Mental health financing challenges, opportunities and strategies in low- and middle-income countries: findings from the Emerald project

Abstract

Background Current 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. Aims To 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. Method In 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. Results Key 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. Conclusions Including 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 interest D.C. is a staff member of the World Health Organization.

Meeting the mental health needs of low- and middle-income countries: the start of a long journey

“…Specifically, the project developed a set of tools to estimate the resources needed to achieve equitable and sustainable mental health financing. 6 However, the Emerald programme also highlights that interventions must consider wider social determinants such as violence, poverty, unemployment, trauma and stigma that both heighten the risk of mental ill health and the adverse consequences of those who are already ill, including direct financial costs. 6,7 A further paper in the Emerald thematic series used interviews from managers and service providers to highlight that successful integration required more than the training of existing primary care clinicians.…”

The impact of social, national and community-based health insurance on health care utilization for mental, neurological and substance-use disorders in low- and middle-income countries: a systematic review

“…A large multi-country survey supported by the WHO showed that 76-85% of people with severe mental disorders (psychosis, bipolar disorder and suicide attempt) in low-income countries had not received any treatment in the previous 12 months; whilst the treatment gap for minimally adequate treatment for major depression and anxiety exceeds 80% (83.5% and 90.2%, respectively) among LMICs [18][19][20]. There is concern that if mental health priorities are not explicitly defined and reflected in the financing policies and activities supporting the overall implementation of health financing reforms, true UHC inclusive of mental health care will not be achievable in LMIC contexts [21,22]. A study on mental health financing challenges, opportunities and strategies for LMICs recently concluded that the inclusion of mental health in ongoing reforms to national insurance schemes represents one of the most promising avenues for sustainable mental health financing [21].…”

“…There is concern that if mental health priorities are not explicitly defined and reflected in the financing policies and activities supporting the overall implementation of health financing reforms, true UHC inclusive of mental health care will not be achievable in LMIC contexts [21,22]. A study on mental health financing challenges, opportunities and strategies for LMICs recently concluded that the inclusion of mental health in ongoing reforms to national insurance schemes represents one of the most promising avenues for sustainable mental health financing [21]. As emphasized by the Lancet Commission on Global Mental Health and Sustainable Development, achieving UHC must involve the explicit inclusion of mental health within reimbursement and mandatory insurance schemes as a standard, not as a complementary option [17].…”

Scaling-up a New Socio-mental Health Service Model in Iran to Reduce Burden of Neuropsychiatric Disorders: An Economic Evaluation Study

“…The resources that are made available are also typically directed towards more specialized and institutional services, which are not easily accessible. Without appropriate access to decent services and adequate protection, individuals with mental disorders and their families are correspondingly facing a di cult choice, namely, paying out of pocket for treatments of variable and sometimes poor quality or going without treatments altogether [4].…”