‘Mental Health Was Always The Last; Always An After Thought’: Policy Analysis Of Domestic Financing And Prioritisation For Mental Health In Ghana

Abstract

Background Mental health remains a low health priority globally. Despite the high burden of mental health in Ghana, little is known about the extent of financing and prioritisation by policymakers and other relevant stakeholders.

Aims This study aims to understand the determinants of low domestic public financing and the prioritisation of mental health in Ghana, and to identify opportunities and strategies to increase policy attention.

Method Kingdon’s multiple streams framework was used to map barriers to domestic financing for mental health. We conducted a document analysis of relevant policies, strategies and articles, and carried out semi-structured interviews with relevant national stakeholders. We analysed interview transcripts deductively following the key domains for the multiple streams framework.

Results We found that low public financing for mental health stems from several issues at the level of the ‘problem stream’: low awareness and misunderstandings in general society, stigma and discrimination, insufficient public funding of the health sector in general, catastrophic healthcare expenditure insufficiently documented, limited political attention to mental health and limited donor interest. There is clear evidence of dynamism on the ‘policy solution stream’, including development of national laws, policies, strategies and institutions; adoption of international strategies and recommendations; and existence of policy entrepreneurs and windows. The democratic system of Ghana creates opportunities in the ‘politics stream’, but also raises the issue of continuity across governments.

Conclusions In Ghana, mental health is not yet sufficiently recognised as a societal issue, which affects demand for services and contributes to the low policy priority and resource allocation by the government. Greater investment is therefore needed to raise public awareness through coalition building, research, campaigns and education activities.