Mental health system costs, resources and constraints in South Africa: a national survey

Abstract The inclusion of mental health in the Sustainable Development Goals represents a global commitment to include mental health among the highest health and development priorities for investment. Low- and middle-income countries (LMICs), such as South Africa, contemplating mental health system...

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Veröffentlicht in:Health policy and planning Jg. 34; H. 9; S. 706 - 719
Hauptverfasser: Docrat, Sumaiyah, Besada, Donela, Cleary, Susan, Daviaud, Emmanuelle, Lund, Crick
Format: Journal Article
Sprache:Englisch
Veröffentlicht: England Oxford University Press 01.11.2019
Oxford Publishing Limited (England)
Schlagworte:
Budgets
Constraints
Costing
Discharge
Drugs
Editor's Choice
Embedded systems
Expenditures
Government spending
Health care
Health care expenditures
Health care policy
Health Expenditures - statistics & numerical data
Health Resources - statistics & numerical data
Health services
Hospitalization - economics
Hospitalization - statistics & numerical data
Human resources
Humans
Infrastructure
Inpatient care
Investments
Legislation
Low income groups
Medically Uninsured - statistics & numerical data
Mental disorders
Mental Disorders - economics
Mental health
Mental health services
Original
Patient Readmission - economics
Patient Readmission - statistics & numerical data
Polls & surveys
Public finance
Public health
Resource availability
South Africa
Surveys and Questionnaires
Sustainable development
Uninsured people
South Africa
mental health system
mental healthcare
Health system costs
policy implementation
developing countries
health planning
ISSN:0268-1080, 1460-2237, 1460-2237
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Zusammenfassung:Abstract The inclusion of mental health in the Sustainable Development Goals represents a global commitment to include mental health among the highest health and development priorities for investment. Low- and middle-income countries (LMICs), such as South Africa, contemplating mental health system scale-up embedded into wider universal health coverage-related health system transformations, require detailed and locally derived estimates on existing mental health system resources and constraints. The absence of these data has limited scale-up efforts to address the burden of mental disorders in most LMICs. We conducted a national survey to quantify public expenditure on mental health and evaluate the constraints of the South African mental health system. The study found that South Africa’s public mental health expenditure in the 2016/17 financial year was USD615.3 million, representing 5.0% of the total public health budget (provincial range: 2.1–7.7% of provincial health budgets) and USD13.3 per capita uninsured. Inpatient care represented 86% of mental healthcare expenditure, with nearly half of total mental health spending occurring at the psychiatric hospital-level. Almost one-quarter of mental health inpatients are readmitted to hospital within 3 months of a previous discharge, costing the public health system an estimated USD112 million. Crude estimates indicate that only 0.89% and 7.35% of the uninsured population requiring care received some form of public inpatient and outpatient mental healthcare, during the study period. Further, mental health human resource availability, infrastructure and medication supply are significant constraints to the realization of the country’s progressive mental health legislation. For the first time, this study offers a nationally representative reflection of the state of mental health spending and elucidates inefficiencies and constraints emanating from existing mental health investments in South Africa. With this information at hand, the government now has a baseline for which a rational process to planning for system reforms can be initiated.
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ISSN:0268-1080
1460-2237
1460-2237
DOI:10.1093/heapol/czz085