@article{2a49c083fc114d6e8752d2e3a5c339dc,
title = "Mental health financing challenges, opportunities and strategies in low- and middle-income countries: findings from the Emerald project",
abstract = "BackgroundCurrent coverage of mental healthcare in low- and middle-income countries is very limited, not only in terms of access to services but also in terms of financial protection of individuals in need of care and treatment.AimsTo identify the challenges, opportunities and strategies for more equitable and sustainable mental health financing in six sub-Saharan African and South Asian countries, namely Ethiopia, India, Nepal, Nigeria, South Africa and Uganda.MethodIn the context of a mental health systems research project (Emerald), a multi-methods approach was implemented consisting of three steps: a quantitative and narrative assessment of each country's disease burden profile, health system and macro-fiscal situation; in-depth interviews with expert stakeholders; and a policy analysis of sustainable financing options.ResultsKey challenges identified for sustainable mental health financing include the low level of funding accorded to mental health services, widespread inequalities in access and poverty, although opportunities exist in the form of new political interest in mental health and ongoing reforms to national insurance schemes. Inclusion of mental health within planned or nascent national health insurance schemes was identified as a key strategy for moving towards more equitable and sustainable mental health financing in all six countries.ConclusionsIncluding mental health in ongoing national health insurance reforms represent the most important strategic opportunity in the six participating countries to secure enhanced service provision and financial protection for individuals and households affected by mental disorders and psychosocial disabilities.",
keywords = "COST-EFFECTIVENESS, COVERAGE, Low and middle income countries, SERVICES, financing, mental health, mental health systems",
author = "Dan Chisholm and Sumaiyah Docrat and Jibril Abdulmalik and Atalay Alem and Oye Gureje and Dristy Gurung and Charlotte Hanlon and Jordans, {Mark J. D.} and Sheila Kangere and Fred Kigozi and James Mugisha and Shital Muke and Saheed Olayiwola and Rahul Shidhaye and Graham Thornicroft and Crick Lund",
note = "Funding Information: The research leading to these results is funded by the European Union's Seventh Framework Programme (FP7/2007–2013) under grant agreement n° 305968. S.D. is a PhD scholarship beneficiary funded by the South African Medical Research Council under the National Health Scholars Programme. G.T. is supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London and by the NIHR Applied Research Centre (ARC) at King{\textquoteright}s College London NHS Foundation Trust, and the NIHR Applied Research and the NIHR Asset Global Health Unit award. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. G.T. receives support from the National Institute of Mental Health of the National Institutes of Health under award number R01MH100470 (Cobalt study). G.T. is supported by the UK Medical Research Council in relation the Emilia (MR/S001255/1) and Indigo Partnership (MR/R023697/1) awards. C.H. and C.L. are supported by PRIME, which is funded by the UK Department for International Development (201446). G.T., C.H., A.A. and C.L. are funded by the NIHR Global Health Research Unit on Health System Strengthening in Sub-Saharan Africa, King's College London (GHRU 16/136/54) using UK aid from the UK Government. The views expressed in this publication are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. C.H. additionally receives support from AMARI as part of the DELTAS Africa Initiative (DEL-15-01). Acknowledgements Publisher Copyright: Copyright {\textcopyright} The Royal College of Psychiatrists 2019.",
year = "2019",
month = aug,
day = "6",
doi = "10.1192/bjo.2019.24",
language = "English",
volume = "5",
pages = "1--9",
journal = "Bjpsych open",
issn = "2056-4724",
publisher = "Cambridge University Press",
number = "5",
}