Training grandmothers to support learning

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Zimbabwe has 15 million people but only about ten psychiatrists; the biggest barrier to mental health care is not knowledge but people to deliver it

Friendship Bench answered that with an idea that sounds too simple to work: train grandmothers, respected elders already trusted in their communities, to deliver structured problem-solving talk therapy on a wooden bench outside a clinic. It is not an education programme, but it protects the thing learning depends on, a young person's mental wellbeing.

THE PLACE
Zimbabwe, now spreading to other countries

THE INVESTMENT
Training a workforce that already exists in a community

THE WIN
Proven in a landmark randomised trial and now running across all of Zimbabwe

THE PROBLEM

Zimbabwe carries a heavy burden of common mental disorders. Around a quarter of primary care patients experience depression, anxiety or related conditions, locally described as kufungisisa, or thinking too much. Yet the country has only about ten psychiatrists for a population of some 15 million, a ratio common across sub-Saharan Africa.

For young people, untreated distress does not stay in one box: it undermines school attendance, concentration, relationships and the ability to learn. The treatment gap is not mainly a gap in what works, but in who is available to deliver it. 

TAKING ACTION

Psychiatrist Dixon Chibanda founded Friendship Bench in 2006, in the aftermath of mass displacement, when he realised there would never be enough clinicians to meet the need.

Working with an inaugural group of 14 grandmothers in Harare, he found a workforce hiding in plain sight: older women, rooted in their communities, empathetic and trusted. Trained and supervised in evidence-based problem-solving therapy, they deliver a short course of sessions on a simple wooden bench in the grounds of a primary care clinic, in local language and idiom. Clients are then introduced to a peer support group known as Circle Kubatana Tose, holding hands together.

The grandmothers shaped the model themselves, including its name, chosen to strip away the shame that a word like mental could carry. 

INVESTMENT SUCCESS!

Friendship Bench is one of the most rigorously evidenced mental health interventions to come out of a low-income country. A cluster randomised controlled trial published in JAMA in 2016, conducted by the University of Zimbabwe, the London School of Hygiene and Tropical Medicine and King's College London, found that people who received the intervention were more than three times less likely to have symptoms of depression after six months than those who received usual care, with significant reductions in anxiety and suicidal thoughts.

The model has since been backed by more than 100 peer-reviewed studies, including work with young people living with HIV.

By 2023 it had scaled to all ten provinces of Zimbabwe, with more than 2,000 trained community health workers reaching over 300,000 people in a single year. 

KEY WINS

300,000+ people reached in 2023 alone 

3x less likely to have depression at 6 months, versus usual care (JAMA trial) 

All 10 provinces of Zimbabwe covered 

WHY INVESTMENT WORKED

A workforce already in the community

Training trusted grandmothers sidesteps the impossible wait for more psychiatrists and gives the model deep local credibility.

Culturally owned, not imposed

Delivered in Shona, using local idioms, on an unthreatening bench, so people come without stigma.

A structured, evidence-based method

Problem-solving therapy is simple to teach, simple to supervise, and works even when delivered by non-clinicians.

Proven, then published, repeatedly

A landmark randomised trial and more than 100 peer-reviewed papers turned a local idea into a globally credible one.

Designed to sit inside government systems

Delivered in public primary care clinics, which is what makes national scale and sustainability possible.

Cheap and replicable

Low cost per client and a clear method make it portable across countries and contexts.

SCALE AND SPREAD

From 14 grandmothers in Harare, Friendship Bench has trained thousands of lay health workers and spread across Zimbabwe and beyond. Versions have been adapted in Malawi and Zanzibar, and the model has inspired programmes in New York City, Washington DC, Vietnam and Jordan, with a pilot explored in London.

Chibanda, now a professor at the University of Zimbabwe and the London School of Hygiene and Tropical Medicine, set out the story in a 2025 book, The Friendship Bench: How Fourteen Grandmothers Inspired a Mental Health Revolution.

PARTNERS AND PHILANTHROPY

Friendship Bench grew from research funded by the Government of Canada through Grand Challenges Canada, which supported the original trial, and is delivered in partnership with Zimbabwe's public health system and universities.

Its international spread has been backed by philanthropic funders including the philanthropist MacKenzie Scott and the Mulago Foundation. Chibanda is a founding member of the Coalition for Scaling Mental Health.

FRIENDSHIP BENCH AT A GLANCE

WHERE

Zimbabwe (national); adapted in Malawi, Zanzibar, Vietnam, Jordan and the United States 

 

FOUNDED

2006

LED BY

Friendship Bench; founder Dixon Chibanda (psychiatrist)

FOCUS

Community mental health; problem-solving therapy delivered by trained lay grandmothers

CORE IDEA

Task-shift talk therapy to trusted community elders, delivered on a bench in primary care

HEADLINE RESULT

3x less likely to have depression at 6 months (JAMA trial); 300,000+ reached in 2023

EVIDENCE

Cluster RCT in JAMA (2016); 100+ peer-reviewed studies

 

PHILANTHROPY

Grand Challenges Canada (research); MacKenzie Scott; Mulago Foundation

SCALE

All 10 provinces of Zimbabwe; 2,000+ community health workers; international replications

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