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Global Health Economics and
Sustainability
Financing mental health reforms in Africa

mental health are a multilayered construct with diverse however, interventions targeting severe mental disorders
dimensions, including political, economic, and social. may show promise in improving productivity in LMICs
These dimensions usually lie outside the remits of the (Lund et al., 2024). In SSA, the cost of intervention is small
health system. The historic lack of adequate investment for a package of depression, alcohol abuse, epilepsy, and
and prioritization in mental health, insecurity, education, schizophrenia at 3 – 4 USD per capita every year, except
food, employment, income inequality, and living standards in South Africa at 13.3. In upper-middle-income countries
have all been associated with poor mental health; thus, the (Jamaica, Marshall Islands, Mauritius, North Macedonia,
promotion of mental health is multisectoral. The feasible Saint Vincent and the Grenadines, and South Africa),
measures for reforms to offset such determinants vary. the cost is 6 – 8 USD. Upper-middle-income countries
Such measures include transforming mental health services allocate around 5% of their health budget to mental health,
with explicit human rights-based approaches; building contrary to 0.5% for LMICs. For low-income countries
responsive, resilient, and sustainable primary health (LICs) and LMICs to achieve basic mental health services
systems; supporting employment policies and programs delivery, LICs would need to increase funding fivefold, and
to help acquire, retain, or regain jobs; and legalizing social LMICs would need to double their allocation. In the global
welfare sustainable systems. For example, in Belgium and South, countries such as Uganda, where poverty, disease,
Canada, multisectoral approaches beyond mental health and ignorance are common, demand for resolute mental
care have been examined regarding housing, educational, health care can seem a luxury inaccessible to many.
and employment support to patients (Van Rensburg & A Ugandan Mental Health Study in 2022 reported
Brooke, 2023). In Poland, mental health centers have been that 32% of adults suffer from mental disorders, ranking
incorporated into the local communities, emphasizing Uganda among the top six countries in Africa, with 14
patient-centeredness, societal integration, and accessibility million people suffering from mental problems (Kaggwa
(Korolkiewicz et al., 2024). Furthermore, France and New et al., 2022). Suppose these 14 million affected people
Zealand have integrated a mental health people-powered interact with at least two other individuals. This situation
model within a well-being framework (McGorry et al., potentially translates to the entire nation of 45 million
2022). Other successful multisectoral initiatives have been people being affected directly or indirectly by mental
reported in Burkina Faso, Ghana, Kenya, Nigeria, Malawi, health. The surge will profoundly impact Uganda because
South Africa, and Zimbabwe, with greater involvement there are limited facilities for mental health care. Only one
of families in providing care, use of herbal medications, national referral mental hospital (Butabika) exists. The
rituals, and prayers in mental illness recovery (Van der facility staffing is presently at 50% from the proposed 86%
Zeijst et al., 2023). This situation contributes to positive and yet the number of patients accessing for services is
therapeutic outcomes, cost savings, close income gaps, increasing mostly the inpatients. Thus, the bed occupancy
and unemployment. Close to 28% of countries do not rate of 212% is a challenge. More so, primary care is
have a separate budget for mental health, and 36% of these inadequate to address mental health concerns. Despite the
countries spend <2% of their health budget on mental health sector reforms deliberated on for over three decades,
health, far below the 12% recommended by the World little attention has been paid to mental health financing.
Health Organization. Indeed, Uganda and Lesotho are not Mental health is allocated 1% of the health budget in
unique.
Uganda, a country without a National Health Insurance
A Lancet Commission report on mental health indicates Scheme. Undoubtedly, the call for reforms demands a
that mental disorders will cost the global economy 16 shift in mental health financing; thus, the need for mental
trillion US dollars (USD) by 2030. The economic value health services is palpable.
associated with poor mental health is estimated at 5 trillion In pursuit of the African Agenda 2063, financing
and 1 trillion USD from lost productivity (WHO, 2022). reforms could positively impact mental health coverage by
The global cost of care is projected at 387 USD billion increasing mental health funding and using existing funds
annually for depression and anxiety (Arias et al., 2022). effectively. Furthermore, improving financial structures and
The estimated cost of mental disorders in Africa is 30.3 integrating mental health into the budgets and programs
billion USD (UNICEF, 2021), whereas for East Africa, 4% of ministries, departments, and agencies, including off-
of its gross domestic product (GDP) is estimated to be lost budget programs in a harmonized method, requires high
in productivity (Arias et al., 2022). prioritization by development actors to integrate mental
Studies show that every 1 USD invested in mental health into their projects. They must also prioritize mental
health is estimated to return 4 USD in improved health health in global financing partnerships and design health
and productivity (The Lancet Global Health, 2020); financing systems relevant to universal health coverage

Volume 3 Issue 2 (2025) 22 https://doi.org/10.36922/ghes.3700