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 |