Abstract
BackgroundPeople with mental disorders in low-income countries are at risk of being left behind during efforts to expand universal health coverage.AimsTo propose context-relevant strategies for moving towards universal health coverage for people with mental disorders in Ethiopia.MethodsWe conducted a situational analysis to inform a SWOT analysis of coverage of mental health services and financial risk protection, health system characteristics and the macroeconomic and fiscal environment. In-depth interviews were conducted with five national experts on health financing and equity and analysed using a thematic approach. Findings from the situation analysis and qualitative study were used to develop recommended strategies for adequate, fair and sustainable financing of mental health care in Ethiopia.ResultsOpportunities for improved financing of mental health care identified from the situation analysis included: a significant mental health burden with evidence from strong local epidemiological data; political commitment to address that burden; a health system with mechanisms for integrating mental health into primary care; and a favourable macro-fiscal environment for investment in human capabilities. Balanced against this were constraints of low current general government health expenditure, low numbers of mental health specialists, weak capacity to plan and implement mental health programmes and low population demand for mental health care. All key informants referred to the under-investment in mental health care in Ethiopia. Respondents emphasised opportunities afforded by positive rates of economic growth in the country and the expansion of community-based health insurance, as well as the need to ensure full implementation of existing task-sharing programmes for mental health care, integrate mental health into other priority programmes and strengthen advocacy to ensure mental health is given due attention.ConclusionExpansion of public health insurance, leveraging resources from high-priority SDG-related programmes and implementing existing plans to support task-shared mental health care are key steps towards universal health coverage for mental disorders in Ethiopia. However, external donors also need to deliver on commitments to include mental health within development funding. Future researchers and planners can apply this approach to other countries of sub-Saharan Africa and identify common strategies for sustainable and equitable financing of mental health care.
Highlights
People with mental disorders in low-income countries are at risk of being left behind during efforts to expand universal health coverage
Future researchers and planners can apply this approach to other countries of sub-Saharan Africa and identify common strategies for sustainable and equitable financing of mental health care
There are no data on trends in the prevalence of mental health problems over time, the burden of depression in Ethiopia is estimated to have increased by 39.6% from 2005 to 2016 due to demographic transition [25]
Summary
People with mental disorders in low-income countries are at risk of being left behind during efforts to expand universal health coverage. To achieve UHC, there is a need for both population coverage of adequate quality services and financial coverage or risk protection. People with mental disorders who live in low- and middle-income countries (LMICs) have low access to quality mental health care and are vulnerable to suffering and disability [2], human rights abuses [3], stigma and discrimination [4], impoverishment [5] and premature mortality [6]. In Ethiopia, service coverage and financial protection for people with mental disorders is limited, while the adverse economic consequences of these disorders on households are pronounced. Inadequate financial coverage is a major barrier to accessing mental health care in Ethiopia
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