Department of Research, George Institute for Global Health, New Delhi; Department of Public Health, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka; Department of Medicine, University of New South Wales, Sydney, Australia.
Centre for Mental Health Law & Policy, Indian Law Society, Pune, Maharashtra, India.
Indian J Med Res. 2023 Jun;157(6):524-532. doi: 10.4103/ijmr.IJMR_2449_19.
BACKGROUND & OBJECTIVES: Investment in mental health is quite meagre worldwide, including in India. The costs of new interventions must be clarified to ensure the appropriate utilization of available resources. The government of Gujarat implemented QualityRights intervention at six public mental health hospitals. This study was aimed to project the costs of scaling up of the Gujarat QualityRights intervention to understand the additional resources needed for a broader implementation.
Economic costs of the QualityRights intervention were calculated using an ingredients-based approach from the health systems' perspective. Major activities within the QualityRights intervention included assessment visits, meetings, training of trainers, provision of peer support and onsite training.
Total costs of implementing the QualityRights intervention varied from Indian Rupees (₹) 0.59 million to ₹ 2.59 million [1United States Dollars (US $) = ₹ 74.132] across six intervention sites at 2020 prices with 69-79 per cent of the cost being time cost. Scaling up the intervention to the entire State of Gujarat would require about two per cent increase in financial investment, or about 7.5 per cent increase in total cost including time costs over and above the costs of usual care for people with mental health conditions in public health facilities across the State.
INTERPRETATION & CONCLUSIONS: The findings of this study suggest that human resources were the major cost contributor of the programme. Given the shortage of trained human resources in the mental health sector, appropriate planning during the scale-up phase of the QualityRights intervention is required to ensure all staff members receive the required training, and the treatment is not compromised during this training phase. As only about two per cent increase in financial cost can improve the quality of mental healthcare significantly, the State government can plan for its scale-up across the State.
全球，包括印度在内，对精神卫生的投资都相当微薄。为确保合理利用现有资源，必须明确新干预措施的成本。古吉拉特邦政府在六家公立精神卫生医院实施了 QualityRights 干预措施。本研究旨在预测 QualityRights 干预措施扩大规模的成本，以了解更广泛实施所需的额外资源。
从卫生系统的角度出发，采用基于成分的方法计算 QualityRights 干预措施的经济成本。QualityRights 干预措施中的主要活动包括评估访问、会议、培训师培训、提供同伴支持和现场培训。
以 2020 年的价格计算，在六个干预点，实施 QualityRights 干预措施的总成本从 59 万印度卢比（₹）到 259 万印度卢比（₹）不等，其中 69-79%的成本为时间成本。将该干预措施扩大到古吉拉特邦全境，需要在财务投资上增加约 2%，或在总成本上增加约 7.5%，包括全州公共卫生设施中精神卫生条件患者的常规护理成本以外的时间成本。
本研究结果表明，人力资源是该项目的主要成本贡献者。鉴于精神卫生部门受过培训的人力资源短缺，在 QualityRights 干预措施扩大规模阶段需要进行适当规划，以确保所有工作人员都接受所需的培训，并且在培训阶段治疗不会受到影响。由于仅增加约 2%的财务成本就可以显著提高精神卫生保健的质量，州政府可以计划在全州范围内扩大该措施的规模。
