Health Policy and Planning
Volume 30 Issue 2 March 2015
http://heapol.oxfordjournals.org/content/current

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Integrating mental health and social development in theory and practice
Sophie Plagerson*
Author Affiliations
Centre for Social Development in Africa, University of Johannesburg, Auckland Park, Johannesburg 2006, South Africa
Accepted December 17, 2013.
Abstract
In many low and middle income countries, attention to mental illness remains compartmentalized and consigned as a matter for specialist policy. Despite great advances in global mental health, mental health policy and practice dovetail only to a limited degree with social development efforts. They often lag behind broader approaches to health and development. This gap ignores the small but growing evidence that social development unavoidably impacts the mental health of those affected, and that this influence can be both positive and negative. This article examines the theoretical and practical challenges that need to be overcome for a more effective integration of social development and mental health policy. From a theoretical perspective, this article demonstrates compatibility between social development and mental health paradigms. In particular, the capability approach is shown to provide a strong framework for integrating mental health and development. Yet, capability-oriented critiques on ‘happiness’ have recently been applied to mental health with potentially detrimental outcomes. With regard to policy and practice, horizontal and vertical integration strategies are suggested. Horizontal strategies require stronger devolution of mental health care to the primary care level, more unified messages regarding mental health care provision and the gradual expansion of mental health packages of care. Vertical integration refers to the alignment of mental health with related policy domains (particularly the social, economic and political domains). Evidence from mental health research reinforces aspects of social development theory in a way that can have tangible implications on practice. First, it encourages a focus on avoiding exclusion of those affected by or at risk of mental illness. Secondly, it underscores the importance of the process of implementation as an integral component of successful policies. Finally, by retaining a focus on the individual, it seeks to avoid uneven approaches to development.

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Overcoming challenges to sustainable immunization financing: early experiences from GAVI graduating countries
Helen Saxenian1, Robert Hecht2,*, Miloud Kaddar3, Sarah Schmitt4, Theresa Ryckman2 and Santiago Cornejo5
Author Affiliations
1Consultant to Results for Development Institute, Washington, DC 20005, USA, 2Results for Development Institute, Washington, DC 20005, USA, 3World Health Organization, 1211 Geneva, Switzerland, 4Consultant to World Health Organization, 1211 Geneva, Switzerland, 5GAVI Alliance, 1202 Geneva, Switzerland
Accepted January 6, 2014.
Abstract
Over the 5-year period ending in 2018, 16 countries with a combined birth cohort of over 6 million infants requiring life-saving immunizations are scheduled to transition (graduate) from outside financial and technical support for a number of their essential vaccines. This support has been provided over the past decade by the GAVI Alliance. Will these 16 countries be able to continue to sustain these vaccination efforts? To address this issue, GAVI and its partners are supporting transition planning, entailing country assessments of readiness to graduate and intensive dialogue with national officials to ensure a smooth transition process. This approach was piloted in Bhutan, Republic of Congo, Georgia, Moldova and Mongolia in 2012. The pilot showed that graduating countries are highly heterogeneous in their capacity to assume responsibility for their immunization programmes. Although all possess certain strengths, each country displayed weaknesses in some of the following areas: budgeting for vaccine purchase, national procurement practices, performance of national regulatory agencies, and technical capacity for vaccine planning and advocacy. The 2012 pilot experience further demonstrated the value of transition planning processes and tools. As a result, GAVI has decided to continue with transition planning in 2013 and beyond. As the graduation process advances, GAVI and graduating countries should continue to contribute to global collective thinking about how developing countries can successfully end their dependence on donor aid and achieve self-sufficiency.

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Health seeking behaviour and the related household out-of-pocket expenditure for chronic non-communicable diseases in rural Malawi
Qun Wang, Stephan Brenner, Gerald Leppert, Thomas Hastings Banda, Olivier Kalmus, and Manuela De Allegri
Health Policy Plan. (2015) 30 (2): 242-252 doi:10.1093/heapol/czu004

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Policy options for pharmaceutical pricing and purchasing: issues for low- and middle-income countries
Tuan Anh Nguyen1,2,*, Rosemary Knight3, Elizabeth Ellen Roughead1, Geoffrey Brooks4 and
Andrea Mant3
Author Affiliations
1Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA 5000, Australia 2Pharmacoeconomic and Pharmaceutical Administration Department, Hanoi University of Pharmacy, 13-15 Le Thanh Tong St., Hanoi, Vietnam 3School of Public Health and Community Medicine, University of New South Wales, High St, Kensington NSW 2052, Australia and 4Pharmaceutical Consultant, Adelaide Parade, Woollahra, NSW 2025, Australia
Accepted November 27, 2013.
Abstract
Pharmaceutical expenditure is rising globally. Most high-income countries have exercised pricing or purchasing strategies to address this pressure. Low- and middle-income countries (LMICs), however, usually have less regulated pharmaceutical markets and often lack feasible pricing or purchasing strategies, notwithstanding their wish to effectively manage medicine budgets. In high-income countries, most medicines payments are made by the state or health insurance institutions. In LMICs, most pharmaceutical expenditure is out-of-pocket which creates a different dynamic for policy enforcement. The paucity of rigorous studies on the effectiveness of pharmaceutical pricing and purchasing strategies makes it especially difficult for policy makers in LMICs to decide on a course of action. This article reviews published articles on pharmaceutical pricing and purchasing policies. Many policy options for medicine pricing and purchasing have been found to work but they also have attendant risks. No one option is decisively preferred; rather a mix of options may be required based on country-specific context. Empirical studies in LMICs are lacking. However, risks from any one policy option can reasonably be argued to be greater in LMICs which often lack strong legal systems, purchasing and state institutions to underpin the healthcare system. Key factors are identified to assist LMICs improve their medicine pricing and purchasing systems.