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Table 3 Mental health systems governance matrix for Nepal

From: Current situations and future directions for mental health system governance in Nepal: findings from a qualitative study

Governance principles

Summary of challenges and enabling factors

Recommendations

National level

Health policy formulation level

Policy implementation level

Strategic vision

Interim constitution 2006 recognizes health as a fundamental right

National mental health policy 1996 exists; no revisions to date

Lack of implementation of 1996 mental health policy

Integrate mental health policy provisions in 5 year health plan; establish an accountable mental health unit in MoH

Participation and consensus orientation

Lack of participation of civil society, private sector and government departments in mental health decision making

Increasing consultation with NGOs and other stakeholders in mental health policy formulation

In some districts, the District Public Health Office and NGOs are partnering to provide mental health services in primary health care centers

Establish coordination and collaboration within and beyond health sectors; build consensus among stakeholders regarding involvement of service users in policy, planning and service delivery

Rule of law

Consumer Protection Act 1998 bans the production and sale of goods which are harmful to consumers’ health

Fourth revisions of draft mental health act, but no official endorsement

Mechanisms to monitor misuse of psychotropic drugs in place but rarely implemented

Ratify mental health legislation in line with national and international human rights laws and legislation, and strictly enforce legal provisions in practice

Transparency

Ranked 126 out of 175 by Transparency International on corruption perception index

Processes and mechanism for ensuring transparency in mental health resource allocation and expenditure not well defined

Performance assessment, promotion and transfer of district health manager and district health staff differ in policy and practice

Develop mechanisms and procedures for monitoring and supervision of mental health programs to ensure transparency in health sector

Responsiveness to patients’ health needs

The government policy and programs (2014) state the provision for national insurance program

Health Policy 2014 recognizes the need to increase state’s investment to cover all health care expenses of disabled people, including psychosocial disability

In the absence of clear policy guidelines to address responsiveness, the medical and non-medical expectations of populations not met

Arrange motivational incentives and facilities for health worker retention in rural areas; strengthen mental health information use for the allocation of budget

Equity and inclusiveness

Social security allowance is given to elderly, widow and disabled, including psychosocial disability

Nepal Health Policy 2014 mentions that health services will be provided to poor, marginalized and vulnerable population on the principles of equity and social justice

Knowledge about existence of disability allowances for people with mental illness is low, so very few people have received allowances

Disseminate information about services available in the community for treatment of mental illness and benefits provided by the government

Effectiveness and efficiency

Limited coordination, communication and consultation between bureaucrats and technocrats (clinicians)

Frequent turnover of policymakers; no mental health unit under MoH for policy and planning

Other support systems, such as supply of psychotropic drugs and regular supervision and monitoring, are lacking

Regulate policy on staff turnover; provide training to health workers; ensure regular supply of essential psychotropic drugs and arrange separate counselling room within primary health care facilities

Accountability

Public accounts committee of the parliament looks after accountability

Mechanisms and processes for overseeing financial and administrative adherence in place

No evidence on the effective enforcement of accountability measures

Implement existing mechanisms and processes to make the health system accountable to the population in need of mental health services

Intelligence and information

No national level study on mental health conducted

The HMIS data not used in mental health policy, planning and service provision

Mental health data collected from Out Patients Department registers maintained in district health facilities

Build capacity of government staff for systematic record keeping, and monitoring and evaluation of mental health programs

Ethics

Ethics of mental health research is monitored by Nepal Health Research Council

To ensure bioethics, Nepal Health Research Council has an ethical review committee, and a monitoring and evaluation section

Nepal Health Research Council monitoring team makes field visits to oversee the research activities of the organizations

Sensitize researchers and health workers towards more ethical practice in the field of mental health research and service delivery