Mental Health System Governance in Nepal: Current Situations and Future Directions
Assessing and understanding governance is crucial to ensure accountability and transparency and to improve the performance of mental health systems. Using the health system governance framework developed by Siddiqi and colleagues this paper assesses the situation of mental health system governance in Nepal and provides recommendations for improving governance.
In-depth individual interviews were conducted with national level policymakers and district level planners. The interview checklist was developed based on the Siddiqi framework for assessing governance of health system. Data analysis was done in NVIVO 10 using framework matrices.
The mental health system governance assessment reveals a few positive developments and many challenges. The facilitating factors include availability of mental health policy, inclusion of mental health in other general health policies and plans, increasing participation of Non Governmental Organizations (NGOs) and service user organizations in policy forums, and implementation of a few mental health projects through government-NGO collaboration. The challenges include the contrasting views among policymakers about the involvement of service users and caregivers in mental health policy formulation, the existence of several laws and legislations that have discriminatory provisions for people with mental illness and lack of mental health act to protect against this. The mental health policy of 1996 has not been officially revised or fully implemented. Funding for mental health is limited and inequitable relative to the disease burden. There is no coordinating unit for mental health within Ministry of Health and Population. There are very limited health workers trained on mental health. The mental health planning, treatment guidelines and referral mechanisms are absent at the district level. Mental health record keeping systems are inadequate and data are not used for program improvement and policy formulation. Though the government has included six psychotropic drugs in their free essential drugs list, not all of these drugs are available at the primary health care level.
In the last few years, mental health has received some attention in policy forums but the improvements at the policy level have not been translated at the implementation level. This suggests that there is a need for the development and implementation of mental health system governance procedures and mechanisms and for that establishment of coordination unit at the Ministry is a pre-requisite.
Key words: governance; mental health systems; Nepal.