Developmental assistance for child and adolescent mental health in low- and middle-income countries (2007-2014): Annual trends and allocation by sector, project type, donors and recipients

An analysis of funding patterns in development assistance for mental health: who, when, what, and where

BACKGROUND

Mental health has recently gained increasing attention on global health and development agendas, including calls for an increase in international funding. Few studies have previously characterized official development assistance for mental health (DAMH) in a nuanced and differentiated manner in order to support future funding efforts.

METHODS

Data from the Organisation for Economic Cooperation and Development Creditor Reporting System were obtained through keyword searches. Projects were manually reviewed and categorized into projects dedicated entirely to mental health and projects that mention mental health (as one of many aims). Analysis of donor, recipient, and sector characteristics within and between categories was undertaken cumulatively and yearly.

FINDINGS

Between the two categories of official DAMH defined, characteristics differed in terms of largest donors, largest recipient countries and territories, and sector classification. However, across both categories there were clear and consistent findings: the top donors accounted for over 80% of all funding identified; the top recipients were predominantly conflict-affected countries and territories, or were receiving nations for conflict-affect refugees; and sector classification demonstrated shifting international development priorities and political drivers.

CONCLUSION

Across DAMH, significant amounts of funding are directed toward conflict settings and relevant emergency response by a small majority of donors. Our analysis demonstrated that, within minimal international assistance for mental health overall, patterns of donor, recipient, and sector characteristics favor emergency conflict-affected settings. Calls for increased funding should be grounded in understanding of funding drivers and directed toward both emergency and general health settings.

Child and Adolescent Mental Health Policy in Low- and Middle-Income Countries: Challenges and Lessons for Policy Development and Implementation

Background: Child and adolescent mental health (CAMH) policy is essential for the rational development of mental health systems for children and adolescents. However, there is a universal lack of CAMH policy, especially in low- and middle-income countries (LMICs). Therefore, this review aims to identify challenges and lessons for LMICs to develop and implement CAMH policy. Methods: PubMed (1781-), MEDLINE (1950-), EMBASE (1966-), and PsycINFO (1895-) were searched from inception to December 31, 2018, for publications on CAMH policy development and/or implementation. Abstracts and main texts of articles were double screened, and extracted data were analyzed through thematic synthesis. Results: A total of 31 publications were included through the systematic review. Six major challenges were identified for CAMH policy in LMICs: (i) poor public awareness and low political willingness; (ii) stigma against mental disorders; (iii) biased culture values toward children, adolescents and CAMH, from developmental nihilism to medicalization; (iv) the lack of CAMH data and evidence, from service statistics to program evaluation; (v) the shortage of CAMH resources, including human resources, service facilities, and funding; and (vi) unintended consequence of international support, including reducing local responsibilities, planning fragmentation, and unsustainability. Six lessons to overcome challenges were summarized: (i) rethinking the concept of CAMH, (ii) encouraging a stand-alone CAMH policy and budget, (iii) involving stakeholders, (iv) reinforcing the role of research and researchers in policy process, (v) innovating the usage of human and service resources, and (vi) maximizing the positive influence of international organizations and non-governmental organizations. Conclusion: Many LMICs are still facing various challenges for their CAMH policy development and implementation. To overcome the challenges, great and long-term efforts are needed, which include great determination of from domestic and global agents, multidisciplinary innovations, and collaboration and coordination from different sectors.

Sustainable development for global mental health: a typology and systematic evidence mapping of external actors in low-income and middle-income countries

INTRODUCTION

Mental disorders account for a substantial burden of disease and costs in low-income and middle-income countries (LMICs), but attract few resources. With LMIC governments often under economic pressure, an understanding of the external funding landscape is urgently needed. This study develops a new typology of external actors in global health adapted for the sustainable development goals (SDGs) era and uses it to systematically map available evidence on external actors in global mental health.

METHODS

The new typology was developed in line with conceptualisation in the literature and the SDGs to include 11 types of external actors for health in LMICs. Five databases (EconLit, Embase, Global Health, MEDLINE, PsycINFO) were searched for manuscripts published in peer-reviewed journals in English, French, Italian, Portuguese or Spanish between 1 January 2000 and 31 July 2018 and reporting information on external actors for mental disorders in LMICs. Records were screened by abstract, then full-text against inclusion criteria. Data were extracted and synthesised using narrative analysis.

RESULTS

79 studies were included in the final review. Five were quantitative studies analysing the resource flow of development assistance for mental health globally over the last two decades. The remainder were qualitative studies providing a description of external actors: the majority of them were published in the last decade, focused on Africa, and on public sector (bilateral and multilateral governmental organisations) and third sector organisations (non-governmental organisations). Evidence was particularly scarce for for-profit organisations and individual households.

CONCLUSION

This study reveals opportunities for unlocking additional funding for global mental health in the SDG-era from an ecosystem of external actors, and highlights the need to coordinate efforts and to use sustainable, ethical approaches to disbursements. Further research is needed to understand all external actors and the allocation of their contributions in different settings.

Global child and adolescent mental health: The orphan of development assistance for health

In an analysis of data from the Creditor Reporting System, Chunling Lu and colleagues investigate the level of development assistance from high-income countries towards child and adolescent mental health in low- and middle-income countries.