International Day of Persons With Disabilities 2023

SAFMH News Room

GLOBAL THEME: “United in action to rescue and achieve the SDGs for, with and by persons with disabilities”

SAFMH THEME: “Universal Mental Health Coverage in South Africa

“The world is accepting the concept of universal health coverage. Mental health must be an integral part of UHC. Nobody should be denied access to mental health care because she or he is poor or lives in a remote place.”Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organisation

Too many people do not receive the mental health care they need in South Africa (1 in 10 people according to 2019 data). This goes against our Constitution as well as the UN Convention on Human Rights. This International Day of Persons with Disabilities (IDPD), we reiterate the call that mental health is a universal human right and that we need to achieve the Sustainable Development Goal Number 3, the right to health and wellbeing for, with and by persons with disabilities.

IDPD is celebrated on 3 December annually. “IDPD provides an opportunity for South Africa’s decisionmakers to  recommit to integrating mental health into all Universal Health Coverage efforts and into our existing health system. Everyone has the right to access quality, rights-based, evidence-based, affordable and culturally sensitive mental health services”, says Shayni Geffen, Project Leader: Advocacy and Awareness at the South African Federation for Mental Health (SAFMH).

The South African Federation for Mental Health [SAFMH] fully supports Universal Health Coverage. We want to see the right to health – including mental health – realised for all in South Africa, including for persons with disabilities.  This is a fundamental human right.

Today, we call attention to how universal health coverage also means universal mental health coverage because a person’s health includes their mental health.

Countries need enabling laws and policies to make sure that UHC is realised. The National Health Insurance (NHI) Bill seeks to make this happen in South Africa.

There has been much contestation about the NHI Bill. Whilst we, as SAFMH, welcome that the Bill is rooted in a human-rights based approach to mental health, we do have concerns. These include:

  • The conditional grant budget line item for mental health needs to be revisited (pg. 58; 8.7). This amount is not congruent with the proposed recommendations from a Mental Health Investment Case Report[1] done in 2021 to sufficiently strengthen mental health services and integration. An adequate conditional grant for mental health is necessary to correct the injustices of the past regarding mental health service allocation and investing in scaling up mental health care in the country.
  • There is no commitment to an explicit priority setting exercise for the NHI packages of care. Currently, the Bill states the Health Minister will ultimately determine health care benefits that will be reimbursed through the NHI Fund, as well as the service coverage. This is a serious concern. We advocate that the decisions related to the amounts and types of resources to be made available, eligible populations, and specific rules for allocation are informed by an economic analysis to maximise value and achieve social goals.
  • We are unsure what approach will be used to inform priority setting. We advocate that any priority setting should be informed by a needs-based approach rather than a current service use approach. Considerations around burden of disease, our human rights obligations and treatment gaps should drive the prioritisation of health services and associated budgets. These metrics alone provide good evidence for investing in mental health care.

This IDPD, we reflect that while debates around the NHI will continue and perhaps even intensify in the lead up to the 2024 elections, this should not stunt the immediate implementation of known, uncontroversial rights-based and evidence-based actions desperately needed to improve health system performance.

This IDPD, we continue to advocate for evidence-based, cost-effective mental health services, like those outlined in the Mental Health Policy Framework 2023 – 2030, which can be implemented today to improve the mental wellbeing of all in South Africa. 

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