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Estimating the cost of implementing district mental healthcare plans in five low- and middle-income countries: The PRIME study

  • Dan Chisholm (a1), Soumitra Burman-Roy (a2), Abebaw Fekadu (a3), Tasneem Kathree (a4), Dorothy Kizza (a5), Nagendra P. Luitel (a6), Inge Petersen (a4), Rahul Shidhaye (a7), Mary De Silva (a2) and Crick Lund (a8)...
Abstract
Background

An essential element of mental health service scale up relates to an assessment of resource requirements and cost implications.

Aims

To assess the expected resource needs of scaling up services in five districts in sub-Saharan Africa and south Asia.

Method

The resource quantities associated with each site's specified care package were identified and subsequently costed, both at current and target levels of coverage.

Results

The cost of the care package at target coverage ranged from US$0.21 to 0.56 per head of population in four of the districts (in the higher-income context of South Africa, it was US$1.86). In all districts, the additional amount needed each year to reach target coverage goals after 10 years was below $0.10 per head of population.

Conclusions

Estimation of resource needs and costs for district-level mental health services provides relevant information concerning the financial feasibility of locally developed plans for successful scale up.

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Copyright
This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.
Corresponding author
Dan Chisholm, Department of Mental Health and Substance Abuse, World Health Organization, 1211 Geneva, Switzerland. Email: chisholmd@who.int
Footnotes
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This paper was produced as part of PRIME funded by UK aid from the UK government. However, the views expressed do not necessarily reflect the UK government's official policies.

Declaration of interest

D.C. is a staff member of the World Health Organization. The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the decisions, policy or views of the World Health Organization.

Footnotes
References
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1 World Health Organization. Planning and Budgeting to Deliver Service for Mental Health. Mental Health Policy and Service Guidance Package. WHO, 2003.
2 Chisholm, D, Lund, C, Saxena, S. Cost of scaling up mental healthcare in low-and middle-income countries. Br J Psychiatry 2007; 191: 528–35.
3 Lund, C, Tomlinson, M, De Silva, M, Fekadu, A, Shidhaye, R, Jordans, M, et al. PRIME: a programme to reduce the treatment gap for mental disorders in five low- and middle-income countries. PLoS Med 2012; 9: e1001359.
4 Hanlon, C, Luitel, NP, Kathree, T, Murhar, V, Shrivasta, S, Medhin, G, et al. Challenges and opportunities for implementing integrated mental health care: a district level situation analysis from five low- and middle-income countries. PLoS One 2014; 9: e88437.
5 Fekadu, A, Hanlon, C, Medhin, G, Alem, A, Selamu, M, Giorgis, TW, et al. Development of a scalable mental healthcare plan for a rural district in Ethiopia. Br J Psychiatry 2015, in press (doi: 10.1192/bjp.bp.114.153676).
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7 Kigozi, NF, Kizza, D, Nakku, J, Ssebunnya, J, Ndyanabangi, S, Nakiganda, B, et al. Development of a district mental healthcare plan in Uganda. Br J Psychiatry 2015, in press (doi: 10.1192/bjp.bp.114.153742).
8 Petersen, I, Fairall, L, Bhana, A, Kathree, T, Selohilwe, O, Brooke-Sumner, C, et al. Integrating mental health into chronic care in South Africa: the development of a district mental healthcare plan. Br J Psychiatry 2015, in press (doi: 10.1192/bjp.bp.114.153726).
9 Shidhaye, R, Shrivastava, S, Murhar, V, Samudre, S, Ahuja, S, Ramaswamy, R, et al. Development and piloting of a plan for integrating mental health in primary care in Sehore district, Madhya Pradesh, India. Br J Psychiatry 2015, in press (doi: 10.1192/bjp.bp.114.153700).
10 World Health Organization. mhGAP Intervention Guide for Mental, Neurological and Substance Use Disorders in Non-Specialized Health Settings. WHO, 2010.
11 World Health Organization. Scaling Up Action Against Noncommunicable Diseases: How Much Will it Cost? WHO, 2011.
12 Chisholm, D, Saxena, S. Cost effectiveness of strategies to combat neuropsychiatric conditions in sub-Saharan Africa and South East Asia: mathematical modelling study. BMJ 2012; 344: e609.
13 Buttorff, C, Hock, R, Weiss, H, Naik, S, Araya, R, Kirkwood, B, et al. Economic evaluation of a task-shifting intervention for common mental disorders in India. Bull World Health Organ 2012; 90: 813–21.
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16 Phanthunane, P, Vos, T, Whiteford, H, Bertram, M. Cost-effectiveness of pharmacological and psychosocial interventions for schizophrenia. Cost Eff Resour Alloc 2011; 9: 6.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Estimating the cost of implementing district mental healthcare plans in five low- and middle-income countries: The PRIME study

  • Dan Chisholm (a1), Soumitra Burman-Roy (a2), Abebaw Fekadu (a3), Tasneem Kathree (a4), Dorothy Kizza (a5), Nagendra P. Luitel (a6), Inge Petersen (a4), Rahul Shidhaye (a7), Mary De Silva (a2) and Crick Lund (a8)...
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