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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
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
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
 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)
Macro-fiscal environment
 Macroeconomic conditions High annual GDP growth
Contained inflation
High vulnerable employment
High poverty headcount
 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