Reporting back: The International Dialogue on Sustainable Financing for NCDs & Mental Health

Last week governments from around the world gathered at the World Bank HQ in Washington DC for the International Dialogue on Sustainable Financing for NCDs and Mental Health. This was a follow-up from the 2018 Global Dialogue on Partnerships for Sustainable Financing of NCD Prevention and Control, although this time, as the title suggests, mental health was not only included in the discussions but a central part of the dialogue.

Halfway through the Sustainable Development Goals, we are at a critical juncture with nearly all countries off track to achieve the SDG targets for NCDs and mental health. The cost is not only in lives but also economic, as Bruce Alyward, Assistant Director General at WHO told the Dialogue that the cost of inaction on NCDs and mental health will be US$46 trillion between now and 2030.

Much of the dialogue centred on financing NCDs and mental health within primary healthcare (PHC), as Bente Mikkleson, Director of NCDs at WHO put it at the beginning of day one, “Primary healthcare is the vehicle. PHC reforms are NCD [and mental health] reforms.” Several positive examples of mental health finance reforms were presented by governments such as by the Minister of Health for Moldova who spoke of the transition to a PHC-based health system that has mental health at its core. The transition has been from a system where mental health services were only in tertiary facilities (e.g. mental asylums) to one that has built 35 modern mental health centres within PHC facilities which benefit from finance through the PHC budget but also has separate, dedicated funding so the system is not entirely dependent on one budget.  

Social health insurance was often the primary funding mechanism for reforms and increased coverage of services, and for several countries, this involved catalytic finance or technical support from development partners.

The Philippines presented their positive experience of working with WHO and UNDP to develop a national mental health investment case. In their experience, it was critical to show the cost-effectiveness and impact of interventions for cross-government buy-in (particularly from the finance ministry), which for the Philippines has led to cross-sectoral policies to support their citizen’s mental health. As stated by Monique Vledder, Head of Global Health, Nutrition and Population Department at the World Bank, “Health is an investment, not an expense”. The investment case laid out the cost to the economy of mental ill health and the potential high return on investment. This evidence plus the mental health law has led to an increase in mental health service coverage with 362 mental health access sites across the country and 30 mental health medicines paid for or subsidised by public funding, and the rollout of the WHO Mental Health Action Programme through which there has been a significant scale-up of services for mental, neurological and substance use conditions. The result has been 124,000 users of mental health services, and critically, the expansion of the mental health benefits package under the social health insurance scheme.

To be clear, this was not a pledging event and there was no expectation that governments or donors would commit to increasing mental health finance. It was a policy dialogue to discuss the best ways to increase, improve and integrate NCD and mental health finance so as to learn, and a key milestone in the build-up to the 2025 UN High-Level Meeting on NCDs [and mental health] (HLM NCDs). United for Global Mental Health hopes that the learning and recommendations from the dialogue (an outcome document will be agreed upon and published) will align with our proposals to increase, improve and integrate financing for NCDs and mental health so that the finance elements of the HLM NCDs will progress and lead to more and better mental health finance across the world, especially where it is needed most.