Sulaberidze Lela, Green Stuart, Chikovani Ivdity, Uchaneishvili Maia, Gotsadze George
Curatio International Foundation, 3 Kavsadze str, 0179, Tbilisi, Georgia.
National Institute for Health Research Collaboration for Leadership in Applied Research and Care, Northwest London, Imperial College London, London, UK.
BMC Health Serv Res. 2018 Feb 13;18(1):108. doi: 10.1186/s12913-018-2912-5.
Whilst there is recognition that the global burden of disease associated with mental health disorders is significant, the economic resources available, especially in Low and Middle Income Countries, are particularly scarce. Identifying the economic (system) and financial (individual) barriers to delivering mental health services and assessing the opportunities for reform can support the development of strategies for change.
A mixed methods study was developed, which engaged with a range of stakeholders from mental health services, including key informants, service managers, healthcare professional and patients and their care-takers. Data generated from interviews and focus groups were analysed using an existing framework that outlines a range of economic and financial barriers to improving mental health practice. In addition, the study utilised health financing and programmatic data.
The analysis identified a variety of local economic barriers, including: the inhibition of the diversification of the mental health workforce and services due to inflexible resources; the variable and limited provision of services across the country; and the absence of mechanisms to assess the delivery and quality of existing services. The main financial barriers identified were related to out-of pocket payments for purchasing high quality medications and transportation to access mental health services.
Whilst scarcity of financial resources exists in Georgia, as in many other countries, there are clear opportunities to improve the effectiveness of the current mental health programme. Addressing system-wide barriers could enable the delivery of services that aim to meet the needs of patients. The use of existing data to assess the implementation of the mental health programme offers opportunities to benchmark and improve services and to support the appropriate commissioning and reconfiguration of services.
尽管人们认识到与精神健康障碍相关的全球疾病负担很重，但可用的经济资源，尤其是在低收入和中等收入国家，却极为稀缺。确定提供精神卫生服务的经济（系统）和财政（个人）障碍，并评估改革机会，有助于制定变革战略。
开展了一项混合方法研究，涉及精神卫生服务领域的一系列利益相关者，包括关键信息提供者、服务管理者、医疗保健专业人员以及患者及其护理人员。使用一个现有框架对访谈和焦点小组产生的数据进行分析，该框架概述了改善精神卫生实践的一系列经济和财政障碍。此外，该研究还利用了卫生筹资和项目数据。
分析确定了多种当地经济障碍，包括：资源缺乏灵活性抑制了精神卫生工作人员队伍和服务的多样化；全国各地服务提供参差不齐且有限；缺乏评估现有服务提供情况和质量的机制。确定的主要财政障碍与购买高质量药物的自付费用以及前往精神卫生服务机构的交通费用有关。
与许多其他国家一样，格鲁吉亚存在财政资源短缺的情况，但目前有明显机会提高精神卫生项目的成效。消除全系统障碍能够提供旨在满足患者需求的服务。利用现有数据评估精神卫生项目的实施情况，为服务的基准化和改进以及支持适当的服务委托和重新配置提供了机会。
