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

  • Dan Chisholm (a1), Sumaiyah Docrat (a2), Jibril Abdulmalik (a3), Atalay Alem (a4), Oye Gureje (a5), Dristy Gurung (a6), Charlotte Hanlon (a7), Mark J. D. Jordans (a8), Sheila Kangere (a9), Fred Kigozi (a10), James Mugisha (a9), Shital Muke (a11), Saheed Olayiwola (a12), Rahul Shidhaye (a13), Graham Thornicroft (a14) and Crick Lund (a15)...

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.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.

Corresponding author

Correspondence: Dan Chisholm, Department of Mental Health and Substance Abuse, World Health Organization, CH-1211, Switzerland. Email: chisholmd@who.int

References

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Keywords

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

  • Dan Chisholm (a1), Sumaiyah Docrat (a2), Jibril Abdulmalik (a3), Atalay Alem (a4), Oye Gureje (a5), Dristy Gurung (a6), Charlotte Hanlon (a7), Mark J. D. Jordans (a8), Sheila Kangere (a9), Fred Kigozi (a10), James Mugisha (a9), Shital Muke (a11), Saheed Olayiwola (a12), Rahul Shidhaye (a13), Graham Thornicroft (a14) and Crick Lund (a15)...

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

  • Dan Chisholm (a1), Sumaiyah Docrat (a2), Jibril Abdulmalik (a3), Atalay Alem (a4), Oye Gureje (a5), Dristy Gurung (a6), Charlotte Hanlon (a7), Mark J. D. Jordans (a8), Sheila Kangere (a9), Fred Kigozi (a10), James Mugisha (a9), Shital Muke (a11), Saheed Olayiwola (a12), Rahul Shidhaye (a13), Graham Thornicroft (a14) and Crick Lund (a15)...
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