What the Friendship Bench means for African and Indigenous knowledge?

The Friendship Bench was developed in Zimbabwe by psychiatrist Professor Dixon Chibanda. He started it in 2006 in Mbare, a township in Harare. He recruited 14 grandmothers who lived near the hospital where he worked and trained them to support people with depression and anxiety.

The model draws on a Zimbabwean practice in which people turned to grandmothers for advice during hard times. Early community research shaped its language. The team used Shona concepts such as kuvhura pfungwa, meaning opening up the mind, which communities understood and which became part of the therapy. The same research led to a change of name from mental health bench to friendship bench, because the first name kept people away. Clients call the counsellors ambuya, the Shona word for grandmother.

What the evidence shows

The model was tested in a randomised controlled trial (RCT) run by the University of Zimbabwe, the London School of Hygiene and Tropical Medicine (LSHTM) and King’s College London. Clients received six one to one sessions of 45 minutes each, held on a wooden bench within the grounds of a clinic.

The results were published in the Journal of the American Medical Association (JAMA) in 2016. Half of the patients who received standard care still had symptoms of depression after the trial, compared with 14 percent of those who used the Friendship Bench. For anxiety, the figures were 48 percent and 12 percent. For suicidal thoughts, they were 12 percent and 2 percent. At the time, Zimbabwe had 10 psychiatrists for a population of about 15 million.

The programme then grew across Zimbabwe. It now works with the Ministry of Health and the World Health Organization (WHO) and has more than 2,000 grandmothers. In 2023, over 220,000 people received therapy through the network. More than half a million Zimbabweans have used a bench since it began.

Where the model is used now

The Friendship Bench now operates in several countries. These include Malawi, Kenya, Botswana, Tanzania and Zanzibar in Africa, as well as Vietnam, Jordan and El Salvador. Early work has started in London, and King’s College London is working to bring the model to the United Kingdom.

In the United States, New York City’s mental health plan names the Friendship Bench as a source for its work on social isolation, and benches have been placed in Harlem, Brooklyn and the Bronx. In Washington, DC, HelpAge USA is piloting the model through the DC Grandparents for Mental Health initiative. A team from Friendship Bench Zimbabwe trained the first 20 grandmothers there.

Researchers at the Centre for Global Mental Health have noted that the New York adaptation shows interventions from low and middle income countries can be adapted for high income countries. In mental health, knowledge has usually moved from the Global North to Africa. In this case, Zimbabwean trainers are training practitioners in the United States.

What this says about African knowledge

African universities and services have long relied on theories, assessment tools and interventions developed in Europe and North America. Much of social work and psychology teaching on the continent still follows this pattern. The usual expectation is that knowledge is produced elsewhere and applied in Africa.

The Friendship Bench shows a different pattern. A model built on African relationships, African language and the role of elders was tested to a high standard, scaled within Zimbabwe and then adopted in other countries, including wealthy cities. Its core features stayed in place as it spread. The grandmothers, the bench and the Shona concepts remain central.

The model also reflects Ubuntu, the idea that a person is a person through kinship, community, environment, society and spirituality. The therapy depends on a trusted elder listening, and on the community accepting her role. In terms of the levels of Ubuntu, the bench connects the individual and family to the community and to wider society, with the grandmother as the point of connection. African philosophy is shaping how the therapy is delivered.

The point for Africa is that we do not need to wait for knowledge from elsewhere. We can develop, test, name and share our own, and expect others to use it.

What this means for Indigenous knowledges globally

Indigenous peoples in Australia, the Pacific, the Americas and Asia have their own systems of care based on elders, kinship, land and spirituality. These systems have often been treated as culture rather than knowledge, or studied by outsiders with little benefit to the communities involved.

The Friendship Bench offers some practical lessons for these systems. Indigenous approaches can meet strict evidence standards while keeping their main features. Elders can be trained and paid as part of the health workforce. Knowledge can also move directly between communities in the Global South, and from South to North, without Western institutions acting as the main channel.

The use of the model in Vietnam, Jordan and El Salvador is as important as its use in New York. These exchanges take place between communities with limited services and strong family networks. This kind of South to South learning needs more attention and more funding.

Risks as the model spreads

The spread of the Friendship Bench raises questions that African and Indigenous scholars should keep in view.

Ownership is one. As the model moves into new countries, it matters who holds the rights, the data and the public credit. Global health partnerships can begin as equal arrangements and end with Northern institutions presenting Southern ideas as their own. The Friendship Bench has kept a clear Zimbabwean identity, but other African models may not.

Adaptation is another. Some versions may keep the bench and the image of the older counsellor but drop the concepts, language and community structures behind the model. Those versions are unlikely to produce the same results.

Funding is a third. During the 2025 freeze on United States foreign aid, Friendship Bench lost funding from the United States Agency for International Development (USAID), including grants for training 45 virtual counsellors. African programmes that depend on foreign funding are exposed to decisions made outside Africa. Investment from African governments, universities and donors is part of knowledge sovereignty.

The place of other Indigenous health knowledge is a fourth. The Friendship Bench uses grandmothers to deliver problem solving therapy. Families also rely on healers, spiritual leaders and religious practices. The success of the bench should help these systems gain recognition, rather than suggest that only knowledge presented as therapy is acceptable.

Implications for social work and development

In African social work education, the Friendship Bench can be taught as an African model in its own right, with its Shona concepts and community origins, before students study imported frameworks. Other African models should be taught in the same way.

Researchers can document, test and publish African and Indigenous approaches using methods that respect the communities involved. Open access African journals make this evidence available to the communities it comes from.

Practitioners and policy makers can start with what already works in communities before adopting outside models. Elders, peer networks and community structures already exist in most places. The Friendship Bench shows what is possible when these are trained, supported and paid.

The wider goal is for Africa to produce and share knowledge as a matter of course. The Friendship Bench should be one of many African models used around the world.