Mental health financing challenges, opportunities and strategies in low- and middle-income countries: findings from the Emerald project
Dan Chisholm,
Sumaiyah Docrat,
Jibril Abdulmalik,
Atalay Alem,
Oye Gureje,
Dristy Gurung,
Charlotte Hanlon,
Mark J. D. Jordans,
Sheila Kangere,
Fred Kigozi,
James Mugisha,
Shital Muke,
Saheed Olayiwola,
Rahul Shidhaye,
Graham Thornicroft,
Crick Lund
Affiliations
Dan Chisholm
Health Systems Adviser, Department of Mental Health and Substance Abuse, World Health Organization, Switzerland
Sumaiyah Docrat
Research Officer, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa
Jibril Abdulmalik
Consultant Psychiatrist, Department of Psychiatry, University of Ibadan, Nigeria
Atalay Alem
Professor of Psychiatry, College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, Ethiopia
Oye Gureje
Professor of Psychiatry and Director, WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Substance Abuse, Department of Psychiatry, University of Ibadan, Nigeria; and Professor Extraordinary, Department of Psychiatry, Stellenbosch University, South Africa
Dristy Gurung
Research Coordinator, Transcultural Psychosocial Organization (TPO) Nepal, Nepal
Reader in Global Mental Health, Health Services and Population Research Department, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and Adjunct Associate Professor, Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, Ethiopia
Reader, Health Service and Population Research Department, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and Senior Advisor, TPO Nepal, Nepal
Sheila Kangere
Research Officer, Butabika National Referral and Teaching Mental Hospital, Uganda
Fred Kigozi
Professor of Psychiatry, Butabika National Referral and Teaching Mental Hospital, Uganda
James Mugisha
Research Officer, Butabika National Referral and Teaching Mental Hospital, Uganda
Shital Muke
Research Fellow, Public Health Foundation of India, Bhopal, India
Saheed Olayiwola
Lecturer II, Department of Economics, Federal University of Technology, Nigeria
Rahul Shidhaye
Research Coordinator, Public Health Foundation of India, Bhopal, India; and CAPHRI School for Public Health and Primary Care, Maastricht University, the Netherlands
Graham Thornicroft
Professor of Community Psychiatry, Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
Professor of Public Mental Health, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa; and Professor of Global Mental Health and Development, Health Services and Population Research Department, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
BackgroundCurrent coverage of mental healthcare in low- and middle-income countries is very limited, not only in terms of access to services but also in terms of financial protection of individuals in need of care and treatment.AimsTo identify the challenges, opportunities and strategies for more equitable and sustainable mental health financing in six sub-Saharan African and South Asian countries, namely Ethiopia, India, Nepal, Nigeria, South Africa and Uganda.MethodIn the context of a mental health systems research project (Emerald), a multi-methods approach was implemented consisting of three steps: a quantitative and narrative assessment of each country's disease burden profile, health system and macro-fiscal situation; in-depth interviews with expert stakeholders; and a policy analysis of sustainable financing options.ResultsKey challenges identified for sustainable mental health financing include the low level of funding accorded to mental health services, widespread inequalities in access and poverty, although opportunities exist in the form of new political interest in mental health and ongoing reforms to national insurance schemes. Inclusion of mental health within planned or nascent national health insurance schemes was identified as a key strategy for moving towards more equitable and sustainable mental health financing in all six countries.ConclusionsIncluding mental health in ongoing national health insurance reforms represent the most important strategic opportunity in the six participating countries to secure enhanced service provision and financial protection for individuals and households affected by mental disorders and psychosocial disabilities.Declaration of interestD.C. is a staff member of the World Health Organization.
