oa South African Health Review - Towards universal health coverage for people living with mental illness in South Africa - review

Volume 2018 Number 1
  • ISSN : 1025-1715



Given its human rights-based Constitution of 1996 and as signatory to the United Nations Convention on the Rights of Persons with Disabilities, South Africa is obliged to provide equitable access to care for those with serious mental illness (SMI). Universal health coverage (UHC) means that all people are able to access the health care they need without incurring financial hardship. With the release of the National Health Insurance White Paper in 2017, South Africa confirmed the process of transforming its healthcare system to ensure UHC, including for people living with mental illness (PLWMI).

However, with multiple competing health priorities, there is a risk that mental health may not be addressed, particularly for those with serious mental illness (SMI). The severe functional impairment and psychosocial disability related to SMI limits the individual’s ability to access health care, unless specifically catered for by the health system. At present, both the public and private health sectors are characterised by poorly resourced, fragmented, mainly hospital-based mental health care. Notably, if National Health Insurance does not provide financial protection, it is likely to perpetuate inequity and neglect in the health and mental health care of PLWMI.

This chapter explores UHC for PLWMI in South Africa, with consideration given to the burden of disease due to SMI, current mental health services, and national health policy and plans. We conclude with key recommendations to accelerate progress towards UHC for PLWMI, including the need for a paradigm shift in the organisation and funding of mental health services.

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