A Systematic Review of Task Shifting for Mental Health in Sub-Saharan Africa

Background   

Despite the dire need for mental health services in sub-Saharan Africa, few professionals are available to meet these needs on the continent.  Over the last few years, task shifting using non-specialist workers has been increasingly employed to deliver physical and mental health treatment services.  While evidence suggests this approach is effective for mental health, few studies have examined the effectiveness of task shifting in sub-Saharan Africa.  This systematic review therefore examines 14 recent intervention studies which utilized task shifting for mental health interventions in sub-Saharan Africa. 

Methods

We conducted a rigorous search using Academic Search Complete, MEDLINE, Global Health, and PsychINFO via the EBSCO database host.  Two reviewers independently reviewed the databases and extracted the data.  In addition to the PRISMA guidelines, this review also developed a Methodological Quality Rating Scale and an Outcome Attainment Index to analyze the data.  Studies were analyzed by single site versus multisite interventions as well as group versus individual intervention studies.

Results

Our search generated 2071 articles of which 14 were included in the review.  10 studies task shifted lay workers, 3 studies used nurses, and 1 study used traditional healers to deliver mental health services.  Nearly half of studies (43%) did not use a control group in their intervention study.  Methodological rigor scores ranged from 7-12 on a 12-point scale, with a mean score of 9.9 and a median of 10.  Individual interventions were found to have slightly higher rigor compared with group interventions, while multisite interventions were found to have significantly higher rigor compared with single site studies. 

Conclusions

Initial evidence suggests that task shifting interventions may be a valuable tool for implementing mental health services in settings with limited mental health professionals.  However, current studies are faced with methodological challenges, particularly by lacking comparison groups and detailed fidelity guidelines.  Additionally, studies can be strengthened through the inclusion of multiple sites in the intervention – as opposed to single site – and by ensuring appropriate cultural adaptation of services.