Costs and Cost-Effectiveness of Shamiri, a Brief, Layperson-Delivered Intervention for Kenyan Adolescents: RCT

Shamiri is a cost-effective method that can significantly reduce depression and anxiety. Non-expert providers can offer this effective treatment with just 10 days of training, compared to the several years required to become a licensed mental health provider.
Cost of delivery
Cost for clinically meaningful change
Hours of training for Shamiri Fellows
Weekly sessions


Low- and middle-income countries (LMICs) have the highest socio-economic burden of mental health disorders, yet the fewest resources for treatment. Recently, many intervention strategies, including the use of brief, scalable interventions, have emerged as ways of reducing the mental health treatment gap in LMICs. But how do decision makers prioritize and optimize the allocation of limited resources? One approach is through the evaluation of delivery costs alongside intervention effectiveness of various types of interventions. Here, we evaluate the cost-effectiveness of Shamiri, a group– and school–based intervention for adolescent depression and anxiety that is delivered by lay providers and that teaches growth mindset, gratitude, and value affirmation.


We estimated the cost-effectiveness of Shamiri using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guidelines for economic evaluations. Changes in depression and anxiety were estimated using the Patient Health Questionnaire (PHQ-8) and Generalized Anxiety Disorder questionnaire (GAD-7) at treatment termination and 7-month follow-up using two definitions of treatment benefit. Cost-effectiveness metrics included effectiveness-cost ratios and cost per number needed to treat.


Base case cost assumptions estimated that delivering Shamiri cost $15.17 (in 2021 U.S. dollars) per student. A sensitivity analysis, which varied cost and clinical change definitions, estimated it cost between $48.28 and $172.72 to help 1 student in Shamiri, relative to the control, achieve reliable and clinically significant change in depression and anxiety by 7-month follow-up.


Shamiri appears to be a low-cost intervention that can produce clinically meaningful reductions in depression and anxiety. Lay providers can deliver effective treatment for a fraction of the training time that is required to become a licensed mental health provider (10 days vs. multiple years), which is a strength from an economic perspective. Additionally, Shamiri produced reliable and clinically significant reductions in depression and anxiety after only four weekly sessions instead of the traditional 12–16 weekly sessions necessary for gold-standard cognitive behavioral therapy. The school setting, group format, and economic context of a LMIC influenced the cost per student; however, broader conclusions about the cost-effectiveness of Shamiri have yet to be determined due to limited economic evaluations of mental health programs in LMICs.

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Research Informs Our Work

See below on how research guides us every step of the way:

Science can help us shape the future

The goal of our research is to develop interventions that can help youth actualize their life outcomes, identify which interventions work and why, and develop and test novel and accessible approaches to dissemination and scaling in order to maximize our impact.

Open science

Open science allows us to collaborate and share our work with the world. Our data and publications are open access.

Multicultural collaboration

Multicultural and interdisciplinary collaboration amplifies the communities that we serve.

Contextualized research

Research is not done in a silo. It is done with and for communities. Context matters.

"Culture brings us together, and allows us to remain successful across many generations of Shamirians. It is what makes us unique."

Tom Osborn
Founder & CEO | Shamiri