Table 2 Opportunities for, and threats to, scaling up investment in mental health in Ethiopia
From: Moving towards universal health coverage for mental disorders in Ethiopia
Domain | Opportunities for mental health service scale up | Threats to mental health service scale up | Overall prospects |
|---|---|---|---|
Mental health burden | |||
 Public health burden | High public health burden of mental disorders, well-documented with Ethiopia evidence Increasing burden due to demographic transition | Weak information systems which do not allow quantification of disorder-specific healthcare utilisation Population demand for mental health care is currently low | Good |
Health system | |||
 Service availability and access | Three-tiered system with strong primary care units Recent investments in facilities and workforce, including specialist mental health workers High coverage of health extension workers Gains in child mortality Integration of mental health care into the new Ethiopia primary health care guide (PHCG) Mental health and NCDs integrated within the health extension worker upgrading training and expanded set of core service packages for level IV HEWs | Poor access to basic care (i.e. antenatal care) and high maternal mortality rate Inequity in access between rich/poor and urban/rural Specialist mental health personnel are concentrated in urban areas Limited supervision of task-shared care by mental health specialists Mental health care checklists and indicators not integrated into HEW reporting Low mobilisation and involvement of current and potential mental health service users in planning and developing services | Moderate |
Governance and leadership | |||
 Political will | Mental health on the political agenda in FMoH Regional Health Bureaus committed to new Ethiopia PHCG which includes mental health | Limited Regional Health Bureau buy-in and capacity for mental health care expansion | Good |
 Mental health policies and plans | National mental health strategy with plans for integrated care 12-year plan with specific budgets and targets PRIME demonstration site providing a model for successful implementation Proposal for multi-sectoral National Institute of Mental Health | Limited evaluation of policy implementation No legislation protecting the rights of the mentally ill National mental health strategy expired in 2016 and remains under revision Absence of a national mental health service user organisation | Moderate |
 Health sector plans | Mental health integrated into health sector transformation plan Development of health insurance strategy which includes priority MNS disorders; pilots show promising results New Ministry initiative for scaling up Ethiopia Primary Health Care Guidelines, which has mental health horizontally integrated | Implementation of insurance schemes behind schedule Limited follow-through on mental health targets of the health sector transformation plan (HSTP) | Good |
Macro-fiscal environment | |||
 Macroeconomic conditions | High annual GDP growth Contained inflation | High vulnerable employment High poverty headcount | Good |
 Fiscal context | Debt and deficit relatively low | Revenue and expenditure relatively low | Moderate |
 Priority setting | Government main source of total health and mental health expenditure Health a high budgetary priority | One-third of health budget from external sources THE per capita very low High out-of-pocket expenditure | Moderate |