Mapping mental health finances in Ghana, Uganda, Sri Lanka, India and Lao PDR

Abstract

Background: Limited evidence about mental health finances in low and middle-income countries is a key challenge to mental health care policy initiatives. This study aimed to map mental health finances in Ghana, Uganda, India (Kerala state), Sri Lanka and Lao PDR focusing on how much money is available for mental health, how it is spent, and how this impacts mental health services. Methods:A researcher in each region reviewed public mental health-related budgets and interviewed key informants on government mental health financing. A total of 43 key informant interviews were conducted. Quantitative data was analyzed in an excel matrix using descriptive statistics. Key informant interviews were coded a priori against research questions.Results: National ring-fenced budgets for mental health as a percentage of national health spending for 2007-08 is 1.7% in Sri Lanka, 3.7% in Ghana, 2.0% in Kerala (India) and 6.6% in Uganda. Budgets were not available in Lao PDR. The majority of ring-fenced budgets (76% to 100%) is spent on psychiatric hospitals. Mental health spending could not be tracked beyond the psychiatric hospital level due to limited information at the health centre and community levels. Conclusions:Mental health budget information should be tracked and made publically accessible. Governments can adapt WHO AIMS indicators for reviewing national mental health finances. Funding allocations work more effectively through decentralization. Mental health financing should reflect new ideas emerging from community based practice in LMICs.

An overview of the mental health system in Gaza: an assessment using the World Health Organization’s Assessment Instrument for Mental Health Systems (WHO-AIMS)

“…Nevertheless, the hospital consumed a large portion of the mental health budget and mental health staffing. This biased distribution of resources towards a mental hospital is common in most LMICs: funding from the mental health budget directed towards mental hospitals is 80% in Ghana [ 23 – 25 ], 55% in Uganda [ 26 ], and 67% in the whole world [ 27 ].…”

Perceived stigmatization and discrimination of people with mental illness: A survey-based study of the general population in five metropolitan cities in India

“…Moreover, the availability of psychologists, social workers, and psychiatric nurses remains equally low and is too often restricted to urban areas. [ 17 ] One of the central barriers to adequate treatment of mental illness in India is a lack of funding[ 14 18 19 ] leading to ineffective help-seeking behavior and often poorer treatment outcomes, both associated with stigma toward mentally ill patients and their caregivers. [ 14 20 ] Governmental health and social priorities coined by the transition[ 16 ] result in low-spending priorities toward mental health care which intensifies societal and structural stigma toward mental illness.…”

“…[ 14 20 ] Governmental health and social priorities coined by the transition[ 16 ] result in low-spending priorities toward mental health care which intensifies societal and structural stigma toward mental illness. A study in 2010[ 18 ] mapped the mental health spending in several low-middle income countries and found that in the Indian state of Kerala only 2% of the national health budget was allocated to mental health care. To some degree, similar patterns of national financial priorities can be observed in other low-[ 48 49 ] and middle-income countries, and even in high-income countries such as Germany.…”

Kenya's mental health law

“…There is concern, however, about a glaring failure to implement existing legal provisions, which is coupled with lack of awareness of the same on the part of both the public and some mental health professionals (Jenkins et al , 2011 ). This lack of awareness may also explain the lack of civil society action and effort aimed at prompting the state to fully implement the available legal provisions and policies (Raja et al , 2010 ).…”