Sustainable financing options for mental health care in South Africa: findings from a situation analysis and key informant interviews
Abstract Background With the implicit neglect for the integration of mental health services into general health service development in South Africa, there is an urgent need for an understanding of the ways in which existing reforms may be leveraged to incorporate the objectives of the National Menta...
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| Format: | Article |
| Language: | English |
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BMC
2019-01-01
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| Series: | International Journal of Mental Health Systems |
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| Online Access: | http://link.springer.com/article/10.1186/s13033-019-0260-4 |
| _version_ | 1818508872133902336 |
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| author | Sumaiyah Docrat Crick Lund Dan Chisholm |
| author_facet | Sumaiyah Docrat Crick Lund Dan Chisholm |
| author_sort | Sumaiyah Docrat |
| collection | DOAJ |
| description | Abstract Background With the implicit neglect for the integration of mental health services into general health service development in South Africa, there is an urgent need for an understanding of the ways in which existing reforms may be leveraged to incorporate the objectives of the National Mental Health Policy Framework and Strategic Plan (MHPF) and the mechanisms by which these reforms can be structured and financed in the context of fiscal constraint. Methods A situational analysis guided by a newly developed analytical framework for sustainable mental health financing was conducted. The review was followed by qualitative, indepth interviews with a range of expert national stakeholders. Results Although the MHPF is said to be consistent with ongoing efforts toward the implementation of National Health Insurance (NHI), there is clear evidence of discordance between the MHPF and the NHI. The most promising strategies for sustainable mental health financing include: increased decentralization of resources to primary and community mental health services; active integration of mental health into ongoing NHI implementation including expanding the mandate of District hospitals and drawing on the private sector; submission of costed budget bids to support a mental health conditional grant and ensuring that explicit outcomes and deliverables are in place to monitor Provincial implementation. Conclusion This paper has suggested several ways in which existing reforms may be leveraged to incorporate the objectives of the MHPF and achieve better mental health outcomes for South Africans, revealing critical opportunities for mental health service scale-up to be embedded in South Africa’s future health delivery strategy. The realization of a conditional grant for mental health will require technical expertise to cost existing services towards the development of an investment case for mental health service scale-up nationally, projecting potential resource requirements and returns on investment of a strong service platform. In the longer-term, the NHI benefit package must be expanded to include comprehensive mental health services at all levels. Explicit results-based financing mechanisms within the NHI Fund must also be incorporated for mental health to incentivise quality of care. Private providers engaged by the NHI must commit to make use of evidence-based mental health interventions. |
| first_indexed | 2024-12-10T22:37:53Z |
| format | Article |
| id | doaj.art-74dc18520696434ea2783a8ed3cf3802 |
| institution | Directory Open Access Journal |
| issn | 1752-4458 |
| language | English |
| last_indexed | 2024-12-10T22:37:53Z |
| publishDate | 2019-01-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal of Mental Health Systems |
| spelling | doaj.art-74dc18520696434ea2783a8ed3cf38022022-12-22T01:30:48ZengBMCInternational Journal of Mental Health Systems1752-44582019-01-0113111110.1186/s13033-019-0260-4Sustainable financing options for mental health care in South Africa: findings from a situation analysis and key informant interviewsSumaiyah Docrat0Crick Lund1Dan Chisholm2Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape TownAlan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape TownDepartment of Mental Health and Substance Abuse, World Health OrganizationAbstract Background With the implicit neglect for the integration of mental health services into general health service development in South Africa, there is an urgent need for an understanding of the ways in which existing reforms may be leveraged to incorporate the objectives of the National Mental Health Policy Framework and Strategic Plan (MHPF) and the mechanisms by which these reforms can be structured and financed in the context of fiscal constraint. Methods A situational analysis guided by a newly developed analytical framework for sustainable mental health financing was conducted. The review was followed by qualitative, indepth interviews with a range of expert national stakeholders. Results Although the MHPF is said to be consistent with ongoing efforts toward the implementation of National Health Insurance (NHI), there is clear evidence of discordance between the MHPF and the NHI. The most promising strategies for sustainable mental health financing include: increased decentralization of resources to primary and community mental health services; active integration of mental health into ongoing NHI implementation including expanding the mandate of District hospitals and drawing on the private sector; submission of costed budget bids to support a mental health conditional grant and ensuring that explicit outcomes and deliverables are in place to monitor Provincial implementation. Conclusion This paper has suggested several ways in which existing reforms may be leveraged to incorporate the objectives of the MHPF and achieve better mental health outcomes for South Africans, revealing critical opportunities for mental health service scale-up to be embedded in South Africa’s future health delivery strategy. The realization of a conditional grant for mental health will require technical expertise to cost existing services towards the development of an investment case for mental health service scale-up nationally, projecting potential resource requirements and returns on investment of a strong service platform. In the longer-term, the NHI benefit package must be expanded to include comprehensive mental health services at all levels. Explicit results-based financing mechanisms within the NHI Fund must also be incorporated for mental health to incentivise quality of care. Private providers engaged by the NHI must commit to make use of evidence-based mental health interventions.http://link.springer.com/article/10.1186/s13033-019-0260-4Mental health systemsHealthcare financingSustainable mental health financingNational Health ProgramsHealth Care ReformGlobal Mental Health |
| spellingShingle | Sumaiyah Docrat Crick Lund Dan Chisholm Sustainable financing options for mental health care in South Africa: findings from a situation analysis and key informant interviews International Journal of Mental Health Systems Mental health systems Healthcare financing Sustainable mental health financing National Health Programs Health Care Reform Global Mental Health |
| title | Sustainable financing options for mental health care in South Africa: findings from a situation analysis and key informant interviews |
| title_full | Sustainable financing options for mental health care in South Africa: findings from a situation analysis and key informant interviews |
| title_fullStr | Sustainable financing options for mental health care in South Africa: findings from a situation analysis and key informant interviews |
| title_full_unstemmed | Sustainable financing options for mental health care in South Africa: findings from a situation analysis and key informant interviews |
| title_short | Sustainable financing options for mental health care in South Africa: findings from a situation analysis and key informant interviews |
| title_sort | sustainable financing options for mental health care in south africa findings from a situation analysis and key informant interviews |
| topic | Mental health systems Healthcare financing Sustainable mental health financing National Health Programs Health Care Reform Global Mental Health |
| url | http://link.springer.com/article/10.1186/s13033-019-0260-4 |
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