Health Policy In Ghana Research Articles

Burden of out-of-pocket payment for maternal healthcare and its catastrophic effects in the era of free maternal and child health policy in Ghana

BackgroundGhana introduced a free maternal healthcare policy within its national health insurance program in 2008. Despite this, there are reports of significant out-of-pocket (OOP) payments for maternal healthcare in Ghana. This study examines OOP payments for maternal healthcare services and their catastrophic effects, including the correlates of catastrophic OOP payments. MethodsCross-sectional quantitative data were collected from 414 mothers through health facility exit interviews in two regions of Ghana. Catastrophic OOP payments were computed by expressing total health expenditure as a percentage of household total expenditure and non-food expenditure at various thresholds (5 %, 10 %, 20 % and 25 %). The correlates of catastrophic OOP payments were assessed using logistic regression models. ResultsThe median OOP payments for maternal healthcare was GH₵866.5(US$109.3). The median non-medical OOP cost (GH₵479[US$ 59.9]) was higher than the median medical OOP cost (GH₵296.5[US$ 37.1]). The median OOP cost was higher for delivery (GH₵454[US$56.8]) compared to ANC (GH₵356.5[US$44.5]) and PNC (GH₵21.5[US$2.6]). Non-medical supplies comprise 58 % of the total OOP payments. About 73 % and 90 % of respondents spent more than 5 % of their annual household total and non-food expenditure on maternal healthcare, respectively. Rural areas and care at private facilities were significantly associated (AORs<1; p-values<0.05) with lower probabilities of incurring catastrophic OOP expenditure. Tertiary education was associated (AORs> 1; p-values<0.05) with a higher probability of incurring catastrophic OOP payments. ConclusionOOP payments for maternal care are still prevalent in Ghana. We call for a reform of Ghana’s free maternal healthcare policy to include non-medical supplies within its benefit package.

Assessment of School Health Policy in Ghana; Perspective of Teachers in Second Cycle Institutions in the Kwadaso Municipal Area, Kumasi

Background: The focus on school health has moved from the classroom to a more comprehensive approach focusing on students’ health behaviours and a supportive school environment in health promotion. As school health policy helps to reduce health risk behaviours, knowledge and perspectives of Teachers in school health are key. Method: An institutional school-based cross-sectional study involving 220 teachers in second-cycle institutions in the Kwadaso Municipal-Ghana from June to August 2022. Data was collected using a structured questionnaire and analysed using STATA version 16, Microsoft Excel, and Jamovi 2.3.12. Descriptive statistics and Chi-square association tests were conducted between the outcome and independent variables. Results: The age range was 24-56 years. Most respondents were first-degree graduates (52.5%). The study found that the school's health program covers all aspects of the health needs of the students (Mean=2.98, SD= 1.34). Also, the school health programs focused on preventive measures (Mean=2.46, SD= 1.081). Again, about 41.63% perceived that they passionately share the view that effective implementation of the health policy in their school is associated with their classroom responsibility (Mean=2.34, SD=0.918). Items such as 'My school has adequate classrooms’ (110 [50.2%], Mean=2.33, SD 1.169, 'My school has friendly facilities for People Living with Disability (84[38.0%], mean=2.70 and SD of 1.315) have seen a high agreement. About 44.3% of the respondents believe that the school health program has improved their knowledge. Conclusion: Most teachers had adequate perspective in the school health program due to their high knowledge of school health issues.

"You Can't Look at an Orange and Draw a Banana": Using Research Evidence to Develop Relevant Health Policy in Ghana.

We examined factors that either enabled or inhibited the process of evidence-based decision making regarding health policy in Ghana. We conducted qualitative interviews with 2 major groups of stakeholders: health policy and systems research producers (research producers [RPs]) and policy makers (PMs). In-depth interviews were conducted with 12 RPs, who were representatives from 11 health policy and systems research institutions; and 12 PMs working in various national health-related agencies, ministries, and departments. We analyzed the data using the thematic analysis approach. Interview results showed 5 recurring themes in their discussion of enablers and inhibitors of the evidence-to-policy process: (1) the quality, relevance, and quantity of available research evidence; (2) how findings are communicated to PMs; (3) the strength of relationships between RPs and PMs; (4) available structures that promote evidence-based policy making; and (5) the political context in which research and policy making occurs. These findings point to some specific areas for further collaboration and communication among Ghanaian stakeholders to ensure that appropriate health policies are developed from an evidence base.

Formulation and Implementation of Reproductive Health Policies in Ghana: Analysis of the Views of Key Community Leaders and State Technocrats

This qualitative study evaluated the views of ten elites concerning their roles and views in the formulation and implementation of reproductive health (RH) policies in Ghana. The elites comprised of politicians, State policy technocrats, community leaders including a Traditional Chief; the group of elites also included representatives from all three major religions in Ghana: African traditional religions, Christianity and Islam. The results of the study indicated both positive and negative impacts of RH policies on the improvement of the economic welfare of individuals and small owner businesses. A major finding was the role of awareness in the acceptability of RH policies related to the birth control (BC) methods and products and contraceptives. The influence of the affordability of BC products and contraceptives was a common point of agreement of the ten elite people. The limited numbers of proper family planning clinics and specialist clinics in Ghana were seen to be a hindrance towards the acceptance of RH policies related to the use of BC products and contraceptives. The elites agreed that the Ghanaian society was a conservative one and this presented a general difficulty concerning the discussion of family planning and sexual matters. While there was a consensus on the role of awareness in increasing the acceptance and use of BC products and contraceptives, there was some disagreement of the proper role of non-governmental organizations, including religious organizations, in creating awareness of BC products and contraceptives in the community.

The practice of Medical Laboratory Science Post-Act 857 era: Perceived role conflicts with ‘Laboratory Physicians’ and other scientists in Ghana

Medical Laboratory Science practice in Ghana faced several challenges at a period without regulation. In this era where the practice of the profession is regulated, turfs are being held to impede the development of medical laboratory professionals. In responding to the threat to the profession, the Medical Laboratory Science Professional Body in Ghana commissioned an expert committee to review what pertains to international practice. The committee was to proffer direction to the implementors of health policies in Ghana. The outcome of the committee’s work was disseminated as a position paper which is presented to the scientific community to inform of the autonomy of the medical laboratory science profession post regulatory era in Ghana.

Challenges and Suggestions to Promote Maternal Service Provision and Utilization Under the Free Maternal Health Policy in Ghana: Perspectives of Health Directors and Facility Managers

INTRODUCTIONTo promote service uptake and reduce maternal deaths, a policy was implemented under Ghana’s National Health Insurance Scheme in 2008. This study explored the benefits and limitations of the policy, health system challenges, and community-level challenges resulting in suggestions to mitigate the challenges.METHODSThe study design was cross-sectional, utilizing qualitative data collection. It was carried out in the Kassena-Nankana East Municipality, Ghana, involving in-depth interviews (IDIs) with directors of Ghana Health Service and facility managers. A total of eight IDIs were conducted. Data were transcribed, read, and analyzed based on themes which were presented using key quotes.RESULTSThe policy promoted the use of services. Nonetheless, challenges existed as a result of limited service coverage, inadequate human resources and infrastructure, lack of medications and equipment, lack of transport, and the influence of religion, culture, and family members. There was a need to strategize so that women with a low socioeconomic status would receive service over those of a high socioeconomic status. Other suggestions included the inclusion of family planning services, accreditation of private facilities, provision of a shift system for specialists to move to rural areas, and provision of incentives for health personnel in rural areas. It was also suggested that health personnel make known their challenges as well as to provide education on women’s rights and service expectations. The provision of transport vouchers to women as well as alternative arrangements to be made with private transport owners were also suggested.CONCLUSIONImplementing the suggestions may improve service provision and utilization leading to the reduction of maternal deaths and contributing towards achieving universal health coverage.

Women's Lived Experiences of Giving Birth in Ghana: A Metasynthesis of the Literature

BACKGROUNDThe purpose of this metasynthesis is to analyze women's lived experiences of giving birth in Ghana during and after the Millennium Development Goals (MDGs), when health policy in Ghana was changed to urge women to birth in health services with skilled attendants.METHODAn interpretive phenomenological framework guided the review of the literature. Three electronic databases were searched as well as reference lists and author searches. Articles that met the screening criteria for inclusion were coded and thematically analyzed, then drawn together to construct the essence of women's experiences of giving birth in Ghana.RESULTSSeven themes were constructed from the data and these were poor quality health services, maltreatment by midwives, mixed emotions about pregnancy and childbirth, supernatural fears, women wanting safe births with skilled birth attendants, uncertainty about reaching a health facility, and decision-making hierarchy. There were three counter themes and these were women wanting a home birth with a traditional midwife, defiance against dominant decision-makers by some women, and a belief that “not all nurses are bad.”CONCLUSIONGhanaian women have heeded the MDGs and health policy messages to birth with skilled attendants, but in reality, they are not always accessible, available, appropriate, or of high quality. Maternal health services still need much improvement including more resources such as staff, essential services, medicines, and quality assurance standards.

Caregiver Perception of Sickle Cell Disease Stigma in Ghana: An Ecological Approach.

Sickle cell disease (SCD) stigma is a major community health issue. The challenges of caring for someone with SCD can be overwhelming. We explored stigma and related factors for caregivers of pediatric patients with SCD in Kumasi, Ghana. Guided by the Ecological Systems Theory, we used in-depth interviews with a semistructured guide to learn about the perception of stigmatization for Ghanaian caregivers of patients with SCD. Overall, participants were knowledgeable about SCD. We identified three themes, including (1) blame for SCD, (2) public misconception about SCD, and (3) shame for the financial burden of SCD. Findings demonstrate the need to design an SCD stigma reduction program for caregivers, families, and the community. Providers need to consider SCD stigma and interaction with multiple ecological levels, including the family, community, health care system, culture, and health policy in Ghana. Findings can be used as a catalyst to explore the reduction of stigmatization in other sub-Saharan countries.

Ghana's Journey towards Universal Health Coverage: The Role of the National Health Insurance Scheme.

Background: the main aim of the study is to find if the National Health Insurance Scheme (NHIS) in Ghana is achieving universal health coverage (UHC) or not. The study gives the trajectories of health policies in Ghana and their implications on long term health financing. NHIS in Ghana was implemented in 2004, with the aim of increasing subscribers’ access to health care services and reduce financial barriers to health care. On equity access to healthcare, it addresses two core concerns: (1) enrolling particular groups (persons exempted from annual premium payments) and (2) achieving UHC for all citizens and persons with legal residence. It utilizes a multifactor approach to the conceptualization of UHC. The research question: Is Ghana’s NHIS on course to deliver or achieve universal health coverage? Methods: we used qualitative methods. In doing so, the study engaged participants in in-depth interviews, focus group discussions and direct observations of participants in their natural settings, like hospitals, clinics, offices and homes, with purposive and snowball techniques. This data triangulation approach aims to increase the reliability and validity of findings. Results: the empirical evidence shows NHIS performed relatively well in enrolling more exempt groups (particular groups) than enrolling all persons in Ghana (UHC). The biggest challenge for the implementation of NHIS from the perspectives of health insurance officials is inadequate funding. The health insurance beneficiaries complained of delays during registrations and renewals. They also complained of poor attitude of some health insurance officials and health workers at facilities. Conclusions: both health insurance officials and beneficiaries emphasized the need for increased public education and for implementers to adopt a friendly attitude towards clients. To move towards achieving UHC, there is a need to redesign the policy, to move it from current voluntary contributions, to adopt a broad tax-based approach to cover all citizens and persons with legal residence in Ghana. Also, to adopt a flexible premium payment system (specifically ‘payments by installation’ or ‘part payments’) and widen the scope of exempt groups as a way of enrolling more into the NHIS.

The free maternal health policy: acceptability and satisfaction with quality of maternal health services during pregnancy in rural Northern Ghana

Introduction: Ghana introduced a maternal health policy in July 2008 to provide free of cost health services to women. However, the utilization of services does not depend on affordability alone but acceptability as well. Acceptability includes attitudes and behaviors of providers and satisfaction with the quality of care. The study explored women’s views and perceptions about attitudes and behaviors of providers and satisfaction with the quality of services under the free maternal health policy in Ghana. In addition, the views and perceptions of providers were examined.&#x0D; Methods: A convergent parallel mixed-methods study was conducted. The study was carried out in the Kassena-Nankana Municipality in Ghana. A structured questionnaire was distributed among women (n=406) who utilized health facilities during pregnancy. Further, focus group discussions (FGDs) with women (n=10) and in-depth interviews with midwives and nurses (n=25) were held. Quantitative data were analyzed using descriptive statistics, while the qualitative data were recorded, transcribed, read, and coded thematically.&#x0D; Results: Women perceived facilities to be clean, especially the smaller ones. Ninety-eight percent of women (n=313/320) perceived providers to be respectful or friendly, and this was mostly confirmed in the FGDs. More than two-thirds of the women (74%, n=300) were also very satisfied or satisfied with the quality of care due to the respect accorded them by providers. Equally, midwives and nurses were satisfied with the quality of care they provided. Nonetheless, providers believed that the unavailability of drugs and supplies, laboratory services, accommodation, and transportation for emergencies reduced women’s satisfaction with services and the quality of care they could provide.&#x0D; Conclusion: The services provided to women during pregnancy were acceptable under the free maternal health policy. There remain challenges in addressing a lack of infrastructure and commodities that affects the quality of care.

Are health facilities well equipped to provide basic quality childbirth services under the free maternal health policy? Findings from rural Northern Ghana

BackgroundBasic inputs and infrastructure including drugs, supplies, equipment, water and electricity are required for the provision of quality care. In the era of the free maternal health policy in Ghana, it is unclear if such basic inputs are readily accessible in health facilities. The study aimed to assess the availability of basic inputs including drugs, supplies, equipment and emergency transport in health facilities. Women and health providers’ views on privacy and satisfaction with quality of care were also assessed.MethodsThe study used a convergent parallel mixed methods in one rural municipality in Ghana, Kassena-Nankana. A survey among facilities (n = 14) was done. Another survey was carried out among women who gave birth in health facilities only (n = 353). A qualitative component involved focus group discussions (FGDs) with women (n = 10) and in-depth interviews (IDIs) with midwives and nurses (n = 25). Data were analysed using descriptive statistics for the quantitative study, while the qualitative data were recorded, transcribed, read and coded using themes.ResultsThe survey showed that only two (14%) out of fourteen facilities had clean water, and five (36%) had electricity. Emergency transport for referrals was available in only one (7%) facility. Basic drugs, supplies, equipment and infrastructure especially physical space were inadequate. Rooms used for childbirth in some facilities were small and used for multiple purposes. Eighty-nine percent (n = 314) of women reported lack of privacy during childbirth and this was confirmed in the IDIs. Despite this, 77% of women (n = 272) were very satisfied or satisfied with quality of care for childbirth which was supported in the FGDs. Reasons for women’s satisfaction included the availability of midwives to provide childbirth services and to have follow-up homes visits. Some midwives were seen to be patient and empathetic. Providers were not satisfied due to health system challenges.ConclusionGovernment should dedicate more resources to the provision of essential inputs for CHPS compounds providing maternal health services. Health management committees should also endeavour to play an active role in the management of health facilities to ensure efficiency and accountability. These would improve quality service provision and usage, helping to achieve universal health coverage.

GENDER DIFFERENCES IN THE ASSOCIATION BETWEEN MARITAL STATUS AND HYPERTENSION IN GHANA.

Hypertension is a significant contributor to the global burden of cardiovascular and related target organ diseases such as heart failure, coronary heart disease, stroke and kidney failure, and their associated premature morbidity, mortality and disability. Marital status is an important social characteristic known to predict a range of health outcomes including cardiovascular disease. However, little is known about its impact on hypertension in sub-Saharan Africa. This study explored the relationship between marital status and hypertension among women and men in Ghana. Drawing on data from the 2014 Ghana Demographic and Health Survey (GDHS), descriptive statistics and binary logistic regression models were used to analyse the link between marital status and hypertension. About 13% of women aged 15-49 and 15% of men aged 15-59 were found to be hypertensive. After controlling for lifestyle and socio-demographic covariates, the logistic regression models showed significantly higher odds of hypertension for married (OR=2.14, 95% CI=1.30-3.53), cohabiting (OR=1.94, 95% CI=1.16-3.23) and previously married (OR=2.23, 95% CI=1.29-3.84) women. In contrast, no significant association was found between any of the marital status cohorts and hypertension for men. Other significant predictors of hypertension were age, body mass index and wealth status. The results demonstrate that marital status is an independent risk factor for hypertension in Ghana for women, rather than men. This could have immediate and far-reaching consequences for cardiovascular health policy in Ghana. In particular, the findings could lead to better targeted public health interventions, including more effective risk factor assessment and patient education in clinical settings, which could lead to more effective patient management and improved cardiovascular outcomes.

Mixed Methods Research for Health Policy Development in Africa: The Case of Identifying Very Poor Households for Health Insurance Premium Exemptions in Ghana

Despite the utility of applying mixed methods research to understand complex phenomenon, few studies have applied this approach to health policy and in Africa. This article illustrates the application of mixed methods research to inform health policy in Ghana with the intent of complementarity. Through an exploratory sequential mixed methods research design involving 24 focus group interviews and 417 household surveys, we developed criteria for identifying very poor households for health insurance premium exemptions in Ghana. The qualitative procedures identified communities’ concerns regarding being very poor: food insecurity, lack of seeds to sow, compromised access to education, financial insecurity, and status as unemployed widows with children. The survey findings illustrated the distribution and predictors of poverty in the Kassena-Nankana District. Based on these findings, the authors proposed a four-question survey for the Kassena-Nankana District Health Insurance Scheme to administer to determine extreme poverty. Based on these recommendations, the local government has a unique opportunity to increase the very poor’s access to and utilization of health care services.

Process Tracing and Bayesian Updating for impact evaluation

Commissioners of impact evaluation often place great emphasis on assessing the contribution made by a particular intervention in achieving one or more outcomes, commonly referred to as a ‘contribution claim’. Current theory-based approaches fail to provide evaluators with guidance on how to collect data and assess how strongly or weakly such data support contribution claims. This article presents a rigorous quali-quantitative approach to establish the validity of contribution claims in impact evaluation, with explicit criteria to guide evaluators in data collection and in measuring confidence in their findings. Coined ‘Contribution Tracing’, the approach is inspired by the principles of Process Tracing and Bayesian Updating, and attempts to make these accessible, relevant and applicable by evaluators. The Contribution Tracing approach, aided by a symbolic ‘contribution trial’, adds value to impact evaluation theory-based approaches by: reducing confirmation bias; improving the conceptual clarity and precision of theories of change; providing more transparency and predictability to data-collection efforts; and ultimately increasing the internal validity and credibility of evaluation findings, namely of qualitative statements. The approach is demonstrated in the impact evaluation of the Universal Health Care campaign, an advocacy campaign aimed at influencing health policy in Ghana.

The effect of maternal education on child health: some evidence from Ghana

Ghana has witnessed marked improvement in child health over the past three decades, albeit the progress has been slow and unevenly distributed across the country. The country's under-five mortality rate, though better than the average for sub-Saharan Africa, lags behind that of some low and middle-income countries in the sub-region. The situation is not different from the incidence of diseases such as acute respiratory infection (ARI), diarrhoeal diseases and fever among children in Ghana. While a number of studies have been conducted to investigate the factors that influence child health, there is limited evidence regarding the effect of maternal education on child health in Ghana. This paper seeks to examine the effect of maternal education on under-five morbidity particularly the incidence of ARI, diarrhoea and fever in Ghana. Using the 2008 Ghana Demographic and Health Survey (GDHS) and employing logistic regression, the paper shows that higher maternal education significantly and consistently reduces the incidence of diarrhoea, ARI and fever among children aged under-five in Ghana. The paper recommends the integration of maternal education in maternal and child health policies in Ghana.

Female Adolescents And Reproductive Change In Ghana: Evidence From An Adolescent Survey Of Two Communities

The study on Female Adolescent Reproductive Change was undertaken as part of the ongoing effort at understanding some of the problems that confront adolescents in Ghana. The study uses a sample of 1,828 female adolescents aged 12-24 years (1,503 from Cape Coast and 325 from Mankrong) in the Central Region of Ghana as a case study. This has the primary purpose of comparing the situation in an urban vis-à-vis a rural area. The general objective of the study is to examine the possible changes in the reproduction among female adolescents within the context of overall fertility decline in Ghana as a way of assessing the progress made in addressing adolescent reproductive health problems following the adoption of a national adolescent reproductive health policy in Ghana. The study examines age at first sex, first marriage, first pregnancy and first birth as a way of finding out any changes that might have occurred in the recent past. It also looks at issues pertaining to pregnancy incidence and wastage as may be related to school attendance. Throughout, comparisons are made with reports from the Ghana Demographic and Health Surveys (GDHS) and other small-scale studies that have been done in certain areas in Ghana. Overall, the study finds that major positive changes have occurred among female adolescents first with respect to the proportion of female adolescents ever having sexual activity. More and more female adolescents continue to abstain from sex. However, among the small proportion that ever indulges in sex, sexual initiation appears to be earlier when age is controlled for.

Supernatural belief systems, mental health and perceptions of mental disorders in Ghana

Clinical psychology is an underdeveloped profession in Ghana, with insufficient empirical research to guide interventions. In the face of this, it is unclear whether individuals may benefit more from localized interventions that incorporate cultural traditions and spiritual beliefs, rather than solely Westernized interventions. To better inform interventions and advocate for improved mental health policy in Ghana, this study sought to explore possible relationships between depression, anxiety, somatization, general psychological wellbeing and spirituality. The study also explored Ghanaians' subjective self-assessments of spirituality and perceptions of the causes and treatments of mental illness using qualitative in-depth responses. Results from the adult sample of 448 Christians, Muslims and Traditionalists showed significant negative correlations between depression, psychological wellness and spirituality. Qualitative responses revealed that while spiritual interventions for mental disorders was most fr...

Do new democracies deliver social welfare? Political regimes and health policy in Ghana and Cameroon

Democratic reform processes often go hand in hand with expectations of social welfare improvements. While the connection between the emergence of democracy and the development of welfare states in the West has been the object of several studies, however, there is a scant empirical literature on the effects of recent democratization processes on welfare policies in developing countries. This is particularly true for Africa. In a dramatically poor environment, Africans often anticipated that the democratic reforms many sub-Saharan states undertook during the early 1990s would deliver welfare dividends. This article investigates whether and how the advent of democracy affected social policies – focusing, in particular, on health policy – by examining one of the continent's most successful cases of recent democratization (Ghana) and comparing it with developments in a country of enduring authoritarian rule (Cameroon). Evidence shows that democracy can indeed be instrumental to the expansion and strengthening of social policies. In Ghana, new participatory and competitive pressures pushed the government towards devising and adopting an ambitious health reform. Despite façade elections, no similar pressures could be detected in undemocratic Cameroon and health policy remained almost entirely dictated by foreign donors.

An assessment of mental health policy in Ghana, South Africa, Uganda and Zambia.

BackgroundApproximately half of the countries in the African Region had a mental health policy by 2005, but little is known about quality of mental health policies in Africa and globally. This paper reports the results of an assessment of the mental health policies of Ghana, South Africa, Uganda and Zambia.MethodsThe WHO Mental Health Policy Checklist was used to evaluate the most current mental health policy in each country. Assessments were completed and reviewed by a specially constituted national committee as well as an independent WHO team. Results of each country evaluation were discussed until consensus was reached.ResultsAll four policies received a high level mandate. Each policy addressed community-based services, the integration of mental health into general health care, promotion of mental health and rehabilitation. Prevention was addressed in the South African and Ugandan policies only. Use of evidence for policy development varied considerably. Consultations were mainly held with the mental health sector. Only the Zambian policy presented a clear vision, while three of four countries spelt out values and principles, the need to establish a coordinating body for mental health, and to protect the human rights of people with mental health problems. None included all the basic elements of a policy, nor specified sources and levels of funding for implementation. Deinstitutionalisation and the provision of essential psychotropic medicines were insufficiently addressed. Advocacy, empowerment of users and families and intersectoral collaboration were inadequately addressed. Only Uganda sufficiently outlined a mental health information system, research and evaluation, while only Ghana comprehensively addressed human resources and training requirements. No country had an accompanying strategic mental health plan to allow the development and implementation of concrete strategies and activities.ConclusionsSix gaps which could impact on the policies' effect on countries' mental health systems were: lack of internal consistency of structure and content of policies, superficiality of key international concepts, lack of evidence on which to base policy directions, inadequate political support, poor integration of mental health policies within the overall national policy and legislative framework, and lack of financial specificity. Three strategies to address these concerns emerged, namely strengthening capacity of key stakeholders in public (mental) health and policy development, creation of a culture of inclusive and dynamic policy development, and coordinated action to optimize use of available resources.

Mental health policy process: a comparative study of Ghana, South Africa, Uganda and Zambia

BackgroundMental illnesses are increasingly recognised as a leading cause of disability worldwide, yet many countries lack a mental health policy or have an outdated, inappropriate policy. This paper explores the development of appropriate mental health policies and their effective implementation. It reports comparative findings on the processes for developing and implementing mental health policies in Ghana, South Africa, Uganda and Zambia as part of the Mental Health and Poverty Project.MethodsThe study countries and respondents were purposively selected to represent different levels of mental health policy and system development to allow comparative analysis of the factors underlying the different forms of mental health policy development and implementation. Data were collected using semi-structured interviews and document analysis. Data analysis was guided by conceptual framework that was developed for this purpose. A framework approach to analysis was used, incorporating themes that emerged from the data and from the conceptual framework.ResultsMental health policies in Ghana, South Africa, Uganda and Zambia are weak, in draft form or non-existent. Mental health remained low on the policy agenda due to stigma and a lack of information, as well as low prioritisation by donors, low political priority and grassroots demand. Progress with mental health policy development varied and respondents noted a lack of consultation and insufficient evidence to inform policy development. Furthermore, policies were poorly implemented, due to factors including insufficient dissemination and operationalisation of policies and a lack of resources.ConclusionsMental health policy processes in all four countries were inadequate, leading to either weak or non-existent policies, with an impact on mental health services. Recommendations are provided to strengthen mental health policy processes in these and other African countries.