“We need to establish priority areas for the NHI, mental health cannot be neglected.”
The case for Universal Health Coverage (UHC) is clear. Globally, at least 50% of people do not receive the health care they require, and an estimated 100 million people are forced into extreme poverty annually because of out-of-pocket expenditure on health.
In South Africa, the proposed system that seeks to realise UHC for all South Africans is the National Health Insurance (NHI). As the Portfolio Committee on Health’s deliberations on the NHI Bill conclude, there is renewed attention regarding the feasibility and viability of the system.
Given that South Africa has the lowest self-reported rates of mental wellbeing in the world and currently less than 1 in 10 people living with a mental health condition in our country receive the care they need, it is critical that mental health must be given parity with other health conditions. We use this International Universal Health Coverage Day (celebrated annually on 12 December) to advance this call.
We need to establish priority areas for the NHI. The decisions about the types and amounts of resources to be made available, eligible populations, and specific rules for allocation should be informed by an economic analysis to maximise value and achieve social goals. This process should also involve key stakeholders, including people living with mental health conditions and their caregivers.” says Donela Besada, Senior Scientist at the South African Medical Research Council.
Besada was a lead author on the National Department of Health’s commissioned Mental Health Investment Case Report which costed the scale up of mental health care services into the NHI.
“We need this priority setting exercise to 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 why mental health care needs to be invested in.” Besada continues.
Shayni Geffen, Project Leader: Advocacy and Awareness at the South African Federation for Mental Health (SAFMH) adds: “While questions around if and how the NHI moves ahead, people in South Africa urgently need to access a full spectrum of safe, quality mental health services. This must be delivered by well-trained, well-paid, culturally and gender-sensitive health and social care workers, who are able to recognise the comorbidities between physical and mental health.”
Where you live shouldn’t determine your access to care. There are no national guidelines for how much provincial departments of health should spend on mental health care. In the Western Cape spending on mental health per uninsured person is R307.40 while in Mpumalanga it is R58.50 – nearly a R250 variation. This is grossly unequal.” Says Geffen.
When more funds are made available, it’s crucial to invest them into contextually relevant, evidence based mental health services for population mental health. This means prioritising investment into primary and community-based services over tertiary care and using data to monitor progress.
(See here and here to learn more about community-based mental health services in practice and why they are crucial for increasing access to quality healthcare).
More information can be found about International Universal Health Coverage Day here.
