Transcript Financing Mental Health in Uganda

Financing Mental Health
Care in Uganda
Presented by Costella Mbabazi
Research Officer
24th September 2010
Structure
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Background
Methodology
Main Sources
Decision making
Use of allocated funds
Impact on mental health care
Limitations
Emerging gaps
Recommendations
Conclusion
Background
• It is estimated that a 1% allocation out of the
Primary Health Care envelope is made to
mental health, but this has been found to be
less:
• Out of a PHC budget of 351,684,208/= for FY
2008/2009, one Health Sub-district had a
consolidated allocation of 138,000/= for
mental health and reproductive health. (circa
0.04%)
PHC Budget allocation to MH UGX 2008/2009
(Case study)
Justification
 Limited or unequally distributed mental health
resources hinder increasing access to mental health
treatment. Studies indicate that in the poorest
countries, the smallest percentage of overall health
budgets goes to mental health care (Saxena et al.,
2007). Lack of transparency about the sources and
allocations of funds for mental health contributes to
these barriers (Knapp et al., 2006).Findings will:
 influence mental health policy& mental health care
financing decisions, inform more in-depth studies on
financing or costing future community based
psychiatric interventions, & set a framework for
tracking finances for mental health services in
districts.
Methodology
Descriptive study, purposive samples
– Case Study
– Document review
– Key informant interviews
– Trend analysis
Study areas
• Ministry of Health
• Ministry of Finance, Planning & Economic
Development
• National Regional Referral Hospitals, District Health
Office, District Finance Departments &lower health
centers in Hoima, Buliisa & Amuria
Data analysis
• Qualitative data: document review
matrix, coding according to
predetermined themes, cross
tabulation. triangulated
• Quantitative data: Analyzed &
presented using tables & graphs to
illuminate trends
Main sources
• The Government through the Ministry of
Finance, Planning and Economic
Development (most sustainable).
– Allocates to the Ministry of Health, districts and
National Referral Hospitals against an annual
budget. Allocation trends illustrated on next slide
Health sector financing
2004/2005-2008/2009
Total Health Budget
700,000,000,000
600,000,000,000
500,000,000,000
400,000,000,000
300,000,000,000
200,000,000,000
100,000,000,000
0
Allocations to
National Referral
Hospital for Mental
Health
Allocations to districts
through Primary
Health Care
100,000,000
80,000,000
60,000,000
40,000,000
20,000,000
0
Ministry of Health
allocations for its
Mental Health Unit/
Programme
2004/2005-
Main sources cont’d
• Direct donor funding, now diminished because of the
economic crisis
• Out of pocket expenses, yet within East Africa
Uganda has the highest level of income poverty with
an annual income per capita of $300 as compared to
$350 and $580 for Tanzania and Kenya respectively.
• Health insurance, however contracts don’t usually
include coverage for severe psychiatric and
neurological disorders.
• Good will organizations
Decision making for
funds allocation
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Some reliance on contextual political,
socio-economic and environmental factors,
e.g. because of reliance on donors
Centrally a 9 step process presented in the
next slide.
1. National Strategic
Planning Process
1.1 Health Sector Strategic Plan
II (5 year plan)
2. Ministry of Health defines priorities for the
Financial Year in a planning workshop to include
key interventions for mental Health
3. Integrated into the annual
Ministry policy statement
4. Ministry develops annual work
plan
5. Used by districts and lower
health centers to develop
individual plans
6. Government reviews plans and communicates indicative figures
for the financial year.
7. Ministry Budget Working Group makes
allocations to districts &programmes.
Discussed by relevant management teams
9. Health centers make final allocations
based on unique priorities
8. Departmental plans &budgets are
issued to district councils &In Charges
for approval
Use of allocated
funds
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Largely for diagnostic and
treatment purposes.
Purchase of psychotropic and anti
convulsant medicines.
Recruitment and payment of personnel
Medical supplies
Administration costs
Outreach clinics
Community sensitization
Health education
Use of allocated
funds
• Development of Information, Education
and Communication materials
• Home visits
• Policy development
• Legislation development
• Advocacy
• Holistic mainstreaming and integration
Impact on mental
health care
• Minimal allocations for mental health care
yet not always disbursed.
• Poor drug supply, especially for
psychotropic drugs
• Cheaper and alternative modes
of treatment sought by patients,
eg traditional healers
• Health budgets rarely cater for logistical
support needed for support supervision.
• Continued stigma
Impact on mental
health care
• Ill skilled healthcare personnel resulting into
poor and unprofessional service. wrong
prescriptions and dispensing with dire
results, e.g. Chlorpromazine a.k.a. CPZ
(psychotropic) instead of Carbamazepine
a.k.a. CBZ (anti convulsant)
• Negative impact on women as primary
caregivers, e.g. walking long distances at the
opportunity cost of gainful activity
Emerging gaps
• No information on cost effectiveness of
currently funded services YET:
•the number of mental health cases treated at Butabika
Hospital rose from 4,274 in 2005/2006 to 5,604 in
2006/2007 (Dr. James Walugembe RIP).
• one third of the Ugandan population has been said to
have some form of mental disorder. (Ssebunya et al 2009)
Limitations
• Samples were largely purposive and case
study limited to BasicNeeds project areas
• Lack of written documents in some study
areas, eg financial accountability reports at
district finance offices, so had to rely on
memory recall
Recommendations
• Districts
1. Advocate for fund allocation towards
recruitment of specialized personnel.
2. Support supervision to ensure
effective update of HMIS necessary as
evidence of financing need.
3. Ensure that planned for funds are
adequate to support content of the
Health Sector Strategic Plan.
Recommendations cont’d
• Ministry of Health
1. Increase funding allocations to mental
health.
2. Lobby government for ring fenced funds
for drugs and complimentary services for
community mental health.
3. Awareness creation among key decision
makers and policy makers.
4. 4. Current service analysis for effective
resource utilization.
Recommendations
cont’d
Government
1. Increase annual budget allocation to the
health sector.
2. Allocate ringfenced funding for mental
health as a priority health issue.
Conclusion
• Government alone, is not to blame.
Other stakeholders like users need to
own the advocacy process to influence
the decision making process and policy
makers.