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April 26, 2026Open Access

The Effectiveness of Community-Based Mental Health Interventions Delivered by Lay Health Workers in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

Key Points

This research aims to evaluate the efficacy of non-specialist-delivered psychological interventions for mental health issues in sub-Saharan Africa.
Conducted a systematic review and meta-analysis of randomized trials from January 2010 to December 2024.
Screened studies using dual independent review and assessed quality with Cochrane RoB 2 instrument.
Synthesized effect sizes through random-effects modeling and evaluated evidence quality with GRADE methodology.
Ten trials with 4,761 participants were identified, showing an overall symptom reduction with community worker-facilitated care (SMD = -0.82, 95% CI -1.24 to -0.40, p < 0.001).
Significant heterogeneity was found between studies (I² = 97.7%).
The effectiveness of interventions varies based on the type of comparator, suggesting different impacts of care models.

Abstract

Objectives: This study synthesizes evidence through systematic review and quantitative pooling of data regarding the efficacy of non-specialist-delivered psychological interventions for prevalent mental health conditions across sub-Saharan African settings. Material and Methods: Our search encompassed six electronic databases spanning January 2010 through December 2024. Eligible studies comprised randomized trials examining non-specialist-delivered psychological care for prevalent psychiatric disorders within sub-Saharan African populations. A dual independent review was employed for screening, data abstraction, and quality appraisal via the Cochrane RoB 2 instrument. Effect sizes were synthesized through random-effects modeling with standardized mean differences, and evidence quality was evaluated using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Results: We identified ten eligible trials encompassing 4,761 individuals across seven nations (Zimbabwe, South Africa, Uganda, Tanzania, Nigeria, Kenya, Zambia). Therapeutic approaches comprised problem-solving techniques, interpersonal therapy, cognitive-behavioral methods, and tiered care frameworks. Quantitative synthesis demonstrated that community worker-facilitated care yielded substantial symptom reduction relative to comparison groups (combined SMD = -0.82, 95% CI -1.24 to -0.40, p < 0.001), reflecting moderate-to-substantial clinical benefit. Between-study variance was marked (I 2 = 97.7%), attributable to heterogeneity in therapeutic modalities, participant characteristics, and implementation contexts. Subgroup analyses suggested that the type of comparator (enhanced usual care vs. standard/minimal care) may explain some of the heterogeneity. Evidence certainty was judged as moderate per GRADE standards. Conclusion: Non-specialist-delivered psychological interventions demonstrate efficacy in alleviating psychiatric symptomatology across sub-Saharan African contexts. These results provide empirical support for expanding task-delegation models as a means of addressing unmet mental healthcare needs in resource-constrained environments.

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