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Mental health policy process: a comparative study of Ghana, South Africa, Uganda and Zambia

Maye A Omar1*, Andrew T Green1, Philippa K Bird1, Tolib Mirzoev1, Alan J Flisher2, Fred Kigozi3, Crick Lund2, Jason Mwanza4, Angela L Ofori-Atta5 and Mental Health and Poverty Research Programme Consortium (MHaPP)

Author Affiliations

1 Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, 101 Clarendon Road, Leeds LS2 9LJ, UK

2 Department of Psychiatry and Mental Health, University of Cape Town, South Africa

3 Butabika National Referral Mental Hospital and Department of Psychiatry, Makarere University, Kampala, Uganda

4 Department of Social Development Studies Division of Sociology University of Zambia, Zambia

5 University of Ghana Medical School, Accra, Ghana

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International Journal of Mental Health Systems 2010, 4:24  doi:10.1186/1752-4458-4-24

Published: 2 August 2010



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recognised as a leading cause of disability worldwide, yet many countries lack a mental health policy or have an outdated, inappropriate policy.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.


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.


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.


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.