Mental health financing challenges, opportunities and strategies in low- and middle-income countries: findings from the Emerald project

Dan Chisholm*, Sumaiyah Docrat, Jibril Abdulmalik, Atalay Alem, Oye Gureje, Dristy Gurung, Charlotte Hanlon, Mark J. D. Jordans, Sheila Kangere, Fred Kigozi, James Mugisha, Shital Muke, Saheed Olayiwola, Rahul Shidhaye, Graham Thornicroft, Crick Lund

*Corresponding author for this work

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Current 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.


To 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.


In 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.


Key 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.


Including 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.

Original languageEnglish
Article number68
Pages (from-to)1-9
Number of pages9
JournalBjpsych open
Issue number5
Publication statusPublished - 6 Aug 2019


  • Low and middle income countries
  • mental health
  • mental health systems
  • financing

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