Page 31 - GHES-3-2

Global Health Economics and
Sustainability
Financing mental health reforms in Africa

(UHC) through prepayment approaches. These prepaid Across SSA, the ratio of psychiatrists to population is
sources, through tax-funding and social health insurance below the WHO’s recommendation of 1:10,000, creating
schemes, increase health revenues. Finally, innovative significant challenges for achieving UHC and meeting
finance mechanisms such as social impact bonds for mental sustainable development goals. Momentum has been
health should be fostered. Countries with a high level of increasingly prioritizing mental health in the global health
public health investment have low out-of-pocket payments agenda, which is evident from the specific provisions for
and a high level of financial risk protection compared with mental health in the Sustainable Development Goals and
other countries, which promotes access to mental health the integration of mental health into the Global Declaration
care. For example, out-of-pocket spending in Botswana is on UHC at a UN high-level meeting in 2019. The ratio of
8% of the total health expenditure, compared to Uganda psychiatrists per 100,000 is high in upper-middle-income
(42%); thus, Botswana has more efficiency and equity in countries compared to SSA: 4.6 in Singapore (Ministry of
the health sector. Health Singapore, 2022) and 1.2 in Malaysia (Fernandez,
2022). Comparatively, Uganda has only 53 psychiatrists
2. Regaining the reform momentum countrywide, that is, 0.12/100,000 (Kaggwa et al., 2022). The
Uganda’s Third National Development Plan (NDPIII) number of other mental health-care workers per 100,000
2020/2021 – 2024/2025, does not mention mental health people in Uganda is estimated at 0.1 psychologists, 0.04
care services, indicating the gaps in the existing sectors’ other medical doctors, 0.2 psychiatric clinical officers, 0.01
harmonization framework and implying that mental health social workers, 0.78 nurses, 0.01 occupational therapists,
is not a priority. This omission implies that the right to and 6.4 psychiatric nurses. Training more psychiatrists
health for all is still a challenge and a trend also witnessed requires integrating psychiatric care with primary
in other SSA countries. The mental health treatment gap in care, increasing clinical capacity with digital patient
SSA is alarmingly high at 98.8% (Saade et al., 2023). More management systems, and shifting some responsibilities
disturbingly, 85% of Ugandans with mental disorders are to allied healthcare workers. Such a workforce would be
not seeking care at all, potentially attributable to the high adequate, efficient, and equitably distributed.
costs of treatment as a deterrent. Moreover, worsened Several sub-Saharan countries, such as Uganda, Kenya,
by income inequality where the wealthiest 10% of the and Tanzania, have proposed various tax proposals to
population receives 35.7% of the national income, the generate more revenues; however, political apathy persists
poorest 10% earns 2.5%, and the poorest 20% earns 5.8%. in taxing commercial determinants of health, which can
Subsequently, the proportion of Ugandans who receive be used for mental health investment. Subsequently, such
mental health care is unacceptably low. apathy tends to worsen prevailing financing approaches
to mental ill-health situations. The tax base that has not
In private health care, consultation costs 60,000 to
365,000 Ugandan shillings (UGX) (15.87 – 96.55 USD) per been explored for investment in health includes the sugar-
sweetened beverage industry, plastic shopping bags, and
session. Private medical schemes for prepayment insurance the gambling and betting industry. Other culprits that
coverage limits are capped at 1,000,000 – 6,000,0000 UGX
(264.54 – 15,872.34 USD) for in-patients and 500,000 could be targeted to fund mental health programs are the
– 1,500,000 UGX (132.27 – 396.81 USD) for outpatients tobacco and alcohol industries. Taxing these industries
based on profitability, their position in exasperating poor
per year. Multiple therapy sessions over an extended mental health, and their lack of accountability in financing
period render many patients, particularly young people countries’ mental health programs to date needs reform.
and those from the lower-income quintile, unable to bear Such taxation strategies could alleviate the health financing
such a financial burden. This situation exposes them to gap; thus, there is still a fiscal space for aggressive taxation,
catastrophic expenditures, especially if they have comorbid which could benefit mental health.
conditions. This trend implies that access to healthcare is a
privilege for a few individuals, undermining UHC’s vision; Uganda’s proposed national health insurance scheme,
hence, healthcare as a commodity remains scarce for low- which is relevant to UHC, is an opportunity to promote
income families. health equity and improve mental health; however, there
is a need to scale the integration of mental health in all
3. Setting benchmarks for the SSA sectors. Such integration requires robust government
Most countries’ health systems in SSA were inherited leadership that finance ministries can facilitate as part of a
from colonialism; consequently, their premise is reactive, strategic and cross-governmental approach.
not preemptive. The human resource shortage for mental From a macroeconomic stability perspective, the
health is another gray area demanding financing reform. context of financing mental health is malleable. The policy

Volume 3 Issue 2 (2025) 23 https://doi.org/10.36922/ghes.3700