Acceptance and Commitment Therapy in a Low-Income Country in Sub-Saharan Africa: A Call for Further Research

Yonas E Geda,Aida Tefera,Steven C Hayes,Janina Krell-Roesch,Thomas G Szabo,Yaphet Fisseha,Deborah Rosenbaum,Teferra Beyero,Mesfin Araya

doi:10.3389/fpubh.2021.732800

Abstract

A worsening trend of critical shortages in senior health care workers across low- and middle-income countries (LMICs) in sub-Saharan Africa has been documented for decades. This is especially the case in Ethiopia that has severe shortage of mental health professionals. Consistent with the WHO recommended approach of task sharing for mental health care in LMICs, Acceptance and Commitment Therapy (ACT), which is an empirically validated psychological intervention aimed at increasing psychological flexibility, may be delivered by trained laypersons who have a grassroots presence. In this paper, we discuss the need for and potential role of ACT to be delivered by health extension workers (HEWs) to address mental health care needs across Ethiopia. To this end, we also reviewed previous studies that have examined the effectiveness of ACT-based interventions in African countries including in Nigeria, Sierra Leone, Uganda, and South Africa. All studies revealed significant improvements of various mental health-related outcome measures such as decreased psychological distress and depressive symptoms, or increased subjective wellbeing and life satisfaction in the groups that received an ACT-based intervention. However, to date, there is no study that applied ACT in Ethiopia. Thus, more research is warranted to examine the effectiveness and, if proven successful, to scale up a task sharing approach of an ACT-based intervention being delivered by trained HEWs at a grassroots level, possibly paving the way for an innovative, sustainable mental health service in Ethiopia as well as other African LMICs.

Highlights

Sustainable health care requires a combination of infrastructure, human resources, and supply chain management
To further address the question as to whether applying ACT may be a promising approach for tackling the mental health care shortage in Ethiopia, we reviewed previous studies that have examined the effectiveness of ACT-based interventions in African countries
Consistent with the World Health Organization (WHO) recommended approach of task sharing for mental health care in low- and middle-income countries (LMICs), ACT may be delivered by trained laypersons who have a grassroots presence

Summary

INTRODUCTION

Sustainable health care requires a combination of infrastructure, human resources, and supply chain management. There are not yet enough studies that examined the mediational role of psychological flexibility and/or the mental health impact of ACT interventions in Africa This is consistent with a recent publication in Lancet that highlighted the past and current mismatch in clinical trial efforts and disease burden globally, i.e., only 2% of randomized clinical trials registered between 2010 and 2019 were conducted in sub-Saharan Africa albeit this region is expected to have the most rapid population growth worldwide over the decades [35]. It is paramount to examine whether ACT-based interventions delivered by trained health care workers have an impact on mental health outcomes (both in the short- and long-term) in various groups of individuals including, but not limited to, persons with specific mental and behavioral health problems, such as depression or anxiety, as well as transdiagnostic conditions, such as perceived stress or chronic diseases.

Results

CONCLUSIONS

DATA AVAILABILITY STATEMENT