Are government or non-governmental organization staff more effective in delivering frontline mental health services? Evidence from a culster randomized controlled trial
Large treatment gaps in mental health services exist in low- and middle-income countries. While low-intensity psychological interventions delivered by non-specialists show promise in closing this gap, evidence is limited regarding whether government health systems can scale these services effectively. Utilizing a randomized controlled trial across 222 villages in Tigray, Ethiopia, we compare the effectiveness of a psychological intervention, group Problem Management plus (gPM+), delivered in five sessions using two distinct platforms—government-employed Health Extension Workers (HEWs) and NGO-stipended local facilitators (LFs)—vis-a-vis a control arm that receives no intervention. At the one-month follow-up, we find that gPM+ significantly reduces adverse mental health symptoms (particularly depression and anxiety) across both delivery arms, and the intervention is more effective when delivered by LFs (0.22 SD) compared to HEWs (0.11 SD). However, at the 12-month follow-up, treatment effects largely attenuate to zero (mainly due to spontaneous recovery in the control arm) and we find no impacts on child development. The cost per month of depression averted is lower for LFs (PPP $120) vis-a-vis HEWs (PPP $145 to $162, depending on whether HEW time is costed). These findings show that low cost psychological interventions can effectively reduce adverse mental health symptoms in the short term when delivered through both government and NGO platforms, but NGO platforms are slightly more cost-effective.
Authors
Hidrobo, Melissa; Deyessa, Negussie; Getahun, Tigabu; Gilligan, Daniel O.; Hailemicheal, Adiam Hagos; Leight, Jessica; Mulford, Michael; Zafar, Sarim
Citation
Hidrobo, Melissa; Deyessa, Negussie; Getahun, Tigabu; Gilligan, Daniel O.; Hailemicheal, Adiam Hagos; et al. 2026. Are government or non-governmental organization staff more effective in delivering frontline mental health services? Evidence from a culster randomized controlled trial. IFPRI Discussion Paper 2450. Washington, DC: International Food Policy Research Institute. https://hdl.handle.net/10568/185915
Keywords
Africa; Sub-saharan Africa; Eastern Africa; Mental Health; Government; Nongovernmental Organizations; Interventions; Randomized Controlled Trials
Access/Licence
Open Access