The challenges
Productivity loss from moderate or severe psychological distress is estimated to
be about 7% of Ghana’s GDP. Psychological distress is also strongly linked to
unemployment in Ghana. Despite this, Ghana’s spending on mental health is just
1.4% of total health expenditure, meaning that the majority of people with mental
health conditions cannot access treatment.
Insufficient financing limits mental health service provision in Ghana. Mental health
services compete with other health priorities for funding. To address this, the Mental
Health Authority has to articulate a compelling need, outline the benefits of investment
in mental health, and lobby for long-term funding for better mental health services
The solution
We proposed the production of a well-founded investment case and an advocacy tool
to support people lobbying for funds for mental health services, which would outline
the social and economic benefits of such investments.
What did the programme do?
In partnership with the Mental Health Authority, we convened a high-level technical
working group representing a broad base of knowledge and perspectives. This group
oversaw and supervised the creation of the investment case. Members of the working
group included government and non-government actors; development partners;
researchers; and people with key areas of expertise, such as health economics,
financing, evidence and advocacy, and people working in mental health service
provision and access.
To build consensus for the investment case, we built time for debate, negotiation and
reflection into the overall process.
The working group also developed a dissemination plan, which outlined key actions
for members of the group to undertake. This was critical in ensuring the investment
case was used to advocate for more funding for mental health.
With the working group we developed a detailed and evidence-based background
paper supporting the investment case; an advocacy brief; media talking points; and
a press pack. TV and newspaper coverage of the need for mental health investment
was instrumental for generating wider understanding of the need for investment and to
garner greater support.
The Mental Health Authority subsequently developed a costing of mental health
services with the World Health Organization(WHO) and used this as a basis for
engagement with the National Health Insurance Authority. The mental health benefits
package has been through all the stages of National Health Insurance Authority
review and we anticipate that this will be announced as part of the National Health
Insurance Scheme, around the time the programme completes.
How we made a difference
The investment case has been used by government staff in programme
implementation districts as a tool for advocacy and health education activities, and
by district staff to engage with District Chief Executives to garner support for mental
health. It has been extensively used by the Mental Health Authority to make the case
for mental health investment. It was also highlighted at the launch and dissemination
of the Mental Health Policy and the launch of the WHO Director General’s Special
Initiative.
Some key proposals of the investment case have been implemented, such as the
establishment of the Mental Health Review Tribunal; the establishment of Regional
Visiting Committees; work to improve access to psychotropic medicines; training of
healthcare workers in mental health, both through our programme and WHO, with the
Mental Health Authority; public education on mental health; the Authority’s work on
reducing stigma and discrimination; and continued advocacy led by the Authority for
adding mental health to the National Health Insurance Scheme benefits package.
The investment case is frequently endorsed by staff within the Authority. The Chair
of the Mental Health Authority Board quoted the investment case when inaugurating
the Mental Health Review Tribunal and Visiting Committees, and during her keynote
address at the Mental Health Authority’s first international research conference. The
former CEO of Mental Health Authority quoted the investment case at a high-level
roundtable on investment in mental health, facilitated by FCDO.
Civil society organisations, as well as programme grantees, have used the investment
case extensively. For example, it has been used to support advocacy meetings
with District Assemblies, to plan mental health programming, to lobby for increased
investment in mental health at the community level, and to inform inputs into local
Medium-Term Development Plans.
The key themes from the investment case were used by the Mental Health Society of
Ghana, BasicNeeds-Ghana and the Mental Health Authority for media work, including
television media appearances and a full-page front cover in the Daily Graphic
newspaper. These activities raised awareness and generated discussion of the need
for investment in mental health.
Lessons learned
- The importance of a multi-sector national working group to lead on developing
an investment case from the outset is key. - Policy advocacy works well when informed and driven by evidence. Analysis
of the evidence can develop key messages for campaigns and complementary
media advocacy to better communicate the need for funding. - Identifying groups who can use an investment case, and providing compelling
data and messages for that group, enables targeted advocacy. - Dissemination and use of evidence are separate, and not all dissemination
leads to use. Evidence and an advocacy tool alone are not enough. Use of
evidence leading to change requires sustained and determined effort across a
range of stakeholders
