WP03 - Adequate, fair and sustainable resourcing for mental health (health system inputs)

Objectives

This work package focuses on core health system resources and funding mechanisms that are a pre-requisite for improving service coverage and meeting the psychological health needs of populations in low and middle-income countries (LMIC). The following tasks will be undertaken:

Ghana: A community meeting of the Mental Health and Poverty Project
Ghana: A community meeting of the Mental Health and Poverty Project; Copyright: UCT / MHaPP Ghana
  • Identify and quantify the human, infrastructural, informational and financial resource inputs needed to scale-up a defined set of mental health service
  • Assess the extent and impact of inadequate mental health service access or coverage in different national settings on household consumption and production, and the economic consequences of improved access to appropriate care and
  • Generate sustainable health financing strategies for scaled-up delivery of mental health services in participant countries

Work package Description

The current state of mental health service development and the consequences of unmet need on health, social and economic outcomes in resource-constrained countries raise a number of key policy questions:

1) Adequacy: What human, financial and other resources are needed to scale-up prioritised services and reduce the existing treatment gap? What are the implications of this scale-up on the existing health system?

2) Fairness: How are mental health resources currently distributed? What is the level of financial or social protection for persons with mental health problems? Where protection is weak or lacking, what are the economic consequences of mental ill-health for households?

3) Economic outcomes: To what extent does the delivery of evidence-based mental health care that is integrated into routine primary and maternal health care settings lead to improved economic outcomes for individual patients and their households?

4) Sustainability: How can scaled-up mental health services best be paid for in a way that is feasible, fair and appropriate within the fiscal constraints and structures of different countries?

Nepal: TPO Nepal's children program
Nepal: TPO Nepal's children program; Copyright: TPO Nepal

Work Package 3 sets out to address these health systems financing questions by applying a mixed-methods approach that includes the development of analytical tools and survey instruments, quantitative data analysis and policy analysis. Specific highlights include:

1) Resource adequacy: we plan to build on earlier efforts to assess mental health resource needs and develop a fully integrated health systems resource planning tool for mental, neurological and substance use (MNS) disorders. In order to meet this objective, we propose to utilise the OneHealth model, which is a new software tool being developed by international costing experts from WHO and other UN agencies to strengthen health system analysis, costing and financing scenarios at the country level. Through the application of the tool we will generate new estimates of the cost of scaling up conditions and interventions, assess the health system implications of planned scale-up and thereby facilitate integration of mental health programme-specific plans into broader national health plans.

2) Resource distribution and fair financing: An initial task will be to characterise different aspects of coverage in each Emerald country, which we propose to do using the 3-dimensional approach used in the World Health Report 2010 on health system financing and universal coverage. Subject to local ethical approval, we then propose to assess the economic consequences of any unmet mental health needs for affected individuals and their families, with a view to determining the full extent of any impacts and losses, including rates of unemployment and impoverishment. We propose to do this through analysis of household-level and individual-level surveys that are being implemented in each of the participating country sites.

3) Economic outcomes: We will use longitudinal follow-up data among enlisted households to identify changes in social and economic outcomes following improved access to mental health care in these populations. In so doing, we intend to arrive at a better understanding of the impact of mental ill-health on household income, production and capital formation.

4) Sustainable financing: The final task focuses on how best to finance estimated resource needs for mental health service scale-up in a way that is feasible but also fair. We will be conducting a mixed-methods approach that will involve: in-depth consultation with national policy-makers and planners (plus international financial institutions and external partners as required); examination of government plans or commitments (such as medium term expenditure frameworks); analysis of key inefficiencies in the health system (including the hospital : community service balance); and the application of technical tools, including mapping financing arrangements and the scope of health insurance. On the basis of these assessments, we will prepare and present to national planners a mental health financing strategy for each of the participating countries.