Docrat Sumaiyah, Lund Crick, Chisholm Dan
1Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
2Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Int J Ment Health Syst. 2019 Jan 21;13:4. doi: 10.1186/s13033-019-0260-4. eCollection 2019.
With the implicit neglect for the integration of mental health services into general health service development in South Africa, there is an urgent need for an understanding of the ways in which existing reforms may be leveraged to incorporate the objectives of the (MHPF) and the mechanisms by which these reforms can be structured and financed in the context of fiscal constraint.
A situational analysis guided by a newly developed analytical framework for sustainable mental health financing was conducted. The review was followed by qualitative, indepth interviews with a range of expert national stakeholders.
Although the MHPF is said to be consistent with ongoing efforts toward the implementation of National Health Insurance (NHI), there is clear evidence of discordance between the MHPF and the NHI. The most promising strategies for sustainable mental health financing include: increased decentralization of resources to primary and community mental health services; active integration of mental health into ongoing NHI implementation including expanding the mandate of District hospitals and drawing on the private sector; submission of costed budget bids to support a mental health conditional grant and ensuring that explicit outcomes and deliverables are in place to monitor Provincial implementation.
This paper has suggested several ways in which existing reforms may be leveraged to incorporate the objectives of the MHPF and achieve better mental health outcomes for South Africans, revealing critical opportunities for mental health service scale-up to be embedded in South Africa's future health delivery strategy. The realization of a conditional grant for mental health will require technical expertise to cost existing services towards the development of an investment case for mental health service scale-up nationally, projecting potential resource requirements and returns on investment of a strong service platform. In the longer-term, the NHI benefit package must be expanded to include comprehensive mental health services at all levels. Explicit results-based financing mechanisms within the NHI Fund must also be incorporated for mental health to incentivise quality of care. Private providers engaged by the NHI must commit to make use of evidence-based mental health interventions.
由于南非在将精神卫生服务纳入一般卫生服务发展方面受到隐性忽视，迫切需要了解如何利用现有改革来纳入《精神卫生政策框架》（MHPF）的目标，以及在财政约束背景下构建和资助这些改革的机制。
在一个新开发的可持续精神卫生融资分析框架的指导下进行了情况分析。随后对一系列国家专家利益相关者进行了定性、深入访谈。
尽管据说《精神卫生政策框架》与正在进行的国家医疗保险（NHI）实施努力相一致，但有明确证据表明《精神卫生政策框架》与国家医疗保险之间存在不一致。可持续精神卫生融资最有前景的策略包括：将资源更多地下放至基层和社区精神卫生服务；将精神卫生积极纳入正在进行的国家医疗保险实施工作，包括扩大地区医院的职责范围并利用私营部门；提交有成本核算的预算申请以支持精神卫生有条件赠款，并确保有明确的成果和可交付成果以监测省级实施情况。
本文提出了几种利用现有改革来纳入《精神卫生政策框架》目标并为南非人实现更好精神卫生成果的方法，揭示了将扩大精神卫生服务规模的关键机遇纳入南非未来卫生服务战略的机会。实现精神卫生有条件赠款将需要技术专长来为现有服务成本核算，以制定全国精神卫生服务扩大规模的投资方案，预测潜在资源需求和强大服务平台的投资回报。从长远来看，国家医疗保险福利包必须扩大，以包括各级全面的精神卫生服务。国家医疗保险基金内还必须纳入基于明确结果的融资机制，以激励精神卫生护理质量。国家医疗保险聘用的私营提供者必须承诺使用循证精神卫生干预措施。
