Accessibility, availability of psychotropic medicines

An estimated prevalence of 14.77 per cent (4,351,780) of Ghana’s population suffers from mental and substance use disorders. Despite these staggering figures, very little attention is being paid to mental health promotion, prevention, treatment and rehabilitation.

The treatment gap (i.e. the proportion of those who need conventional psychiatric treatment but do not have access to it) of mental disorders is estimated at 98 per cent.

Even though the WHO gives clear and specific guidelines on how to reduce this and its consequences, little has been achieved in Ghana.

Over the years, there have been major challenges with availability, affordability, quality and variety of available psychotropic medicines.

Problem

The fundamental problem of the perennial shortage of psychotropic medicines is financial, the key issues being mental health financing, challenges with the current supply chain and the absence of the needed commitment by policymakers to mental health.

There is an absence of a comprehensive, coherent and sustained policy on mental health financing. Patients and carers often have to make out-of-pocket payment for care. Meanwhile, patients may not be working and carers have reduced productivity due to the time taken off work to care for their relatives.

The Mental Health Act 2012 (Act 846) indicates that mental health service is free and is to be offered under the National Health Insurance Scheme (NHIS), without explanations on how to fund the ‘free’.

This ambiguity may be a reason the NHIS is ‘reluctant’ to reimburse for medicines used in treating mental disorders and also ties the hands of the private sector from increased participation in this sector.

The Supply Chain Process for mental health medicines is cumbersome. The current procurement procedure takes 18 months for the tender process to be completed at the Ministry of Health, as opposed to other sectors of health care where tender is carried out at the facility level and takes a shorter time.

Also, suppliers who are awarded contracts fail to honour bids won because prices would have changed from what they quoted for, as well as delays in reimbursement. In addition, local manufactures are not too keen to produce psychotropic medicines because of the absence of a policy that encourages them to compete for international competitive bidding by the Government of Ghana (GOG).

Another disturbing fact is that funds for the procurement of medicines are not ring-fenced, so amounts released are usually far less than the amount budgeted for.

Low prioritisation of mental health needs of citizens by policy makers contributes to the problem of gaps in care for mental health patients. This could be due to the lack of awareness of the effects of mental illness on our well-being, total health and productivity as a result of the lack of accurate and systematically gathered data that will give a true scale of mental illness; and, therefore, only poor estimates of need are used for budgeting accordingly.

However, there is an associated loss of productivity among the general population estimated at seven per cent of Ghana’s GDP.

The absence of mental health indicators in the national and international health reports also affects policy direction.

Solutions

To enable the concept of ‘free’ mental health services to achieve its goal of making psychotropics available and affordable in the whole country, a piloting of an insurance and financing model is proposed among other things. Mental health patients will access medicines for free through an insurance scheme developed under the auspices of Mental Health Authority/NHIS and private partnership.

Funding of the insurance scheme will be initiated with one-time seed money from GOG and donors (development partners, NGOs and big Pharma) placed in a revolving fund for paying suppliers of psychotropic medicines.

The procurement of psychotropics and their reimbursement after distribution should be mainstreamed as is done with general procurement of other medicines by national, regional and district-level government and private agencies. This will enhance the availability and accessibility of psychotropics to all patients at all levels of health care under the insurance scheme.

Mental health care should also be made a part of existing basic health packages or essential interventions. For example, mental health care could be included in the free maternal care packages (15.6 per cent of women develop a serious mental illness during pregnancy and 19.8 per cent after childbirth according to the WHO) and in services to the elderly.

GOG may propose to corporate bodies to allocate a percentage of their Corporate Social Responsibility budget to support the Mental Health Fund in exchange for tax relief.

The writers are Mental Health specialists with the Ghana Health Service
Email: graceowaboagye@gmail.com