Mental health policy process: a comparative study of Ghana, South Africa, Uganda and Zambia.
BACKGROUND
Mental illnesses are increasingly recognised as a leading cause of disability worldwide, yet many countries lack a mental health policy or have an outdated, inappropriate policy. This paper explores the development of appropriate mental health policies and their effective implementation. It reports comparative findings on the processes for developing and implementing mental health policies in Ghana, South Africa, Uganda and Zambia as part of the Mental Health and Poverty Project.


METHODS
The study countries and respondents were purposively selected to represent different levels of mental health policy and system development to allow comparative analysis of the factors underlying the different forms of mental health policy development and implementation. Data were collected using semi-structured interviews and document analysis. Data analysis was guided by conceptual framework that was developed for this purpose. A framework approach to analysis was used, incorporating themes that emerged from the data and from the conceptual framework.


RESULTS
Mental health policies in Ghana, South Africa, Uganda and Zambia are weak, in draft form or non-existent. Mental health remained low on the policy agenda due to stigma and a lack of information, as well as low prioritisation by donors, low political priority and grassroots demand. Progress with mental health policy development varied and respondents noted a lack of consultation and insufficient evidence to inform policy development. Furthermore, policies were poorly implemented, due to factors including insufficient dissemination and operationalisation of policies and a lack of resources.


CONCLUSIONS
Mental health policy processes in all four countries were inadequate, leading to either weak or non-existent policies, with an impact on mental health services. Recommendations are provided to strengthen mental health policy processes in these and other African countries.
Omar
Maye A
MA
Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, 101 Clarendon Road, Leeds LS2 9LJ, UK.
Green
Andrew T
AT
Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, 101 Clarendon Road, Leeds LS2 9LJ, UK.
Bird
Philippa K
PK
Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, 101 Clarendon Road, Leeds LS2 9LJ, UK.
Mirzoev
Tolib
T
Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, 101 Clarendon Road, Leeds LS2 9LJ, UK.
Flisher
Alan J
AJ
Department of Psychiatry and Mental Health, University of Cape Town, South Africa.
Kigozi
Fred
F
Butabika National Referral Mental Hospital and Department of Psychiatry, Makarere University, Kampala, Uganda.
Lund
Crick
C
Department of Psychiatry and Mental Health, University of Cape Town, South Africa.
Mwanza
Jason
J
Department of Social Development Studies Division of Sociology University of Zambia, Zambia.
Ofori-Atta
Angela L
AL
University of Ghana Medical School, Accra, Ghana.