Sustainable financing options for mental health care in South Africa: findings from a situation analysis and key informant interviews

Sumaiyah Docrat,Crick Lund,Dan Chisholm

doi:10.1186/s13033-019-0260-4

Abstract

BackgroundWith the implicit neglect for the integration of mental health services into general health service development in South Africa, there is an urgent need for an understanding of the ways in which existing reforms may be leveraged to incorporate the objectives of the National Mental Health Policy Framework and Strategic Plan (MHPF) and the mechanisms by which these reforms can be structured and financed in the context of fiscal constraint.MethodsA situational analysis guided by a newly developed analytical framework for sustainable mental health financing was conducted. The review was followed by qualitative, indepth interviews with a range of expert national stakeholders.ResultsAlthough the MHPF is said to be consistent with ongoing efforts toward the implementation of National Health Insurance (NHI), there is clear evidence of discordance between the MHPF and the NHI. The most promising strategies for sustainable mental health financing include: increased decentralization of resources to primary and community mental health services; active integration of mental health into ongoing NHI implementation including expanding the mandate of District hospitals and drawing on the private sector; submission of costed budget bids to support a mental health conditional grant and ensuring that explicit outcomes and deliverables are in place to monitor Provincial implementation.ConclusionThis paper has suggested several ways in which existing reforms may be leveraged to incorporate the objectives of the MHPF and achieve better mental health outcomes for South Africans, revealing critical opportunities for mental health service scale-up to be embedded in South Africa’s future health delivery strategy. The realization of a conditional grant for mental health will require technical expertise to cost existing services towards the development of an investment case for mental health service scale-up nationally, projecting potential resource requirements and returns on investment of a strong service platform. In the longer-term, the NHI benefit package must be expanded to include comprehensive mental health services at all levels. Explicit results-based financing mechanisms within the NHI Fund must also be incorporated for mental health to incentivise quality of care. Private providers engaged by the NHI must commit to make use of evidence-based mental health interventions.

Highlights

With the implicit neglect for the integration of mental health services into general health service development in South Africa, there is an urgent need for an understanding of the ways in which existing reforms may be leveraged to incorporate the objectives of the National Mental Health Policy Framework and Strategic Plan (MHPF) and the mechanisms by which these reforms can be structured and financed in the context of fiscal constraint
With the implicit neglect for the integration of mental health services into general health service development in South Africa, there is an urgent need for an understanding of the ways in which existing reforms may be leveraged to incorporate the objectives of the MHPF and achieve better mental health outcomes for South Africans and the mechanisms by which these reforms can be structured and financed in the context of fiscal constraint
Two interviewees were affiliated to the Non-Governmental Organization (NGO) sector, one was affiliated to the National Department(s) of Health, one from the National Treasury, with the last stakeholder affiliated to an academic institution with public health financing expertise

Summary

Introduction

With the implicit neglect for the integration of mental health services into general health service development in South Africa, there is an urgent need for an understanding of the ways in which existing reforms may be leveraged to incorporate the objectives of the National Mental Health Policy Framework and Strategic Plan (MHPF) and the mechanisms by which these reforms can be structured and financed in the context of fiscal constraint. Since a landmark publication by Prince et al [1], the notion of “no health without mental health” has stimulated policy-makers in all countries to consider mental health and the treatment of mental disorders as a key priority in the pursuit of equity in health and health service access This has become pertinent in recent years with the emergence of universal health coverage goals and the need to provide broad-based, context- specific primary health care (PHC) [1, 2]. The limited resources that exist are inefficiently concentrated in large psychiatric hospitals, specializing in the treatment of severe mental disorder, with a predominantly vertical (disease focused, as opposed to integrated) model of care [10]

Methods

Results

Discussion

Conclusion