The Power of Grandmothers to Treat Depression and Anxiety: The Friendship Benches 4. VIOLENCE AGAINST WOMEN AND HARMFUL PRACTICES .................................................................................................... 181

for maternal health and fully train maternal health care providers, and that health centres be properly equipped within the next two financial years.1323 Moreover, to improve maternal health in the country, the Ministry of Health is to submit a full audit of maternal health in the country every two years. Finally, the third and fourth petitioners were awarded monetary damages.1324

The case is significant for several reasons. First, the decision gave life to increased activism and judicial provisions related to maternal health in the Ugandan Constitution and gave the topic its rightful place. Second, the Court cited international and regional conventions, including the African Charter on Human and Peoples’ Rights. It indicated that the government could not justify non-compliance, given its core obligations. The Court also held that the government needed to report on reasonable measures to improve maternal health in the country. It is not sufficient for the state to argue that there are challenges to policy implementation.1325 Finally, the case also demonstrated that government policies, omissions and acts in the health care sector and other sectors are subject to judicial review to ascertain their ability to become constitutionalised. In doing so, the Court’s decision demonstrated that public litigation is a viable option to ensure access to justice and protecting rights.

The Power of Grandmothers to Treat Depression and Anxiety: The Friendship Benches

Depression and anxiety are the most common mental disorders in the world. In sub-Saharan Africa, they are a major contributor to the disease burden.1326 Few people in low-income countries have access to effective treatment. Zimbabwe is a case in point here. The country has experienced stark socioeconomic and political challenges and has high prevalence of HIV/AIDS. Political and economic instability and government crackdowns have led to an increase in homelessness. These factors have increased the incidence of mental health disorders. An estimated one in four Zimbabwean adults has a mental health disorder, with depression being most common among women.1327

In recent years, the focus of the government has shifted and the support provided and the portion of the budget allocated to mental health has fallen. Ten psychiatrists care for a population of 13 million,1328 and they are often in wealthier urban areas and expensive to visit. To fill this mental health support gap, one of the Zimbabwean psychiatrists, Dr. Dixon Chibanda, set up a programme called Friendship Bench.

Friendship Bench is a sustainable community-based psychosocial intervention that is evidence-based, accessible and scalable. The aim is to create a safe space and a sense of community to enhance people’s quality of life.1329 According to Dr. Dixon Chibanda, establishment of Friendship Bench was part of an iterative learning process. The initial idea was to train public health nurses in health centres across the country. However, nurses were generally overtasked, and health authorities stated that the initiative could not use their buildings. Thus, Friendship Bench trains older women in the community, known as “Grandmothers.” Grandmothers are generally well respected in their community and often take up a counsellor’s role with younger members of the community. Through Friendship Bench, they listen to younger members of society and offer cognitive behavioural therapy to emphasise problem-solving and behavioural change to help with anxiety, depression and trauma. All therapy is conducted outdoors on wooden benches, and generally underneath a tree, outside health care centres.1330

To be able to help patients within their community, Grandmothers undergo a six-month training course. The key competencies required to join are an ability to read and to use a mobile phone. In addition to receiving valuable capacity-building, Grandmothers earn a monthly allowance. Through their community involvement, they gain a sense of achievement and make long-term connections.

Friendship Bench treats individuals with mental health issues without sounding medical or “Western,” so as to make the intervention more acceptable within the community. Indeed, mental health is a taboo topic in Zimbabwe. Individuals with mental health disorders are often seen as possessed, and churches or traditional faith healers exorcise those suffering from mental health disorders. As such, the organisation refers to anxiety and depression through the Shona vernacular, as kufungisisa (“thinking too much”). Moreover, the first intervention when joining a Bench is called kuvhura pfungwa (“opening the mind”).1331 In this first intervention, the Grandmother invites the client to talk about their worries and problems. The Grandmother selects specific problems to focus on and further expand on; she avoids sounding like she is performing a medical intervention. Grandmothers can also share their experiences and create special ties with the patients, to help them achieve a sense of belonging.

Initially set up as a self-funded initiative, Friendship Bench now receives external funding, which has allowed the organisation to expand rapidly in various areas of the country and abroad. There are now 250 Benches in Zimbabwe. Additionally, local volunteers are developing Friendship Benches in Botswana, Kenya, Malawi and Zanzibar, with each country developing its specialisation. For example, Malawi’s Benches focus more on HIV clinics, while the Kenyan Benches focus their work primarily around tea plantations.

Friendship Bench has thus far recorded commendable results. A 2012 research study conducted with over 500 individuals with depression found that, after they had used Friendship Bench for six months, prevalence of depression was less than 10%.1332 Moreover, Friendship Bench can also provide beneficiaries with access to incomegenerating activities, such as through learning to crochet items or producing bags to sell.

Furthermore, Friendship Bench had to learn how to communicate with and involve community members. For example, the Benches were initially called “Mental Health Benches,” and this put off many clients. Meanwhile, part of Friendship Bench’s success lies in it is cheap and simple nature and the fact that it is led by the community. The fact that Friendship Bench does not address mental health from a Western perspective takes away the stigma related to it. Moreover, many practitioners were sceptical of the intervention initially, as it was not evidencedbased; however, research has proven it to be an effective approach to improving mental health. Friendship Bench thus demonstrates the importance of understanding the community’s needs and involving women in health-related issues.