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Table 3 Overview of findings from the in-depth interviews with stakeholders

From: Moving towards universal health coverage for mental disorders in Ethiopia

Perceived challenges and constraints to increasing public health financing
 Priority given to mental health Inadequate financing relative to burden
Limited buy-in from Regional Health Bureaus
Lacking a unified advocacy effort and clear message
Low population awareness and low demand
 Mental health strategies and plans Mental health is integrated within key policy documents, but implementation is inadequate
Need for health extension worker checklists for reporting mental health
 Financing policies and strategies High out-of-pocket expenditure
Delayed implementation of social health insurance
Community-based health insurance coverage is still low
Plan for ‘sin tax’ but revenue not earmarked for health
External donors show little interest in mental health
 Barriers to budget allocation process Budget allocation is not driven by global burden estimates, which disadvantages mental health
 Impact of macro-economic issues Good economic growth and stable debt may increase fiscal envelope for health care, but external donors are cutting back support proportionately
Options for change for increased financing for public health
 Strengthening mental health systems Continue to expand mental health care to address unmet need
Re-invigorate task-sharing model of integrating mental health into primary care as an efficient strategy to expand access
Expand efforts to counter stigma and raise awareness
 Improving public health financing policies Focus on implementation of existing policies
 Financing mechanisms CBHI and SHI for equitable increase in financial protection
Commitment to community-based health insurance may expand healthcare spending overall, and mental health as part of that
Key elements/criteria for improved public health financing
 Budget planning and allocation for general and mental health Need for sustained advocacy to improve fairness of budget allocation
Better oversight of implementation to ensure that the allocated budget is spent
 Engagement of participants in mental health financing Advocacy from a broad base of stakeholders is needed
 Monitoring and evaluation of health systems/financing HMIS indicators for mental health need to be linked to financing
HMIS system not adequately capturing NGO and private sector