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Location

Uganda, Zambia

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Sector

Public Health, Nutrition and Water

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Type of Investment

Grant

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Project Stage
Test & Transition
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Length of Investment

2019+

Investment Overview

A charity that aims to treat depression in women in Africa with less than $2 per day to spend on their families. StrongMinds currently operates in Uganda and Zambia and addresses depression by delivering facilitator and peer-led courses of Group Interpersonal Psychotherapy (or IPT-G), a cost-efficient, community-based model of depression treatment that has been created and validated by mental health experts.

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The Development Challenge

Depression is a critical development problem to solve. First, the negative impact of depression includes lower education and literacy levels, greater food insecurity, substantial economic insecurity with decreased income, lost productivity and absenteeism from work, and poorer health outcomes for women and their children. Second, depression is a worldwide problem. There are over 300 million cases of depression globally, of which at least 30 million are in Africa. Third, it is especially relevant for women. Depression is more common among females (5.1% prevalence) than males (3.6% prevalence). In Sub-Saharan Africa, 5.9% of women suffer from depression. African women suffering from depression are classified as both a vulnerable and disabled population by the World Health Organization (WHO). Despite one in four women suffering from depression, the services to treat these women are not in place; over 85% of sufferers have no access to treatment according to the WHO.

Finally, depression is consistently overlooked in the global development sphere. Receiving just 0.3% of all global development assistance for healthcare, mental illness is deprioritised by western funding sources as a second-order issue. This further stigmatises those who suffer from depression and fails to acknowledge the multiple negative effects depression has on all aspects of a person’s life. Because of how debilitating depression can be, sufferers are less likely to respond to outreach and services offered by international non-governmental organisations (INGOs) and governments, such as livelihood training or outreach promoting safe sex.

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The Innovation

StrongMinds has modified IPT-G (group interpersonal therapy) with role-playing activities, interactive charts and visual aids, adapted to the cultures and literacy levels of their participants. Each talk therapy group lasts 12 weeks, with 12-15 women coming together each week for approximately 90 minutes. StrongMinds runs facilitator-led sessions (STG), peer-led sessions (PTG), which, according to StrongMinds’ own data, have average healing rates of 75% and 65% respectively.

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Our Investment

StrongMinds is using GIF’s investment to:

  1. Refine their low-intensity, democratised, replicable and scalable IPT-G model, and test its effectiveness in healing depression, reducing depression rates, and improving well-being metrics.

  2. Set up StrongMinds for a successful scale-up by refining the toolkit to support partners implementing its programme through the social franchising model and gain traction with the government to scale with them in the future.

  3. Deepen the understanding of the relationship between mental health and gender equality.

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Investment Objective

To refine StrongMind’s low-intensity replicable and scalable IPT-G (interpersonal group therapy) model, and continue testing its effectiveness in healing depression, reducing depression rates, and improving well-being metrics by conducting two pilots with INGOs and/or MoH in Uganda, Zambia with different levels of engagement. Further, to create the toolkits for replication of the IPT-G model and build a strong pipeline for partnerships with INGOs and MoH in Uganda and Zambia. Lastly, to gather learnings related to each model to determine the model for scale, and define a clear path to scale with one or more partners to scale to 20,000 or more women by 2023.

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Why we invested

Depression is a barrier for women: It affects women more than men, especially after puberty (Weller et al., 2006) and prevents them from accessing and retaining economic opportunities. It therefore constitutes a serious constraint on their agency.



StrongMinds’ model is evidence-based, and more importantly, scalable: This evidence-based model is in line with WHO guidance and based on an RCT conducted in 2002 on a similar intervention in rural Uganda. This is a relatively low-intensity operational model compared to current approaches of providing mental health care through mental health professionals, which is often scarcely available and, when available, is inaccessible to the poor. This intervention is designed specifically to be able to help poor depressed women in Africa (with less than $2 per day to spend on their families).



High additionality of funding for a neglected development problem:There is currently a lack of funding for evidence generation on accessible delivery methods of mental health interventions focusing on women. GIF can provide potentially catalytic funding for mental health treatment of women in developing country contexts as there is limited funding for mental health issues around the world (less than $130M a year). In addition to the funding, GIF can play an important role in helping StrongMinds build the right model for scale, and connect StrongMinds to gender equality thought partners. GIF also envisions part of this grant to be used for gender lens capacity building within the StrongMinds team.


Learning agenda for intersectionality of mental health and gender equality: This investment will help StrongMinds to apply a gender lens to their work and improve programming and partnership and generate evidence which will contribute to the wider development ecosystem. This investment will be an opportunity for GIF to learn from and improve how it internalises gender in its own work.

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StrongMinds in numbers

12 weeks

Of group therapy offered to participants

30 million

Cases of Depression in Africa

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StrongMinds Impact Brief

StrongMinds is a social enterprise founded in 2013 that provides life-changing mental health services to low-income African women and adolescents. StrongMinds delivers facilitator-led and peer-led 10-12-week courses of Group Interpersonal Therapy (IPT-G) for depression with healing rates of 84% and 65%, respectively. This is a relatively low-intensity operational model compared to current approaches of providing mental health care through mental health professionals, which is often scarcely available and inaccessible to the poor, and hence has great potential to scale.

StrongMinds’ model is in line with guidance on IPT-G by the World Health Organisation and builds on evidence from a randomised controlled trial of a similar intervention conducted in rural Uganda in 2002. The study found significantly larger reductions in depression severity for participants of IPT-G compared to people, who did not receive the treatment, both immediately after treatment and in a follow-up survey six months later.

Since starting fieldwork in 2014, StrongMinds has provided IPT-G to more than 78,000 women suffering from depression in Uganda and Zambia. During the Covid-19 pandemic, the Governments of Uganda and Zambia partnered with StrongMinds to conduct public education campaigns that reached 16 million people across Zambia and Uganda through video, radio, and social media.

Use of GIF Funds

In December 2019, GIF awarded a US$1.6m grant to StrongMinds to:

  1. Scale their IPT-G model effectively through partnerships, and thereby reach a larger number of women more efficiently.

  2. Institutionalise a gender-lens approach in their work to actively assess gender outcomes and adapt their programmes to empower women and girls.

Objectives

Refine StrongMind’s low-intensity replicable and scalable IPT-G (interpersonal group therapy) model, and continue testing its effectiveness in healing depression and reducing depression rates and improving well-being metrics by conducting two pilots with INGOs and/or MoH in Uganda and Zambia with different levels of engagement.

Create the toolkits for replication of the IPT-G model and build a strong pipeline for partnerships with INGOs and MoH in Uganda and Zambia. Capture learnings related to each model to determine the model for scale, and define a clear path to scale with one or more partners to scale to 20,000 or more women by 2023.

  1. Scaling through partnerships: development of partnerships to build up organisational expertise in this area, and a replication model that supports cost-effective, high-fidelity delivery through these to support scale-up. This includes creation of necessary toolkits, and monitoring and evaluation (M&E) support modules that are deployed and iteratively refined with partners.

  2. Institutionalising a gender-lens: overt incorporation of gender dimensions across StrongMinds including in their organisational policy and strategy, operations, programme implementation and M&E to become a truly gender transformative organisation.

Impact to Date

In the year 2019 alone, StrongMinds reached over 23,000 patients. However, in March 2020, when Covid-19 disrupted delivery of in-person therapy, StrongMinds rapidly developed and launched a new group teletherapy model. Since then, over 7,000 patients have benefited from it and early results are promising with 83% of patients experiencing a clinically significant reduction in depression symptoms [1]. To promote better mental health during the pandemic and link individuals to their teletherapy service, StrongMinds also successfully launched a mental health chatbot on Whatsapp, Amani. Alongside the public education campaign, this allowed StrongMinds to expand their operations from seven to 42 districts in Uganda and from one to 27 in Zambia in 2020. In Uganda, StrongMinds collaborated with the Ministry of Health (MOH) to provide psychosocial support to frontline health workers, Covid-10 patients, and their family members.

[1] A 5-point drop on the Patient Health Questionnaire (PHQ) -9 scale, an instrument to screen the severity of depression of patients.