Hanlon Charlotte, Alem Atalay, Lund Crick, Hailemariam Damen, Assefa Esubalew, Giorgis Tedla W, Chisholm Dan
1Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
2Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Int J Ment Health Syst. 2019 Feb 25;13:11. doi: 10.1186/s13033-019-0268-9. eCollection 2019.
People with mental disorders in low-income countries are at risk of being left behind during efforts to expand universal health coverage.
To propose context-relevant strategies for moving towards universal health coverage for people with mental disorders in Ethiopia.
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.
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.
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.
在扩大全民健康覆盖的努力中，低收入国家的精神障碍患者有被甩在后面的风险。
提出与埃塞俄比亚国情相关的战略，以推动为精神障碍患者实现全民健康覆盖。
我们进行了形势分析，为精神卫生服务覆盖和财务风险保护、卫生系统特征以及宏观经济和财政环境的SWOT分析提供信息。对五位国家卫生筹资与公平问题专家进行了深入访谈，并采用主题分析法进行分析。形势分析和定性研究的结果被用于制定埃塞俄比亚精神卫生保健充足、公平和可持续筹资的推荐战略。
形势分析确定的改善精神卫生保健筹资的机会包括：当地有力的流行病学数据证明存在重大精神卫生负担；解决该负担的政治承诺；有将精神卫生纳入初级保健机制的卫生系统；以及有利于投资人类能力的宏观财政环境。与之相权衡的是当前政府卫生总支出较低、精神卫生专家数量少、规划和实施精神卫生项目的能力薄弱以及民众对精神卫生保健的需求较低等制约因素。所有关键信息提供者都提到埃塞俄比亚在精神卫生保健方面投资不足。受访者强调了该国经济增长的积极速度和社区医疗保险的扩大所带来的机会，以及确保全面实施现有精神卫生保健任务分担项目、将精神卫生纳入其他优先项目并加强宣传以确保精神卫生得到应有关注的必要性。
扩大公共医疗保险、利用与可持续发展目标相关的高优先项目的资源以及实施现有计划以支持任务分担的精神卫生保健，是埃塞俄比亚实现精神障碍全民健康覆盖的关键步骤。然而，外部捐助者也需要履行将精神卫生纳入发展资金的承诺。未来的研究人员和规划者可以将这种方法应用于撒哈拉以南非洲的其他国家，并确定精神卫生保健可持续和公平筹资的共同战略。
