Economic factors related to mental health in the South African context are here discussed in terms of two domains, namely 1) healthcare spending and 2) mental health care.
1. Healthcare spending
South Africa’s total health expenditure comprises 8.8% of its Gross Domestic Product (GDP), with national spending only accounting for 40% of the total amount.
South African mental health services will be covered under the new National Health Insurance (NHI) scheme, which is being developed and implemented by government as part of its move towards Universal Health Coverage (UHC) and promoting more equitable delivery of health services.
Approximately 84% of the population is served by the country’s public health sector. However, there is pressure on the state to expand the accessibility of healthcare services, given that only 40% of the health budget is state-funded.
At primary health care level, the UHC package of care includes access to mental health services and treatment at district and sub-district levels.
2. Mental healthcare
Public mental health spending as a percentage of the overall health budget is reportedly 4.6% or USD 12.4 (which translates to approximately R204) per capita for mental health inpatient and outpatient care, with a range of 2.1% to 7.7% of mental health spending by provincial health budgets.
Only three out of nine provinces reportedly utilise 5% or more of their health spending on mental health services, with a large majority channelled towards inpatient care (86% of mental health spending).
Information systems aimed at measuring the true burden of mental health conditions is also inadequate, contributing to ineffective allocation of resources towards mental health.
It is also challenging to reliably estimate the precise spending towards building more efficient pathways of care and systems for mental health in community-based settings across South Africa.