Upadhaya Nawaraj, Jordans Mark J D, Pokhrel Ruja, Gurung Dristy, Adhikari Ramesh P, Petersen Inge, Komproe Ivan H
Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal.
Department of Research and Development, HealthNet TPO, Amsterdam, The Netherlands.
Int J Ment Health Syst. 2017 Jun 8;11:37. doi: 10.1186/s13033-017-0145-3. eCollection 2017.
Assessing and understanding health systems governance is crucial to ensure accountability and transparency, and to improve the performance of mental health systems. There is a lack of systematic procedures to assess governance in mental health systems at a country level. The aim of this study was to appraise mental health systems governance in Nepal, with the view to making recommendations for improvements.
In-depth individual interviews were conducted with national-level policymakers (n = 17) and district-level planners (n = 11). The interview checklist was developed using an existing health systems governance framework developed by Siddiqi and colleagues as a guide. Data analysis was done with NVivo 10, using the procedure of framework analysis.
The mental health systems governance assessment reveals a few enabling factors and many barriers. Factors enabling good governance include availability of mental health policy, inclusion of mental health in other general health policies and plans, increasing presence of Non-Governmental Organizations (NGOs) and service user organizations in policy forums, and implementation of a few mental health projects through government-NGO collaborations. Legal and policy barriers include the failure to officially revise or fully implement the mental health policy of 1996, the existence of legislation and several laws that have discriminatory provisions for people with mental illness, and lack of a mental health act and associated regulations to protect against this. Other barriers include lack of a mental health unit within the Ministry of Health, absence of district-level mental health planning, inadequate mental health record-keeping systems, inequitable allocation of funding for mental health, very few health workers trained in mental health, and the lack of availability of psychotropic drugs at the primary health care level.
In the last few years, some positive developments have emerged in terms of policy recognition for mental health, as well as the increased presence of NGOs, increased presence of service users or caregivers in mental health governance, albeit restricted to only some of its domains. However, the improvements at the policy level have not been translated into implementation due to lack of strong leadership and governance mechanisms.
评估和理解卫生系统治理对于确保问责制和透明度以及改善精神卫生系统的绩效至关重要。在国家层面缺乏评估精神卫生系统治理的系统程序。本研究的目的是评估尼泊尔的精神卫生系统治理，以便提出改进建议。
对国家级政策制定者（n = 17）和地区级规划者（n = 11）进行了深入的个人访谈。访谈清单以Siddiqi及其同事制定的现有卫生系统治理框架为指导制定。使用NVivo 10进行数据分析，采用框架分析程序。
精神卫生系统治理评估揭示了一些促进因素和许多障碍。促进良好治理的因素包括有精神卫生政策、将精神卫生纳入其他一般卫生政策和计划、非政府组织（NGO）和服务使用者组织在政策论坛中的参与度增加，以及通过政府与非政府组织合作实施一些精神卫生项目。法律和政策障碍包括未能正式修订或全面实施1996年的精神卫生政策、存在对精神疾病患者有歧视性条款的立法和若干法律，以及缺乏精神卫生法和相关法规以防止此类情况。其他障碍包括卫生部内缺乏精神卫生部门、缺乏地区级精神卫生规划、精神卫生记录保存系统不完善、精神卫生资金分配不公平、接受过精神卫生培训的卫生工作者很少，以及初级卫生保健层面缺乏精神药物。
在过去几年中，在精神卫生政策认可方面出现了一些积极进展，非政府组织的参与度增加，精神卫生治理中服务使用者或照料者的参与度增加，尽管仅限于某些领域。然而，由于缺乏强有力的领导和治理机制，政策层面的改进尚未转化为实施。
