mental health financing 21 12 11 aro

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MENTAL HEALTH FINANCING

..Investing in Mental Health

Dr. Abayomi Sule (MBBS, MBA) 21st

December, 2011


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Contents

Status: What is the situation of Mental health care and financing in Nigeria?

Consideration: Is mental health (financing) important?

Barriers: What are the obstacles to adequate mental health financing?

Action: What can we do?

Sources: Where could the money come from?

Conclusion: Is financing the panacea to all mental health ills?


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Status: What is the situation of Mental

health care and financing in Nigeria?


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BusinessTechnolo

gyCompendium

Sep082006_

V1

- 4 -EMBA 14, Group 34

60%

45%

26%

41%

25%

52%

42%

40%

55%

74%

59%

75%

48%

58%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Public expenditure on health as % of THE(2007)

Private expenditure on health as % of THE(2007)

Healthcare Statistics

9.7%

6.2%

4.1%

8.6%

6.6%

8.3%

4.7%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

9.0%

10.0%

Total expenditure on health as % of gross

domestic product (2007)

Source: WHO 2010

44%

60%

90%

30%

96%

79% 77%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Out-of-pocket expenditure as % of private

expenditure on health (2007)


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What is the situation of Mental health care and financing in

Nigeria

Mental disorders are responsible for about 12 - 15 % of the

worlds total disability more than cardiovascular diseases and

twice as much as cancer.

Every year up to 30% of the population worldwide have some

form of mental disorder, and at least two-thirds of those people

receive no treatment, even in countries with the most resources.

In low-income and middle-income countries, only a minority of

treated people (as low as 104% in Nigeria) received adequate

treatment.

Prevalence of psychiatric disorders estimated 20 46% inNigeria

No functional mental health policy 1991 policy not fully

operational

A bill for a mental health act which was passed at a public

hearing and was adopted by the Senate in 2003 is yet to be

passed at the House of Representatives. Extant legislation was

enacted in 1958

HR for psychiatric care is low. Fewer than 500 specialists in

Nigeria and mostly concentrated in public sector hospitals

Significant private health expenditure which is mostly out-of-

pocket

NHIS provides ambiguous coverage for psychiatric illness

Mental

Health3%

OtherHSE

97%

Hospitalcare91%

OtherMHE9%

Characteristics of MHE in Nigeria


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Consideration: Is mental health(financing) important?


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Is mental health (financing) important?

Public

1. No health without mental health

2. Mental disorders are treatable

3. Mental healthcare is a human right

4. Mental health welfare is an essential

component of economic productivity andwellbeing

5. Reduced public sector spending in other public

agencies such as criminal justice, social

services, child welfare and juvenile justice.

6. Improved educational attainment, employment

and social integration for young people whose

treatment has allowed them to more fullybenefit from their education and childhood

supports.

7. Increased tax revenue from mentally stable

citizens

8. Reversing the brain drain

Private

1. Businesses that promote positive mental health

and have high levels of social connectedness

are more likely to have high productivity and

growth rates. They are certainly better places

to work.

2. Increase productivity from people with mental

illnesses who are able to return to work.

3. Increase the productivity and quality of life of

family members who would otherwise have to

provide care and support.

4. Reduced absenteeism and presenteeism

(present but with significantly diminished

effectiveness) at work.

5. Productive individuals with stable mental health

are more likely to be consumers


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Barriers: What are the obstacles toadequate mental health financing?


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What are the obstacles to adequate mental health financing?

1. Absence of mental health from the public-health priority agenda - WHOs spending on mental health

has consistently remained below 1% of total programme spending. In low income countries such as

Nigeria, it may sometimes be less than 0.5% of total health expenditure

2. Organisation of mental health services - largely centralised, with inadequate human rights

protection and weak linkage with community mental health and general-health services. Centralized

systems resist change.

3. Limited integration with primary health care

4. Inadequate human-resource base for scaling up mental health interventions

5. Inadequate effective public mental health leadership in most countries

All these factor contribute to the mystification and isolation of mental healthcare


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Action: What can we do?


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What can we do?

Government

1. Should identify and scale up a priority package of service

interventions or components that can form the backbone

of a national mental health system that provides

effective interventions and human-rights protection

2. Should place mental health service development on a

more secure financial footing integrate into health

insurance schemes

3. Strengthen their data-collection and monitoring

mechanisms, and entrust the task of monitoring andreporting to national or regional committees with inter-

sectoral representation

4. National and international stakeholders in health

research, such as research councils, donors, and

universities, must increase resources for priority

research in mental health, build research capacity, and

improve the dissemination of findings from such research

5. International donors, multilateral and lending agencies,

and governments of high-income countriesespecially

those that benefit from the so-called brain drainmust

place mental health on their priority agenda for health

assistance to low-income and middle-income countries,

and match this pledge with substantial increases in

resource allocation

6. Encourage Private participation in Mental Health care

Professional Groups

1. Structured and consistent advocacy - for a national

mental health system that provides a strong evidence-

based framework for effective interventions and human-

rights protection

2. Move from a focus on interventions for individuals to a

population-wide focus

3. Actively support and supervise mental health care in

primary care and collaboration with community-based

agencies

4. Actively support the development of community mental

health programmes

5. Strengthen public health (and business management)

perspectives in higher training for mental health

professionals

6. Include mental health in health-systems development,

capacity development for public-health practitioners and

research

7. Expand programmes for people with disability (such as

community-based rehabilitation) to include mental

disabilities

8. Promote priority research agenda in mental health


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Sources: Where could the money comefrom?


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Where could the money come from?

Public/Government

1. Existing revenue

2. Sin tax on alcohol, cigarettes, gambling,

national lottery

3. Out of pocket (fee for service) - most

developing countries

4. Cost sharing

5. Saving funds

6. Private insurance

7. Social insurance

8. Community-based insurance

Structured and consistent advocacy for

improved mental health financing alongside

inter-sectoral collaboration are required

Private

1. Family and Friends

2. Equity

3. Private Equity and Venture capital

4. Loan

Healthcare and indeed Mental healthcareremain one of the few untouched (virgin)

sectors.

The private sector will invest in innovative

MH delivery systems that can generate

appropriate ROI. These initiatives must be -

Viable (the business case must bearticulated); Sustainable (generate

sufficient cash flow); Scalable

(geographically)

Note: Segmentation and Positioning


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Conclusion: Is financing the panacea to allmental health ills?


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Is financing the panacea to all mental health ills?

1. While it there is an evident mismatch between the burden of MH disorders and MH financing;

financing is not an end in itself. Set agenda in terms of social impact never in terms of finite

budgetary allocations (proportion or quantum) only.

2. Financing is a tool

3. A systems/multidimensional perspective is required - Effective mental health policy with adequate

consideration of the simultaneous development of several areas: financing, legislation and humanrights, organization of services, human resources and training, promotion, prevention, treatment and

rehabilitation, advocacy, quality improvement, information systems, research and evaluation and

intersectoral collaboration

4. Consider equity, efficiency, effectiveness

5. Finance can be used as a tool for changing various aspects of the mental health delivery system,

e.g.: shifting from mental hospitals to community care, including general hospitals; integrating

mental health care with primary care; funding for quality.

6. Build and broaden a consensus on mental health as a Public health priority


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Thank You!

mental health financing 21 12 11 aro

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