The Grandmothers Helping Solve Africa's Mental Health Crisis with Esther Tumbare

[00:00:00] You're listening to the Unlocking Africa. I've been working in the public health field for over 25 years. Started my career working in the clinical space but wanted to go into public health. What we know from the data is that mental ill health is the biggest problem in terms of disability in individuals.

[00:00:23] The next step would be having the training materials incorporated in the training of community health workers. I have been blown away by how much interest there's been in this model in many, many different parts of the world. Stay tuned as we bring you inspiring people who are unlocking Africa's economic potential.

[00:00:46] You're listening to the Unlocking Africa podcast with your host, Terser Adamu. Welcome to another episode of the Unlocking Africa podcast where we explore the ideas, innovations and strategies that are unlocking Africa's economic potential. When we talk about Africa's development priorities, conversations often focus on infrastructure, energy, agriculture or technology.

[00:01:15] But there is another challenge affecting productivity, economic participation and quality of life across the continent that receives far less attention. That is mental health. One organization helping to address this challenge is Friendship Bench. Founded in Zimbabwe, Friendship Bench has trained thousands of community health workers,

[00:01:39] supported hundreds of thousands of people and expanded its model across multiple countries by reimagining how mental health care is delivered. By reimagining how mental health care is delivered. Joining me today is Esther Tumbare, CEO of Friendship Bench. Esther leads the organization's efforts to scale one of Africa's most recognized healthcare innovations

[00:02:06] while working closely with governments, health systems and local partners to make community-based mental health care accessible at scale. Esther, welcome, welcome, welcome to the Unlocking Africa podcast. How are you? I'm fine and thank you for having me. It's an absolute pleasure to have you on the podcast. And as always, I like to start from the beginning. So I was hoping you can give us an introduction into who Esther Tumbare is.

[00:02:35] Sure. I am the current CEO for Friendship Bench. I am a public health specialist and physician. I've been working in the public health field for over 25 years. Started my career with, you know, working in the clinical space, but wanted to go into public health because I wanted to have more impact on bigger populations

[00:03:03] rather than the patients sitting in front of me. I have a huge passion for mental health because I believe it's very critical to the overall well-being of individuals. I'm a Zimbabwean and lived in Southern Africa most of my life. And I feel like I've made a lot of influence in terms of the public health space in Southern Africa.

[00:03:29] When people think about Africa's development priorities, mental health rarely makes the list. Why do you think mental health remains such an overlooked issue despite its impact on productivity, education, employment and economic development? I think several things.

[00:03:49] The first thing is that there is not a lot of awareness about what mental health is and what mental well-being is. But there's also not enough recognition of the impact of well-being and overall performance, even when it comes to contribution to the economy of countries and that kind of thing.

[00:04:20] There's not the realization that even when people are physically ill, the mental health aspect of an individual is so important in terms of, you know, their outcomes, you know, the best outcomes. So being in the right state of mind is so important for everything. But there's not enough awareness even, not just amongst communities themselves,

[00:04:49] but also amongst the policymakers and, you know, gatekeepers to resources that are devoted to mental health. In practical terms, what does that shortage actually mean for individuals, families and communities? Yeah. I mean, when you think about the population of Zimbabwe, for example,

[00:05:11] I think currently we have about 16 million people living in the country and probably less than 20 psychiatrists, probably about 15 or 16 psychiatrists. Even when they are there, only accessed by people who are of higher economic standing, whereas the bulk of Zimbabweans, much, much, actually much lower income, you know,

[00:05:37] live in the rural areas and the psychiatrists are based at the hospitals in the bigger towns. And these people, the psychiatrists that are available are based at hospitals and not in the communities, whereas the bulk of mental health issues happen within communities where people have no access.

[00:06:01] So the short answer to your question is there is very little access to specialised care within the country, as is the case in many medium to low income countries. So what has been the impact that you've seen when practitioners are placed within the community?

[00:06:23] So the first thing is that this obviously enables more access to mental health services for communities. But in addition, it kind of normalises mental health. I mean, if services are being provided by lay people, community health workers,

[00:06:49] it is much more acceptable for people to access them than if they are, for example, having to go out and see a psychiatrist. So it has been beneficial in those ways, but it has also resulted in an increase in social cohesion and, you know, the coming together of communities and returning back to where we used to be in the past,

[00:07:17] where communities were much more supportive of each other. So there's been multiple, multiple benefits that have come from this innovation. Mental health is often treated as a healthcare issue. Would you say policymakers should be thinking about it more as an economic issue? Absolutely.

[00:07:41] I think right now what we know from the data is that mental ill health is the biggest problem in terms of disability in individuals. What people don't seem to understand is that people can only be productive if their mental health is in a good state, if they're able to, you know, to work. Productivity is increased.

[00:08:11] It is also important, for example, for children who are in school, for them to do well in terms of their exams and be able to progress and, you know, get the necessary skills that they need to be able to function and to be able to do, to be employed and do their jobs well. There's also a huge loss when, you know, suicide, through suicide.

[00:08:36] We've had suicide rates in the world have gone drastically, increased drastically recently because of the conflicts and because of the environment in which we are living. And a lot of the people that commit suicide are people in their productive years who should be contributing towards the economy. So I think the policymakers and the people that are responsible

[00:09:03] for deciding where resources go should really be thinking about mental health as an economic issue rather than just a health issue. One of the things that makes Friendship Bench so interesting is that rather than waiting for more psychiatrists or psychologists, you've fundamentally rethought how mental health care is delivered. So for listeners hearing about it for the first time,

[00:09:32] what makes the model fundamentally different from traditional approaches to mental health care? Traditionally, mental health has been very specialist focused. Psychiatrists, the psychiatric nurses, the psychologists who have provided care. But what we know in Africa is that we do not have enough specialists to provide care. What we did in Friendship Bench is to put up the question,

[00:10:01] can other people that are lay people be trained to be able to do the same thing that is being done by the doctors and the nurses, given the fact that the majority of people that have mental health challenges are in the mild to moderate aspects of mental health? And we went ahead to test this out by evidence,

[00:10:29] by actually doing randomized controlled clinical trials, looking at the care provided routinely by doctors and nurses versus care provided by trained lay providers, and found that they provided a better job than the doctors and nurses. delivery agents were specifically selected to be the grandmothers.

[00:10:56] And for a reason, grandmothers happen to have, you know, to be wise, to have lived experience and to be respected members of their communities. Even traditionally, Africans have always looked to our elders for support, for guidance. And we found that it is much more acceptable and it normalizes mental health,

[00:11:23] seeking mental health support when it is coming from someone who is not a doctor or a nurse who's dressed in a nurse's uniform. Our approach, therefore, in summary, uses a task-shifting method, which has not been done in the past. It is simple. It uses resources that are already available within communities.

[00:11:48] And I think the one thing that we also did that has made this a huge success is we used, we institutionalized the method. We used systems that are already existing in Zimbabwe in terms of the primary health facilities, centers within the community that are already there. We did not create a parallel system to try and implement this

[00:12:14] because the aim was always in the long run to ensure that we implemented to scale and that we were able to reach everyone in the country. And that's why this has been so successful. It's simple, it's replicable, and it uses, you know, already existing systems. The grandmothers are kind, they're empathetic, they are wise, and they have the time and they actually find a lot of joy in doing this for their communities.

[00:12:43] So they are benefiting as well from this initiative in the same way as the guys that are sitting on the bench are benefiting. The grandmother approach is something that I really like because it shows that Friendship Bench is deeply rooted in local culture and community trust. So how important would you say that the local context has been in achieving the outcomes you've seen so far?

[00:13:12] It's been really critical. First of all, we had to identify individuals that would be accepted by the community in terms of who provides the services. And, you know, grandmothers, whether these services are being provided to adults or they are being provided to young people, through our evidence, our scientific evidence,

[00:13:39] we've demonstrated that these are individuals that are acceptable to communities. The other thing that we have thought about is where the services should be provided. So the context in our environment was also critical. And out in the community, at community halls, under trees, in the, you know, in the yard of the grandmothers, churches, you name it, sessions have been provided.

[00:14:07] It's also been critical to consider the language that is used in describing mental health distress. We have kept away from the traditional wording of depression, bipolar affective disorder, and, you know, that are very scary to individuals and they're very stigmatizing. To use in language that is normal day-to-day language,

[00:14:35] like kufungisisa literally means overthinking, to describe, you know, stress, to describe anxiety and depression. And this kind of language allows for people to come forward because who doesn't overthink? We are all faced with challenges on a day-to-day basis. And it helps when we have a safe space where we are able to unload and talk about what it is we're going through

[00:15:04] and have someone who is there to support, to uplift and help us to think through our challenges and come up with our own solutions. I guess it's safe to say that creating an effective intervention is one challenge, but scaling it across communities, health facilities and countries is something entirely different.

[00:15:28] So what operational challenges have emerged when you move from helping thousands of people to helping hundreds of thousands? Yeah, first of all, like I said, to be able to scale to the extent that we have had to scale, one would really need to think about the systems that are already there. So negotiating with the government and ensuring that, you know,

[00:15:57] we have the buy-in of the government itself, as well as the buy-in of communities to be accepting of these services, addressing the skepticism that comes from other health practitioners and the world in general, that this is an intervention that works, required for us to demonstrate and to show the scientific evidence, both to the Ministry of Health and as well as to the world.

[00:16:25] And even for us to be able to scale needed resources, and we had to, you know, constantly be fundraising from our wishes to get the money to do so. As you say, it's one thing to start off with an innovation, and it's another to go on to a stage where you are generating the evidence. But for you to scale, there are multiple resources that are needed in terms of training people,

[00:16:53] in terms of supervising people, and ensuring that the quality of the services that are provided is of the highest standard. And this requires for there to be appropriate data systems in place for you to collect the data and to analyze it. So obviously, you know, challenges in terms of having the money. Last year was a particularly difficult year for development work for everybody.

[00:17:21] We had to find innovative ways to continue to provide services and supervise the grandmothers as they provide the services, ensuring that the data is of the highest quality so we can continuously monitor and ensure we are, you know, reaching impact and there is reduction in depression for our clients. So it's also a challenge.

[00:17:45] And then reaching certain populations, such as men, who, as you know, are not very good at seeking health services, has been another challenge. And so we've had to do targeted interventions to attract men to come forward and access these services. So all of these were, you know, right now we're in the process of trying to ensure we're reaching every corner of the country.

[00:18:15] And as has been the intention right from the beginning to engage with the government so that they become the doer and payer at scale. And as you know, government's commitment to resources for mental health, finances, budgets for mental health, and to get that to happen takes a lot of time and influence and persuasion and, you know, advocacy.

[00:18:44] So those are some of the challenges that we've had in moving this to scale. You touched on something quite important, which was ensuring quality is maintained. How do you ensure quality, consistency and impact as the model expands into different communities and environments? Yeah. So first of all, we do have a training curriculum for our grandmothers.

[00:19:13] So they undergo training before they are deployed to start doing the work. There is ongoing supportive supervision from teams that are placed in the districts and the provinces where the grandmothers are implementing.

[00:19:30] And as they provide services for our clients, there is continuous, you know, checking of even as they do the sessions on the bench to see that they're staying according to protocol. As they were initially trained. We also collect data to check the baseline of depressive symptoms. We have a questionnaire that the grandmothers use to assess.

[00:20:00] And then we have periodic times where we check and see whether there has been a reduction in depressive symptoms over time. We do a six-week follow-up. We do a six-month follow-up. And then we also do a select number of clients at one year just to check and see if there has been sustained reduction in symptoms.

[00:20:26] We are constantly measuring how many people are reached, how much time we've spent on the bench. We are constantly measuring, you know, assessing who they are reaching. What are the sort of, you know, problems that people are coming on the bench with. And we are constantly checking in with the grandmothers themselves in terms of, you know, their own sense of well-being and fatigue in terms of, you know, listening to people.

[00:20:55] So the role of the, and then there is also a bi-directional referral where if they encounter clients that they feel much more severe or have symptoms that are concerning,

[00:21:11] things such as suicidal ideation or, you know, psychotic features, that is a clear and fair pathway to much higher care with the, you know, with specialists that are, you know, doctors or nurses that have higher training in mental health. The role of the, you know, doctors has continued to be, to supervise and ensure fidelity in the implementation of, of the model.

[00:21:40] And then that has been working really well. We know that scaling is not an easy task. So as CEO, what would you say keeps you awake at night when you think about scaling? Yeah, of course, money.

[00:21:57] You know, traditionally resources dedicated to mental health, whether it be by governments, but also even in the development world have not been a lot. There are other crises in the world that take away money. There's conflict in the world.

[00:22:46] You know, expansion of the world that we do. If we are not sure whether we will have the funding that we need. So we're always grateful when a funder give us multi-year funding because it allows us to better plan what we'll be doing in, you know, in future years. But that doesn't always happen. A lot of times you just get a year or two years of funding. So that definitely keeps me awake at night.

[00:23:12] And of course, what also keeps me awake is are we going to be able, as we hand over to governments and, you know, is our plan moving forward, whether we will continue to have the quality and fidelity to what we set out to do and that our vision and mission will be maintained over time. Thank you for that.

[00:23:40] What's particularly interesting is that Friendship Bench doesn't view scale as simply opening more sites or hiring more staff. A significant part of your strategy involves working through existing public health systems. So what have you learned about building meaningful partnerships with public health systems?

[00:24:02] Yeah, I mean, I spent a lot of my professional years working in the TB and HIV field. And as you know, because, you know, it was considered an emergency. I mean, there was even a presidential emergency fund for Aging Leap, PEPFA. And parallel systems were designed because everyone was worried about the deaths that were occurring.

[00:24:30] The same thing that, you know, that happened with COVID came into place. So I think the beauty of working within existing systems is it allows you to plan for sustainability. And we have a great working relationship.

[00:24:51] So building a working relationship at the national level, getting the Minister of Health by an engagement right from the beginning, but not just at the national level, but also at the subnational level, the provincial, the district, even down to the site level. And ensuring that there's feedback and, you know, you're sharing the data and so on is really critical.

[00:25:21] What we've also found is there was no tools, there were no existing tools that were there for monitoring the implementation of service delivery for mental health. And we worked with the government so that the tools were government owned and that they became part of the national health monitoring system for data monitoring.

[00:25:46] So that even as at a time when Prince of Bain transitions out, there is ownership and ability to be able to monitor to see what is going on.

[00:25:59] The other thing that we've worked very closely with the government is a policy in terms of ensuring that our approach in the community is incorporated in national health policies and that we've been successful in doing that.

[00:26:16] And even working with the government in the rising of the national mental health act that was outdated, you know, it was 10 years old and still had a lot of prohibitive, you know, language and, you know, things that did not allow for lay people to be able to provide services for mental health services for their peers.

[00:26:42] And so engagement with communities, engagement with government and the gatekeepers to health services has been critical in ensuring that there's a greater chance of sustainability of implementation of this model. The governments are a huge partner. And you mentioned handing ownership of the model to government systems.

[00:27:09] Why was that such an important strategic decision? Because the vision of Friendship Bench was to have a friendship bench within walking distance of everyone in the country. The owners of the health system in any one country are the government, the Minister of Health.

[00:27:31] And if you are not going to engage with the Minister of Health in your implementation of this model, then the chances of getting to scale and reaching every corner and everyone within the country is not going to be real. And so, yeah, that's why it was so critical for us to ensure that we have, you know, the buy-in of the government.

[00:28:00] So what does successful integration into a national health care system actually look like to you? So in addition to incorporation of the model in the actual guidelines, the national guidelines of the country,

[00:28:18] I think the next step would be having the training materials or the friendship bench in a box training incorporated in the training of community health workers that are part of the government establishment so that, you know, it becomes routine. It becomes part of what happens, you know, when they are trained.

[00:28:46] And so it doesn't go away. It's institutionalized. The other component that we're still working on is to ensure that there is a dedicated budget for the implementation of this model in terms of the training, in terms of the support and supervision, the M&E tools, the continuous learning,

[00:29:11] the quality improvement over time, service delivery, and so on. And that is, you know, what we feel is critical. We are also at this moment just partnered with UNESCO for the higher and tertiary institutions with the recognition that the mental well-being of our young people in higher and tertiary institutions

[00:29:38] and generally young people in the country has been worsening over time. Suicide rates are going up. There's a lot of, you know, the media, the cyberbullying, the use of drugs and so on, the pressure on young people to succeed, the lack of jobs, you know, unemployment, finishing school and they can't find jobs and that kind of thing.

[00:30:05] And there isn't enough access for young people to mental health services. So what we are doing is not just to ensure there's a friendship bench available at all these higher and tertiary institutions. I think we have 52 of them in the country. But also to ensure that the model is institutionalized in the training curriculum for the staff at the schools, as well as for the students themselves.

[00:30:32] And that, you know, it becomes part and parcel of what is a requirement for the general well-being of students who are attending these institutions. So, you know, and that the schools have a dedicated budget to be doing this over time. So I think those are the elements that I think are critical as you institutionalize. In many situations, the government adoption comes down to one critical question,

[00:31:02] which is can the model deliver meaningful outcomes at a cost that is sustainable? But with this in mind, how should policymakers think about the economic cost of untreated mental health challenges? Yeah, so I think for us, one thing that we have been doing over time is to assess the cost to the treatment of one client using this model

[00:31:29] and see in what ways we can continue to reduce this cost without compromising on the quality of the services that are provided. So simplifying the model as much as possible. And also, you know, even the supervision of the grandmothers as they are providing the services, what is required?

[00:31:55] How many sessions are actually needed for someone to, you know, to feel like they are now OK? Because, you know, in our original model, we were doing six sessions. But on the ground with practical implementation, we're finding that often clients don't need as much as six sessions to be able to feel OK. And that once they have learned those skills to be able to work through a problem,

[00:32:23] they're able to do it on their own without having, you know, someone to sit down with them. So the cost has been going down over time. And obviously, as we hand over to government and we institutionalise the training and the supervision and so on and so on, we expect the cost to go lower and even more lower over time.

[00:32:48] And then comparing that cost of resolving that with the actual losses that are happening and doing some kind of modelling and, you know, cost effectiveness and that kind of thing with a comparison on the loss that is happening through, you know, people with disability that is caused by mental ill health, losses to life, you know, through suicide and so on.

[00:33:18] And it's something that I think, you know, as we discussed with government, those models and, you know, that kind of comparison might be the tipping point in terms of real persuasion for governments to take, you know, mental health seriously. One aspect of the model that stands out to me is the circle. Is it Kubatana Tose? Do I get the pronunciation right? Yes. Fantastic.

[00:33:47] Which combines peer support with income generating activities. How important is the economic empowerment to long term mental well-being? It's very important. In fact, we added this portion to the model because we had identified that lack of poverty and not being able to have the resources for livelihood

[00:34:17] is a key driver of depression and anxiety amongst our people. A lot of people who sit down on the bench do so because they are failing to provide for their families. And so we incorporated this aspect of livelihoods to address that where, you know, individuals that live in this community come together to work on a project that is income generating.

[00:34:45] And whilst in the beginning, we were actually giving a small amount of money, you know, maybe $50 for the start-off fund. Over time, we found that, you know, asset mapping amongst individuals who are in these groups actually resulted more success in the sustainability of these groups. In which case, you know, each one of the members will identify what it is that they have that they can bring to the group.

[00:35:14] We might be wanting to start a project on, you know, selling vegetables, for example. And one person might have a piece of land. The other person might have access to seedlings. A lot of them will have, you know, the labor required to dig up and, you know, to sow the seeds. And another person has manure or fertilizer.

[00:35:36] And, you know, when they bring together their assets, they're able to produce something and, you know, be able to raise income to raise their families. And this has been incredible, you know, also as a way of preventing further anxiety and depression. So it's a preventative method as well. People love being in these groups and a lot of people who are at the brink of, you know, ending their lives, they've come back.

[00:36:06] But when you talk to them and you ask them what has been the most benefit, of course, they talk about, yes, now I'm able to generate income and contribute to, of course, to the overall success of the country. But, you know, for my family as well. But they also talk about how they feel like they're part of something great, that this has brought communities together, that they feel like they have friends. They are not alone.

[00:36:36] They don't feel lonely anymore. They have people to talk to. There's people that check on them when they're sick. And there's overall our communities are becoming more cohesive. There's more, you know, generally a happier kind of community in addition to, you know, the income generating, which is really great.

[00:36:58] With the great work that you're doing, what started as a locally developed solution is increasingly becoming recognized internationally. So at what point did you realize the model had relevance beyond Zimbabwe? Well, you know, people from outside of the country have been watching and they've seen the randomized clinical trials. They've read the paperwork. The evidence is there.

[00:37:28] We've presented at conferences. And it has really been the people from outside of the country that have come forward and said, this is a simple solution that can be duplicated in our countries as well. And as we have thought about it, we realized that there were countries that were facing the same challenges as we are facing.

[00:37:54] And the resources that we have in Zimbabwe are present in those countries as well. There would be need, of course, to contextualize the innovation in those environments to ensure that we are meeting what the communities in those environments need.

[00:38:15] But there's a basic things that are there that can be replicated very easily in terms of, you know, task shifting from specialized care to lay people, in terms of, you know, providing training and supervision, in terms of ongoing data collection and continuous improvement using what you are learning.

[00:38:37] What we just needed to be done would be to ensure that the language that is used is appropriate for the context. And so, you know, whilst in Zimbabwe, we're using, you know, Shona and Debele languages that are, you know, that are not scary. The same way those languages, you know, we can translate the language to wherever we're going.

[00:39:04] And we actually have a team of trainers that are throughout, you know, the world that have undergone the friendship range training and can assist with training in individual countries in the languages in those countries. So it's been translated to, you know, French, to Portuguese, to Arabic, to, you know, multiple different languages that are, you know, out there in the world.

[00:39:32] And so what is just be needed for adaptation in different locations is to identify who would be the delivery agent. It might not necessarily be a grandmother. It might be other peers, you know, other community members. It might be like in Vietnam, it's, you know, many MSM providing support to other MSM. But the concept is the same. You're task shifting.

[00:40:01] You know, you are giving a structured training. You are monitoring for impact. You are monitoring for reduction in depression. And so this can be done anywhere else. And, you know, I initially thought it was a good model for resource-limited settings. But I actually found that the model is actually welcomed and important, even in countries where resources are there.

[00:40:31] Like, you know, we have a presence in the UK, in the United States, in Germany, and so on. And it's because it normalizes mental health and it allows for, you know, people that are non-specialists to be able to support each other. And it's very community driven. And that is the way that we should be going.

[00:40:54] So what would you say you've learned about adapting the solution or model to different cultural and healthcare environments, also without losing what makes it effective? I think what has been important was obviously the evidence. I think nobody was going to...

[00:41:14] It can be innovative, but if you don't have proof of, you know, effectivity through research studies to show that it works, that you can task shift and, you know, you can get quality services being provided by non-specialists, I think has been important.

[00:41:37] But also adjusting to the context, wherever you're going, there is an assessment that is needed to check and see, you know, where would it be ideal to provide these services in those contexts? Would it be in the same places in the communities that we provide our services? A lot of people in the Westernized world have decided that, you know, parks are the best place to do it.

[00:42:03] And, you know, there are certain things that are to do with the model that are non-negotiable, that are critical to the concept, which is one, task shifting. Two, ensuring that training is... quality training is provided. Three, that there's ongoing monitoring and evaluation to check and see if there's a reduction in depression as, you know, you're meeting your objective. And that there's continuous learning that is available there,

[00:42:33] and you're using the language that is culturally relevant to, you know, the environment where you're working. And those have been, you know, the critical things. And I have been blown away by how much interest has been in this model in many, many different parts of the world. So if we begin to look ahead and think about the bigger opportunity,

[00:43:00] if we were to have this conversation in 10 years from now, what would success look like for you for a friendship bench? For me, for the organisation in particular, as in friendship bench, I think what success would look like in 10 years is that we have reached what we intended to do, which is having a friendship bench within walking distance for everyone in the country, in Zimbabwe,

[00:43:30] that these services are freely available and that they're being utilised by our people. And that we're maintaining the quality of the services in Zimbabwe. But it would also be that there is an adaptation of this model to multiple places in the world. In particular, because I understand how similar our challenges are across Africa,

[00:43:58] I would like to see governments in Africa adopt this model. Because I know, you know, having worked in multiple countries in the region, that our challenges are very, very similar in terms of the lack of availability of specialists.

[00:44:18] And actually, it is not necessary for us to have doctors and nurses be the providers of these services. Their work should be focused on more severe mental health issues and the supervision and maintaining of quality of services.

[00:44:38] The success of this model is not just in terms of, you know, the task shifting and in terms of increasing access, but it is also the importance in promoting social cohesion and bringing back the values that we had as communities in the past. We're having communities supporting each other on a day-to-day basis

[00:45:06] and coming together as communities and uplifting each other and, you know, that kind of thing. And so for me, having many more countries adopting this, but having the model successful and reaching scale in Zimbabwe, I would be, you know, what I would call success. And for us, obviously, to be continuing to generate scientific evidence

[00:45:32] that informs the mental health space, even at that time, I think would be success for me. As people, we often have quotes, mantras, African proverbs, or even affirmations that keep us going when times are challenging or when times are good. Do you have one that you could share with us today?

[00:45:55] I would like to repeat something that one of our beneficiaries actually said to me, which is that we thought we were poor in Africa, but we've always had the resources that we need to be able to be successful. And some of the best solutions do come from places you don't expect,

[00:46:24] which, you know, this solution that is impacting the world has come from a humble, very humble beginning in Africa and Zimbabwe. Perfect. That is a very fitting way to close today's great conversation. For me, what stands out is that Friendship Bench is about much more than just mental health. It's a powerful example of how African innovators are rethinking service delivery

[00:46:52] by building solutions that are powerful, but also affordable and can be scaled through existing systems. So it's been an absolute pleasure. No, thank you. It's been a pleasure talking to you too. Thank you. Fantastic. Thank you. And we will speak soon. Thanks. Bye-bye. Thank you to everyone who has listened and stayed tuned to the podcast. If you've enjoyed this episode, please subscribe, share or tell a friend about it.

[00:47:21] You can also rate, review us in Apple Podcasts or wherever you download your podcast. Thank you and see you next week for the Unlocking Africa podcast. Unlocking Africa podcast.