Current situations and future directions for mental health system governance in Nepal: findings from a qualitative study
Abstract Background Assessing and understanding health systems governance is crucial to ensure accountability and transparency, and to improve the performance of mental health systems. There is a lack of systematic procedures to assess governance in mental health systems at a country level. The aim...
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| Format: | Article |
| Language: | English |
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BMC
2017-06-01
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| Series: | International Journal of Mental Health Systems |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13033-017-0145-3 |
| _version_ | 1798045360889790464 |
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| author | Nawaraj Upadhaya Mark J. D. Jordans Ruja Pokhrel Dristy Gurung Ramesh P. Adhikari Inge Petersen Ivan H. Komproe |
| author_facet | Nawaraj Upadhaya Mark J. D. Jordans Ruja Pokhrel Dristy Gurung Ramesh P. Adhikari Inge Petersen Ivan H. Komproe |
| author_sort | Nawaraj Upadhaya |
| collection | DOAJ |
| description | Abstract Background Assessing and understanding health systems governance is crucial to ensure accountability and transparency, and to improve the performance of mental health systems. There is a lack of systematic procedures to assess governance in mental health systems at a country level. The aim of this study was to appraise mental health systems governance in Nepal, with the view to making recommendations for improvements. Methods In-depth individual interviews were conducted with national-level policymakers (n = 17) and district-level planners (n = 11). The interview checklist was developed using an existing health systems governance framework developed by Siddiqi and colleagues as a guide. Data analysis was done with NVivo 10, using the procedure of framework analysis. Results The mental health systems governance assessment reveals a few enabling factors and many barriers. Factors enabling good governance include availability of mental health policy, inclusion of mental health in other general health policies and plans, increasing presence of Non-Governmental Organizations (NGOs) and service user organizations in policy forums, and implementation of a few mental health projects through government-NGO collaborations. Legal and policy barriers include the failure to officially revise or fully implement the mental health policy of 1996, the existence of legislation and several laws that have discriminatory provisions for people with mental illness, and lack of a mental health act and associated regulations to protect against this. Other barriers include lack of a mental health unit within the Ministry of Health, absence of district-level mental health planning, inadequate mental health record-keeping systems, inequitable allocation of funding for mental health, very few health workers trained in mental health, and the lack of availability of psychotropic drugs at the primary health care level. Conclusions In the last few years, some positive developments have emerged in terms of policy recognition for mental health, as well as the increased presence of NGOs, increased presence of service users or caregivers in mental health governance, albeit restricted to only some of its domains. However, the improvements at the policy level have not been translated into implementation due to lack of strong leadership and governance mechanisms. |
| first_indexed | 2024-04-11T23:20:36Z |
| format | Article |
| id | doaj.art-133647c9b25141e4b5a662de9f2f6d52 |
| institution | Directory Open Access Journal |
| issn | 1752-4458 |
| language | English |
| last_indexed | 2024-04-11T23:20:36Z |
| publishDate | 2017-06-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal of Mental Health Systems |
| spelling | doaj.art-133647c9b25141e4b5a662de9f2f6d522022-12-22T03:57:28ZengBMCInternational Journal of Mental Health Systems1752-44582017-06-0111111210.1186/s13033-017-0145-3Current situations and future directions for mental health system governance in Nepal: findings from a qualitative studyNawaraj Upadhaya0Mark J. D. Jordans1Ruja Pokhrel2Dristy Gurung3Ramesh P. Adhikari4Inge Petersen5Ivan H. Komproe6Transcultural Psychosocial Organization NepalDepartment of Research and Development, HealthNet TPOTranscultural Psychosocial Organization NepalTranscultural Psychosocial Organization NepalTranscultural Psychosocial Organization NepalSchool of Nursing and Public Health Medicine, University of KwaZulu-NatalDepartment of Research and Development, HealthNet TPOAbstract Background Assessing and understanding health systems governance is crucial to ensure accountability and transparency, and to improve the performance of mental health systems. There is a lack of systematic procedures to assess governance in mental health systems at a country level. The aim of this study was to appraise mental health systems governance in Nepal, with the view to making recommendations for improvements. Methods In-depth individual interviews were conducted with national-level policymakers (n = 17) and district-level planners (n = 11). The interview checklist was developed using an existing health systems governance framework developed by Siddiqi and colleagues as a guide. Data analysis was done with NVivo 10, using the procedure of framework analysis. Results The mental health systems governance assessment reveals a few enabling factors and many barriers. Factors enabling good governance include availability of mental health policy, inclusion of mental health in other general health policies and plans, increasing presence of Non-Governmental Organizations (NGOs) and service user organizations in policy forums, and implementation of a few mental health projects through government-NGO collaborations. Legal and policy barriers include the failure to officially revise or fully implement the mental health policy of 1996, the existence of legislation and several laws that have discriminatory provisions for people with mental illness, and lack of a mental health act and associated regulations to protect against this. Other barriers include lack of a mental health unit within the Ministry of Health, absence of district-level mental health planning, inadequate mental health record-keeping systems, inequitable allocation of funding for mental health, very few health workers trained in mental health, and the lack of availability of psychotropic drugs at the primary health care level. Conclusions In the last few years, some positive developments have emerged in terms of policy recognition for mental health, as well as the increased presence of NGOs, increased presence of service users or caregivers in mental health governance, albeit restricted to only some of its domains. However, the improvements at the policy level have not been translated into implementation due to lack of strong leadership and governance mechanisms.http://link.springer.com/article/10.1186/s13033-017-0145-3GovernanceMental health servicesMental health systemGlobal mental healthNepalLow- and middle-income countries |
| spellingShingle | Nawaraj Upadhaya Mark J. D. Jordans Ruja Pokhrel Dristy Gurung Ramesh P. Adhikari Inge Petersen Ivan H. Komproe Current situations and future directions for mental health system governance in Nepal: findings from a qualitative study International Journal of Mental Health Systems Governance Mental health services Mental health system Global mental health Nepal Low- and middle-income countries |
| title | Current situations and future directions for mental health system governance in Nepal: findings from a qualitative study |
| title_full | Current situations and future directions for mental health system governance in Nepal: findings from a qualitative study |
| title_fullStr | Current situations and future directions for mental health system governance in Nepal: findings from a qualitative study |
| title_full_unstemmed | Current situations and future directions for mental health system governance in Nepal: findings from a qualitative study |
| title_short | Current situations and future directions for mental health system governance in Nepal: findings from a qualitative study |
| title_sort | current situations and future directions for mental health system governance in nepal findings from a qualitative study |
| topic | Governance Mental health services Mental health system Global mental health Nepal Low- and middle-income countries |
| url | http://link.springer.com/article/10.1186/s13033-017-0145-3 |
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