesis #1 – Hairdressers trained by healthcare professionals have tools to enable them to be more empathetic towards clients, detect problems and, if necessary, refer them to the appropriate caregivers. This first hypothesis will be verified by interviewing the hairdressers and their clients reporting on the change in the nature and frequency of interactions.

- Hypothesis #2 - The intervention improves clients' well-being and mental health. They feel more heard, are less afraid of the stigma surrounding the subject and they receive new information to contact mental health professionals directly if needed. This should be visible through the increase in psychometric scores following the standards of the quantitative literature, namely the Multidimensional Scale of Perceived Support (MSPSS), the WHO-5 Well-Being index (WHO-5) and the Patient Health Questionnaire index (PHQ-9) which will be measured with a Likert scale. 

- Hypothesis 3 - Hairdressers feel more empowered and their well-being improves. They feel more empowered by acquiring new skills through training. Their well-being and mental health improve thanks to regular peer-mentoring supervised by healthcare professionals. The evolution of well-being and mental health will be measured with the indicators presented in hypothesis n°2. • 

- Hypothesis 4 - The intervention improves women's participation in decision-making within households and in the labor market. This hypothesis builds on the results of Baranov (2020) in rural Pakistan, who find that improved mental health led to women's financial empowerment. If the intervention leads to better health, this should have a positive effect on employment status and productivity (measured by income, mainly in self-employment). We believe that improving mental health can lead to stronger bargaining power for women in their homes. These results will be measured by specific questions on participation in the labor market, decision-making within the household and their productivity.

We currently developed a chatbot that we use to communicate with the mental health ambassadors, in order to collect the returns of impact of their actions. The sensitized clients are free to use a code to let us know they have been sensitized and that enables us to track the actions.

Besides, we also have an e-learning website that enables selected candidates to start their training online, before the physical training.

We intend to develop a more performant tracking system, that could be more reliable. A few discussions are on, like for instance being able to identify key words during conversations, measuring the path of conversations, tones, etc.

• Use of inclusive writing in foundation working papers
• Multicultural team (Cameroun, Bénin, Togo, Côte d’Ivoire, Canada, Suisse, Togo,…)
• Headquarters located in Lomé with branches in Paris, Lomé, Douala, Abidjan.
• A week of 4 and half days for the team members
• Mental health first aid training for the team members
• Individual psychological support for the team members
• A sports subscription for the team members

Key Resources :

• Grants (FID, Giving Joy, UE)
• Organization of an annual fundraising gala
• Annual crowdfunding campaign
• Volunteering
• Bluemindfoundation.org platform

Key activities :

• Heal by Hair
• Full Scholarship for African Psychiatrists
• Youth Teen Tank
• Blue’December
• Ubunt’Blue Day

 Partners + Key Stakeholders

• Hands from Above
• Rema
• African Media Agency
• Ministère de la Femme, de la Famille et de l'Enfant de la République de Côte Ivoire
• Ministère de la Santé Publique, de l'Hygiène et de la Couverture Maladie de la République de Côte Ivoire
• Organisation Mondiale de la Santé - Représentation en République de Côte Ivoire
• Union Européenne (UE)
• Nature et Traditions
• CONAPAPECI
• ADEBA NATURE
• JCDECAUX - République de Côte Ivoire
• HEMLEY
• DALBERG

Cost Structure

• Staff
• Online Platform

Type of Intervention

• Workshop (training)
• Grants 

Channels

• Bluemindfoundation.org
• Hairdressers network

Surplus

• Research Center
• Women and girls clients of the Heal by Hair Women Mental Health Ambassador Network hairdressers
• Professional network of women hairdressers to destigmatize mental health and help each other
• Increased feeling of well-being
• Sensitization of children and the community
• Increase in the number of women feeling socially connected
• First consultation with therapists
• Satisfaction and social valorization 
• Increased revenue and value creation
• Training and empowerment

Segments

Beneficiary:

• Women and girls clients of the Heal by Hair Women Mental Health Ambassador Network hairdressers

Value Proposition

User Value Proposition

• Professional network of women hairdressers to destigmatize mental health and help each other

Impact Measures

• Increased feeling of well-being
• Sensitization of children and the community
• Increase in the number of women feeling socially connected
• First consultation with therapists
• Satisfaction and social valorization 
• Increased revenue and value creation
• Training and empowerment 

Customer Value Proposition

N/A

Revenue

• Donation

1. We intend to have permanent or long term donors, acting as sponsors to the Program and specifically to women.
2. We intend to develop a network of local partnerships, to facilitate the training and events.
3. We intend to develop and start selling products related to the Program (shampoos, conditionners, towel, etc.). The benefits would be redirected to the Heal by Hair Program.
4. We aim at development specific partnerships with the Heal ministries, for them to endorse the Program and help deploy it across the countries, as a national Program.

We alreay received a few grants :

• Development innovation Fund : 227 396,8 €
• European Union : 1 600 €
• Dalberg : 1 500 €
• Giving Joy  : $500
• Université Paris-Saclay : 6527,31€  
  -Université Paris 1 : 3566€