A systematic review of task shifting for mental health in sub-Saharan Africa

Abstract

Despite an increasing demand for mental health services in sub-Saharan Africa, few professionals are available to meet these needs. In the last few decades, task shifting using non-specialist workers has been increasingly employed to deliver physical and mental health treatment services. While evidence suggests task shifting is effective for mental health service provision, few studies have examined the literature in sub-Saharan Africa. This systematic review includes 14 intervention studies utilizing task shifting for mental health interventions in sub-Saharan Africa. Researchers conducted a rigorous systematic search using four databases: Academic Search Complete, MEDLINE, Global Health, and PsychINFO. In addition to PRISMA guidelines, this review also developed a Methodological Quality Rating Scale and an Outcome Attainment Index to analyze the data. Our systematic search generated 2,071 articles with 14 included in the review. Methodological rigor scores ranged from 7 to 12 on a 12-point scale (mean = 9.9, median = 10), with nearly half of studies (43%) not using a control group in their intervention study. 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. Initial evidence suggests that task shifting interventions are a valuable tool for implementing mental health services in settings with limited professionals. However, current studies are faced with methodological challenges, particularly by lacking comparison groups and detailed fidelity guidelines. Additionally, studies can be strengthened by including multiple sites in the intervention and ensuring appropriate cultural adaptation of services.