To systematically identify and test promising implementation strategies to maximise the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) of the evidence=based friendship Bench programme in Zimbabwe.
With a population of 13 million people Zimbabwe has only 13 psychiatrists and 2 clinical psychologists working in government facilities. However, the proportion of lay health workers at community level employed by the city health department (over 400 for Harare) can, through task-sharing, fill part of this treatment gap for CMD. The evidence-based FB model offers one of the few feasible options to currently meet the enormous population mental health needs in Harare, and across Zimbabwe. We anticipate the FB program to serve as a key element of a future and more comprehensive mental health care system evolving through the slow and arduous training of other health personnel to take on other duties. We are already piloting additions to the FB to expand the services to those with more severe symptoms through training nurses to prescribe medication. ➢ Our group has been working to reduce the mental health treatment gap for several years. These efforts culminated with the testing of a model, the Friendship Bench (FB), suitable to the reality of Zimbabwe to treat CMD in primary care. This model (described below) was tested in a fully powered cluster RCT in Harare with excellent results. Currently, this is the only successful RCT of a psychological intervention delivered by Community Health Workers (CHW) in primary care clinics in Sub-Saharan Africa (SSA). ➢
- Medical Research Council, United Kingdom