Using the RE-AIM framework to evaluate the implementation of scaling-up the Friendship Bench in Zimbabwe - a...

Area of Science:

• Global Mental Health
• Public Health Interventions
• Implementation Science

Background:

• The Friendship Bench (FB) is an evidence-based brief psychological intervention delivered by community health workers (CHWs).
• This study evaluates the real-world implementation of FB in Zimbabwe three years post-introduction.
• It is one of the first evaluations of a scaled-up psychological intervention in sub-Saharan Africa (SSA).

Purpose of the Study:

• To evaluate the real-world implementation and performance of the Friendship Bench program.
• To assess the program's effectiveness across different primary health care (PHC) clinic sizes using the RE-AIM framework.
• To identify areas for improvement in scaling up psychological interventions in SSA.

Main Methods:

• Quantitative indicators based on existing FB data and the RE-AIM guide were used.
• Thirty-six primary health care clinics in Harare, Chitungwiza, and Gweru were included.
• Data were collected through existing records, interviews, and field observations, focusing on Reach, Adoption, and Implementation domains.

Main Results:

• Small clinics achieved significantly higher reach (34%) compared to medium (9%) and large (15%) clinics.
• Adoption rates were high across all clinic types (59%-71%).
• Small clinics demonstrated superior performance in implementation (53%) compared to medium (43%) and large (40%) clinics.

Conclusions:

• The Friendship Bench program has successfully transitioned to local leadership over three years.
• Larger clinics showed poorer reach, indicating a need for targeted implementation improvements.
• Integrating program data into health information systems and optimizing scale-up strategies are crucial for sustaining task-shared psychological interventions in SSA.