Research Article: Global child and adolescent mental health: The orphan of development assistance for health

Date Published: March 9, 2018

Publisher: Public Library of Science

Author(s): Chunling Lu, Zhihui Li, Vikram Patel

Abstract: In an analysis of data from the Creditor Reporting System, Chunling Lu and colleagues investigate the level of development assistance from high-income countries towards child and adolescent mental health in low- and middle-income countries.

Partial Text: More than 40% of the world population is 24 years old or younger, the vast majority of whom live in low- and lower middle–income countries [1]. Globally, a quarter of disability-adjusted life years (DALYs) for mental disorders and substance abuse is borne by this age group [2], and about 75% of mental disorders diagnosed in adulthood have their onset before the age of 24 years [3]. Most children and young people in developing countries, however, do not have access to mental health care.

We identified 1,384 DAMH_CA projects with primary targets on child and adolescent mental health (lower bound). Among them, 404 were allocated to “Other Social Infrastructure and Services,” and the most common themes were in providing special care for children with autism and raising awareness of drug abuse among youths. There were 252 projects for “Emergency Response,” with the most common themes being providing psychosocial assistance and care to children in disasters or conflict areas. There were 225 projects for “General Health,” with the most common themes being improving psychological healthcare for children and addressing alcohol and drug use among adolescents. There were 149 projects for “Government and Civil Society,” with the most common themes being controlling tobacco and alcohol use and improving well-being for children and youth affected by wars (Table 1).

Between 2007 and 2015, a total of US$190.3 million was disbursed to projects with the primary purpose of improving the mental health of children and adolescents, accounting for 12.5% of DAMH and 0.10% of the total DAH disbursed over this period. The DAMH_CA increased from US$6.6 million in 2007 to US$30.2 million in 2015, with fluctuations over time. The percentages of DAMH_CA in total DAMH increased from 10% in 2007 to 17% in 2008 and dropped to 6% in 2013. In 2015, 14% of DAMH was for child and adolescent mental health (Fig 1).

The humanitarian aid sector received the largest cumulative DAMH_CA, with a total amount of US$77.2 million (40.5% of total DAMH_CA), followed by the government and civil society sector (US$58.6 million [30.8%]), the health sector (US$38.0 million [20.0%]), and the education sector (US$15.6 million [8.2%]) (Fig 2). In terms of each sector’s proportion in DAMH_CA, government and civil services had the largest proportion in 2007 and 2008. It was then replaced by humanitarian assistance between 2009 and 2014 and returned to the leading position in 2015 (38.4% in total DAMH_CA in 2015), followed closely by “Humanitarian Aid” (37.9%), “Health” (18.3%), and “Education” (5.4%).

In terms of channel of delivery, from 2007 to 2015, nongovernmental organizations (NGOs) and civil society received the largest cumulative DAMH_CA of US$110.6 million (58.1% of total DAMH_CA), followed by UN organizations and WHO (US$46.4 million [24.4%]); the public sector in recipient countries received a relatively small fraction (US$23.1 million [12.1%]) (see S2 Fig).

Fig 3 presents the world map of average annual per capita DAMH_CA for 132 countries. Throughout the analysis period, 21 countries did not receive any funding on DAMH_CA, including 3 low-income countries (Guinea-Bissau, Gambia, and Comoros), 8 lower middle–income countries (e.g., Lesotho, Tonga, and Djibouti), and 10 upper middle–income countries (e.g., Gabon, Namibia, and Botswana). Per capita, 69 countries received less than US$0.01 DAMH_CA, including 20 low-income countries (e.g. Rwanda, Mozambique, and Guinea), 26 lower middle–income countries (e.g., India, Senegal, and Nigeria), and 23 upper middle–income countries (e.g., China, Mexico, and Chile). Only 14 countries received more than US$0.05 DAMH_CA per capita, with 4 of them receiving more than US$0.2 per capita: West Bank and Gaza Strip (US$2.9 per capita), Kiribati (US$1.3), Lebanon (US$0.4), and Bosnia and Herzegovina (US$0.2). Numerical values of annual DAMH_CA per capita for each country (in both upper and lower bounds) are reported in S4 Table and S5 Table.

Interventions targeting the five leading causes for disability or death among children and adolescents received relatively small disbursements. The lower-bound estimates show that the cumulative amount of disbursements to trauma-related mental disorders accounted for 1.13% of total DAMH_CA, followed by substance abuse (0.76%), autism (0.19%), suicide (0.02%), depression (0.02%), and anxiety (0.01%) (see S9 Fig). Findings on investments in these disorders remain similar when using upper-bound estimates (S5 Fig).

Using the CRS data with a multi-sectoral perspective, we tracked 44 donors’ aid disbursements to DAMH_CA projects implemented in 132 developing countries between 2007 and 2015. The total amount of DAMH_CA with a primary target on the mental health of children and adolescents was US$190.3 million over the 8 years, accounting for 12.5% of total DAMH and 0.1% of total DAH. Per capita, 90 developing countries received either 0 or less than US$0.01 average DAMH_CA, including 23 low-income countries (out of 36 total low-income countries [64%]). Global child and adolescent mental health is truly the orphan of DAH. Our findings are consistent with a recent publication on DAMH_CA [13].



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