2025 Q2 Report

In January 2025, the abrupt suspension of USAID funding materially affected the global mental health sector. StrongMinds experienced a loss of approximately USD 1 million over three years, constraining the delivery of mental health services to more than 57,000 adolescents in Uganda. Several planned or ongoing partnerships in Zambia and Kenya, as well as a new initiative in Nigeria, were also paused due to funding shortfalls.

Beyond the organisation itself, the reduction in US development assistance created broader system-level disruption. In Uganda and Zambia, the withdrawal of US funding is estimated to have reduced national health budgets by approximately 25–33%, placing additional pressure on already limited mental health allocations. This shift has also complicated longer-term efforts to scale cost-sharing models in which governments gradually assume responsibility for implementation of StrongMinds’ IPT-G approach.

In response, StrongMinds has begun adapting its strategy to operate effectively in a more constrained and uncertain funding environment. This includes accelerating work through its Innovation Lab to reduce costs per patient and develop simplified, scalable treatment models suitable for government adoption. Current efforts include testing streamlined therapy formats, continuing exploration of group-based Single-Session Interventions, and piloting ultra-low-cost delivery models over the next 6–12 months. The organisation aims to offer a menu of care options with varying cost and effectiveness profiles, enabling governments to select approaches aligned with their fiscal capacity and population needs.

In parallel, StrongMinds’ global advocacy efforts are focused on maintaining mental health visibility in international policy forums, including high-level global health convenings in 2025. Together, these efforts reflect a longer-term strategy to position StrongMinds as a technical assistance partner to African governments, supporting the development of resilient, affordable, and locally owned mental health systems.

Friendship Bench Zimbabwe continues to advance the integration and handover of the Friendship Bench model to the Government of Zimbabwe, with a focus on achieving impact at scale while maintaining consistent and high-quality programme delivery across all ten provinces. During the reporting period, several activities were undertaken to support programme fidelity, system integration, and continuous learning.

As part of efforts to strengthen data systems and government alignment, Friendship Bench completed the onboarding of the DHIS2 data collection platform, enabling seamless integration with the Government of Zimbabwe’s health information infrastructure, including the electronic health register. To date, 2,096 community health workers have been trained in the use and calibration of the DHIS2 platform. In addition, 600 mobile data collection devices were distributed, currently supporting an average of four community health workers per device, with plans to improve this ratio over time to further strengthen data quality.

Friendship Bench also participated in sector-wide consultation workshops alongside the Ministry of Health and Child Care, the World Health Organization, and civil society partners. These engagements focused on identifying and standardising key performance indicators for national mental health programming, including the co-development of data collection tools, shared KPI definitions, and ongoing training to support consistent and effective use of information.

During the quarter, structured “pause and reflect” sessions were held with implementation teams to support shared learning across geographic sites. These sessions facilitated peer exchange on operational challenges and effective practices. Ministry of Health and Child Care staff continued to work closely with Friendship Bench teams to integrate the model within government systems, with programme data and insights channelled to the Programme Management Unit (Friendship Bench, MoHCC, and WHO) for synthesis and adaptive management. Together, these processes support ongoing alignment with Zimbabwe’s national mental health strategy and strengthen the foundations for sustainable, government-led scale-up.

Over the past quarter, the organisation prioritised strengthening its monitoring and evaluation systems, with a focus on participant flow from registration to programme completion. On average, participants completed intake within eight days of sign-up and attended their first group session within a further eight days, resulting in therapy commencement within approximately 16 days. Between April and June, 533 individuals registered for services, 44 therapy groups were completed, and 270 participants attended at least one session. Attendance continued to improve, with participants attending an average of five out of eight sessions.

Progress was also made in post-programme follow-up. Through more structured outreach, assessment completion rates reached 77% at three months and 56% at six months post-completion. Average PHQ-9 scores at both time points were 5, indicating sustained mild to no depressive symptoms.

Programme quality was further strengthened through the introduction of a peer supervision model within the Quito team, designed to support cost-effective scale while maintaining care standards. Additional safeguards were introduced through the establishment of a pro bono referral network of local clinical psychologists for participants requiring more intensive support.

During the quarter, the organisation published its 2024 Impact Report (available in English and Spanish) and secured new partnerships to support growth and learning. This included a sub-grant through IMPAQTO, funded by the Hilton Foundation, to deliver mental health services as part of the Regenera programme for women entrepreneurs in three cities in Ecuador, and a research partnership supported by Agency Fund to examine barriers to mental health care access.

Mental health outcomes were assessed using the Patient Health Questionnaire (PHQ) among users in Zimbabwe. Of 21,748 users acquired, 2,653 (12%) completed both baseline and endline assessments. Among these users, the average reduction in depression symptoms was 2.31 points over a two-week period. Thirty-six percent recorded a reduction of five points or more, and 45% of those who improved moved into the “not depressed” category. Importantly, the airtime incentive was associated not only with higher completion but also stronger outcomes: 62% of incentivised users experienced reductions in PHQ-8 scores, compared to 55% of non-incentivised users. While causality cannot yet be established, this suggests that improved engagement may translate into greater therapeutic benefit, reinforcing the case for incentives as a scalable design feature.

A condensed “3-Day Challenge” version of the AFFIRM programme was piloted to test whether a more time-bound and structured format could improve outcomes. While overall completion rates were lower than the full programme, users who completed the challenge demonstrated substantially stronger results, with an average 5.11-point reduction in PHQ scores—more than double the average observed in the standard intervention. These results highlight a potential trade-off between reach and depth of impact and suggest that alternative formats may be effective for specific user segments. Any further investment in this model would require more rigorous testing, including randomised assignment and targeted recruitment, to assess whether the observed gains are driven by selection effects or genuine differences in effectiveness.

Re-establishing the All-Party Parliamentary Group (APPG) on Wellbeing Economics required more time and groundwork than initially anticipated. A significant proportion of Members of Parliament who had previously engaged with the APPG were no longer in Parliament, necessitating extensive outreach to newly elected MPs to rebuild awareness and engagement.

Updates to APPG rules also introduced additional constraints. Revised guidance increased the threshold for officer participation and created practical limitations for certain roles, including Parliamentary Private Secretaries, who are technically permitted to join APPGs as members but not as officers and are often advised internally to limit participation due to perceived conflicts of interest. These changes reduced the pool of eligible MPs able to take on leadership roles and slowed the process of re-establishing the group.

These developments underscored the time-intensive nature of rebuilding parliamentary groups, particularly on emerging policy agendas. High parliamentary turnover and regulatory changes increased the need for sustained engagement, cross-party relationship-building, and early outreach to establish momentum and leadership capacity.

The experience also reinforced the importance of framing wellbeing policy in terms aligned with current political priorities. With economic growth central to the government’s agenda, engagement has focused on presenting robust evidence demonstrating the economic case for wellbeing, including links to productivity, public service efficiency, workforce participation, and long-term economic resilience. This approach has been reflected in formal policy submissions and supporting research highlighting the value-for-money case for integrating wellbeing into public spending and employment policy decisions.

The programme has successfully completed its 12-week core intervention for all participants in both Wave 1 and Wave 2, with follow-up “booster” sessions now underway. End-of-programme data collection has been completed for all participating older adults, including measures of life satisfaction, as well as surveys of caregivers to understand potential benefits for family members.

The government partner has indicated strong interest in scaling the programme across Tamil Nadu. To support this, draft implementation guidelines have been developed and shared to inform potential expansion.

The project has now entered the longer-term evaluation phase, with six-month follow-up surveys underway for Wave 1 participants and their caregivers. Alongside this, refresher training is being provided to government volunteers, and programme delivery continues to be closely monitored to ensure quality as the intervention progresses.