Page 32 - GHES-3-2

Global Health Economics and
Sustainability
Financing mental health reforms in Africa

shift of fiscal space increase to 5% of GDP going to the centers, including in-patient services outside the hospital
mental health sector may yield primarily to doubling the premises. Furthermore, it developed municipality networks
per capita expenditure on health (Okwero et al., 2010), for providing social care for mental illness. Norway has
potentially increasing mental health service coverage Europe’s most facilitated mental health sector and the
by nearly 40% – 80%. Such a proactive approach by highest professionalism and human resource levels. In
governments would ensure that patients have better, contrast, the Benelux countries (Belgium, the Netherlands,
more affordable buffers, cushioning them from financial and Luxemburg) developed integrated care systems with a
hardship rather than expanding social safety nets following vast network of health and social services financed by social
a crisis. Cognizant of this, mandatory health insurance in health insurance on a not-for-profit basis. For example,
Egypt, Morocco, Gabon, Ghana, Zambia, Mali, Rwanda, Belgium established a hospital-centric community-based
Tanzania, and Togo receives budget transfers or public system founded on partnerships and proactive outreach
subsidies (ISSA, 2023). planning. This approach was accompanied by the forming
From a systemic level, policymakers must empower the of regional mental health networks within the national
sector with professional planners at all levels to lead the mental health ecosystem. (Salvador-Carulla, 2021).
process under the auspices of the National Development 4. Enhancing leadership and investment in
Plan to realize reforms. Moreover, catalytic funding should
be provided in those contexts where governments cannot mental health
find this fully in support of a UHC-based approach. Nonetheless, reforms are often overlaid on existing
Countries could also pursue creating mechanisms by systems, risking further fragmentation and mixed signals
multilateral or bilateral partners to mobilize new financing, to stakeholders. Therefore, countries should systematically
including from the private sector, at affordable terms, such and explicitly embed such adjustors in their reform
as public-private partnerships (PPPs) for domestic resource strategies. We suggest strategies for engaging stakeholders,
mobilization in the US. Venture capital (VC) companies including governments, non-government organizations,
invested a record-breaking 637 million USD in more than and the private sector, including advocacy techniques,
60 mental health-oriented companies in 2019 to improve community participatory frameworks, partnership models,
mental healthcare (Shah & Berry, 2021). Therefore, it is and stakeholder analysis approaches. First, advocacy could
desirable to support the SSA mental health innovation involve engaging influential mental health advocates
ecosystem for digital health care of mental illnesses through who serve as goodwill “ambassadors” and champions
VC investments. However, SSA’s inadequate pooling of VC among their peers and the target audiences to advocate
hinders the rise of private-profit start-up investment and for systemic changes and build visibility and sustainability
makes it harder to increase funding to the health sector. of mental health services. Second, engaging community
Also, the PPPs can mainstream mental health insurance to participation through leaders helps establish conditions
provide population-based (rather than beneficiary-based) for dialog and implement linkages in the community to
services. Ultimately, this situation ensures financial risk foster ownership, for example, designing mental health
protection for people living with mental illness. Policy awareness campaigns through sports and school health
support can help countries meet their needs as they programs. Third, routine sharing of inputs and outcomes
undertake important reforms by shifting and transitioning through partnership to improve mental healthcare in the
from input to output-based financing (performance and community, for example, the partnership model of anti-
revenue retention), which can be implemented at facility stigma activities in Singapore has been conducted by
levels; however, their implementation needs regulation and the Institute of Mental Health, Health Promotion Board,
oversight mechanisms. statutory boards of state psychiatric institutions, National
Case-to-case management of public health facility Council of Social Service, and not-for-profit organizations,
issues could be implemented, involving actual costing from such as the Singapore Association for Mental Health and
facilities and interactions with key actors to attain UHC. Silver Ribbon Singapore.
In the Netherlands and France, health-care purchasing Given that stigma is a significant barrier to accessing mental
and payment options are engaged in integrated and health care, in our view, strategies to reduce stigma include
chronic mental health care (Polin et al., 2021). Consumer the promotion of mental health advocacy, litigation, and
organizations were integrated into care planning and awareness. These should embrace inclusivity and culturally
provision systems in Scandinavian countries. For example, sensitive practices that address stigma and other disparities,
Norway developed a strong community-decentralized thus promoting equitable access to services. Shahwan et al.
care system that integrated community mental health-care (2022) proposed a framework that includes (1) raising mental

Volume 3 Issue 2 (2025) 24 https://doi.org/10.36922/ghes.3700