Treating depression at scale

How StrongMinds’ scaling success helps women across Africa lead healthier, more productive and satisfying lives

Depression is the most prevalent mental illness in the world.  Nowhere is this more evident than in Africa, where approximately 100 million people suffer from the disease [1], costing the economy roughly U.S. $5 billion a year.

For African women – who are afflicted at twice the rate of men – depression is the number one cause of disability. Compared with her healthy peers, a woman with depression is more likely to miss work, experience physical pain, and struggle to care for her children. They are also less likely to take full advantage of healthcare or livelihood programs offered by NGOs, rendering those initiatives less effective. Yet, due to the lack of investment in mental health services, 85 percent of people who experience depression in Africa – including 66 million women – have no access to effective treatment. [2]

Since 2014, StrongMinds has been providing free, lay counselor-led, community-based group talk therapy for depression to women in Uganda and Zambia.

At the time of initial partnering with Spring Impact in 2018, StrongMinds had already reached over 50,000 depressed women in just four years. Nevertheless, StrongMinds was asking itself:

“How can we deliver depression treatment on a much larger scale, enlisting others across the social, private, and public sectors to reach millions of women and enable them to lead more healthy, productive and satisfying lives? Can we improve outcomes for other NGOs’ development initiatives by layering in StrongMinds’ mental health services?” 

Mapping the right pathway to scale

With these big aspirations and no clear path forward, StrongMinds partnered with Spring Impact to chart its journey to scale.  After gathering initial insights from StrongMinds participants, staff, and key stakeholders, Spring Impact facilitated a series of strategic discussions with StrongMinds to crystallize its impact ambitions and identify its highest potential pathways to scale.

“It’s a very pragmatic approach. We found real value in Spring Impact’s support to us to answer the questions we were already asking ourselves. Spring Impact brings a framework to help break down very big issues and challenges into manageable components.  If you want to analogize it: people get personal trainers to keep them honest. Spring Impact was like our personal trainer for scaling.”

If you want to analogize it: people get personal trainers to keep them honest. Spring Impact was like our personal trainer for scaling.

Our work together helped StrongMinds ultimately decide to shift its core focus to partnership with INGOs and governments throughout Africa as its primary scale mechanism, while still delivering depression treatment directly in Uganda and Zambia.  Equipped with the mindset, tools, and charted path to scale, StrongMinds has set out to test its hypotheses and value to partners in real world conditions, kicking off several pilot partnerships including Grassroot Soccer, AVSI, and PACT.

“When we’ve been asked by prospective partners, donors, and key stakeholders how serious and committed we are about scale, the collaboration with Spring Impact is such an important part of that story. When we’re asked ‘how are you going to do this’ we can say ‘I’m glad you asked – here is our strategy, plan, and tools.’ It’s a moment of pride in how far we’ve come, taking an abstract idea and turning it into a concrete approach to partnership.”

When we’re asked ‘how are you going to do this’ we can say ‘I’m glad you asked – here is our strategy, plan, and tools.’


To date, StrongMinds has significantly increased its impact, providing group talk therapy to more than 500,000 participants. More than 80% of clients are depression-free at the conclusion of treatment, and those results are sustained six months post-treatment. This work has also yielded increases in participant work attendance (16%), family food security (13%), children’s school attendance (30%), and social connectivity (28%).

The team has also achieved further success in urging Ministry of Education and Sports (MoES) officials to place adolescent mental health higher on Uganda’s national education agenda. After continuous ministry liaison with StrongMinds teams, MoES issued a directive to all schools to prioritize learners’ mental health.

Under new procedures, institutions must begin implementing at least one hour of basic counseling and psychosocial support each week. At a minimum, 1% of institutional funds should go to delivering specialized mental health services, and schools are to partner with local providers to ensure all members’ mental well-being. The ministry also recommends teletherapy to tackle depression among staff and students, with StrongMinds Uganda listed in the circular as a suggested toll-free service.

What’s more, the community-based depression treatment model approach pioneered by StrongMinds – which sees local community members trained as non-specialists to provide community-centered mental health support –  has been endorsed by World Health Organization. This increases the number of available individuals qualified as mental health leads, which is particularly vital in low-resourced communities.

“When we first began treating people with depression, each cycle of treatment was 16 weeks. StrongMinds can now provide treatment with the same levels of effectiveness over only 6 weeks, making it easier to reach even more people. StrongMinds has also deployed a task-shifting model, training government and NGO partners to provide therapy, allowing the organization to reach new populations and geographies”.

StrongMinds has been able to reach half a million people because we believe in innovating until we get it right.

Adapting and innovating

Spring Impact’s applied scale methodology has allowed StrongMinds to adapt its strategies to the changing needs and opportunities, while keeping long-term impact aims front and center.

The lean testing principles imparted through this work – which help organizations test their assumptions through real-world experiments – allow StrongMinds to incorporate newer innovations in remote, mobile phone-based therapy and other digital services into its proven approach, which have the strong potential to further enrich partnerships and increase reach.

To discuss exciting partnership opportunities, please contact StrongMinds at [email protected].

For more information on Spring Impact’s support to ambitious teams seeking to scale impact, please reach out to [email protected]

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