Abstract
Background and aimsCurrent coverage of mental health care in low- and middle-income countries is limited, not only in terms of access to services but also in terms of financial protection of persons in need of care and treatment. This is especially pertinent considering the established relationship between mental illness and poverty and the need to ensure the financial risk protection of persons with mental disorders and their families as part of country’s efforts to attain universal health coverage. This study set out to review the health and socio-economic contexts of Nigeria as well as to generate strategies for sustainable mental health financing that will be feasible, within the specific context of the country.MethodsA multi-methods approach was developed and applied, consisting of three steps: a situational analysis of Nigeria’s health system, macro-fiscal economic profile, and socio-political status, including a strengths, weaknesses, opportunities and threats (SWOT) analysis of the Nigerian socio-economic, general and mental health context; key informant interviews with 12 expert stakeholders drawn from state and non-state actors in the health and financial sectors; and a policy analysis of sustainable financing options.ResultsKey challenges identified were: poor funding; reduced access to care, resulting in a huge treatment gap; and out of pocket payment for services—leading to impoverishment. Comprehensive coverage of mental health conditions within the ongoing health insurance reforms was identified as a key strategy for moving towards sustainable mental health financing in Nigeria. Other identified strategies include enhanced integration of mental health into primary care; incorporation of mental health into other strategic and currently funded programmes; adoption of performance-based financing measures; and renewed engagement with stakeholders, including external donor institutions.ConclusionsA suite of feasible and actionable measures can be implemented to increase mental health service financing, reduce health-related financial burden on households, increase help-seeking and access to quality mental health care and, ultimately, reduce the large treatment and financing gap for mental disorders in Nigeria.
Highlights
Effective and optimally functional health systems should deliver high-quality services to all persons, whenever and wherever they need such services [1]
Successful attainment of universal health coverage (UHC) is a unifying goal for health system strengthening, as well as an explicit target for the sustainable development goals (SDGs) which are anchored on the principle of not leaving anyone behind [2]
This paper provides a situational analysis of where Nigeria lies, both with respect to the key dimensions of UHC and the broader health system characteristics, constraints, determinants and capacities, including the macroeconomic and fiscal environment
Summary
Effective and optimally functional health systems should deliver high-quality services to all persons, whenever and wherever they need such services [1]. Persons or households with lower incomes, greater vulnerability and longer-term health care needs are affected This is especially true in Nigeria and other LMICs where out-of-pocket (OOP) payments remain the most common mode of procuring health care services. Current coverage of mental health care in low- and middle-income countries is limited, in terms of access to services and in terms of financial protection of persons in need of care and treatment. This is especially pertinent considering the established relationship between mental illness and poverty and the need to ensure the financial risk protection of persons with mental disorders and their families as part of country’s efforts to attain universal health coverage. This study set out to review the health and socio-economic contexts of Nigeria as well as to generate strategies for sustainable mental health financing that will be feasible, within the specific context of the country
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