Moving towards universal health coverage for mental disorders in Ethiopia.
Charlotte Hanlon, Atalay Alem, Crick Lund, Damen Hailemariam, Esubalew Assefa, Tedla W Giorgis, Dan Chisholm
Author Information
Charlotte Hanlon: 1Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. ORCID
Atalay Alem: 2Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Crick Lund: 1Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Damen Hailemariam: 4School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Esubalew Assefa: 5Department of Economics, Faculty of Arts and Social Sciences, The Open University, Milton Keynes, UK.
Tedla W Giorgis: 6Office of the Minister, Federal Ministry of Health, Addis Ababa, Ethiopia.
Dan Chisholm: 7Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland.
BACKGROUND: People with mental disorders in low-income countries are at risk of being left behind during efforts to expand universal health coverage. AIMS: To propose context-relevant strategies for moving towards universal health coverage for people with mental disorders in Ethiopia. METHODS: We conducted a situational analysis to inform a SWOT analysis of coverage of mental health services and financial risk protection, health system characteristics and the macroeconomic and fiscal environment. In-depth interviews were conducted with five national experts on health financing and equity and analysed using a thematic approach. Findings from the situation analysis and qualitative study were used to develop recommended strategies for adequate, fair and sustainable financing of mental health care in Ethiopia. RESULTS: Opportunities for improved financing of mental health care identified from the situation analysis included: a significant mental health burden with evidence from strong local epidemiological data; political commitment to address that burden; a health system with mechanisms for integrating mental health into primary care; and a favourable macro-fiscal environment for investment in human capabilities. Balanced against this were constraints of low current general government health expenditure, low numbers of mental health specialists, weak capacity to plan and implement mental health programmes and low population demand for mental health care. All key informants referred to the under-investment in mental health care in Ethiopia. Respondents emphasised opportunities afforded by positive rates of economic growth in the country and the expansion of community-based health insurance, as well as the need to ensure full implementation of existing task-sharing programmes for mental health care, integrate mental health into other priority programmes and strengthen advocacy to ensure mental health is given due attention. CONCLUSION: Expansion of public health insurance, leveraging resources from high-priority SDG-related programmes and implementing existing plans to support task-shared mental health care are key steps towards universal health coverage for mental disorders in Ethiopia. However, external donors also need to deliver on commitments to include mental health within development funding. Future researchers and planners can apply this approach to other countries of sub-Saharan Africa and identify common strategies for sustainable and equitable financing of mental health care.
