1.0 Background

Mental health conditions are a growing public health concern in all parts of the world. Strengthening policy and increasing interest and investment in mental health is a major goal for public health and sustainable development. On June 1st, 2019, President Uhuru Kenyatta indicated in his official Madaraka Day speech that the country was facing a mental health crisis and ordered the Ministry of Health to implement programmes and policies to address the problem. A Cabinet meeting held on 21st November 2019, went further and directed the formation of a Mental Health Taskforce to address the mental health concerns of Kenyans and help guide the government on resource allocation for mental health.

While there is increased focus on addressing the mental health in Kenya, government expenditure to mental health is still very low (about 0.01% of the total expenditure). Furthermore, private medical insurance covers are discriminatory, and most insurance companies do not cover for mental health care. Consequently, people with mental illness often must pay out-of-pocket to access health mental health services. To advocate for better resource allocation to mental health, the Ministry of Health seeks to develop an investment case for mental health.

Mental health conditions do not only lead to individual human suffering but also have social and economic implications. These include, among others, the increasing financial burden on the health systems and the loss of productivity among the workforce, as individuals who suffer from mental health conditions are more likely to leave the labor force (due to premature death or disability), miss days of work (absenteeism) or work at reduced capacity (presenteeism).

This document presents the TORs for technical assistance to the Ministry of Health to support the development of the mental health investment case for Kenya. This work is being undertaken as a collaborative effort between WHO and UNDP.

Purpose

The overall aim of an investment case assessment is to define the costs of inaction or the status quo response, to identify priority areas of action, and quantify the benefits of these actions.

Developing the investment case will include undertaking a quantification of the costs of mental health conditions to the health sector and to the national economy at large, and of the benefits of scaled up action. It includes a return on investment (ROI) analysis that compares the current costs of mental health conditions in the country with the estimated health and economic returns that implementing a set of cost-effective interventions (both scaled up treatment of mental health conditions and population-based preventive programmes) would have over a five, ten and twenty-year period.

The investment case approach also incorporates institutional perspectives to ensure that the recommendations made are in the context of institutional capacities and economic and political environments.

Tasks of the consultants

The consultants will work closely with the Ministry of Health, WHO, UNDP and other experts on the team to provide technical support to the process of developing the mental health investment case. The specific tasks for the consultants are outlined below.

1. Mental Health Specialist

• Collect existing data on prevalence of different mental health conditions in Kenya


• Undertake review on the Mental Health System in Kenya using WHO health system blocks and health system functions


• Participate in interviews of respondents for institutional context component


• Provide input into the institutional context report and final report for this activity

2. Health Economist

• Provide country level data to update One Health tool to be used in estimation


• Participate in interviews to collect data from stakeholders


• Work with the team to estimate health costs, impact and return on investment for mental health


• Provide input into the investment case component report and final report for this activity

Qualifications and Experience

This assignment requires regional and national consultants with the following qualifications:

A. National consultant - Mental Health Specialist

o At least a Master’s degree in medicine (Psychiatry Specialization)

o Experience in mental health service in Kenya

o Demonstrated analytical and writing skills

o Team player with good interpersonal, communication, report writing, analytical and presentation skills are required.

o Fluent (Read - Write - Speak) in English

B. National consultant -Health Economist

o At least a Master’s degree in health economics, economics, or related degree. PhD in the same will be an added advantage

o Experience in developing investment cases for mental health

o Experience working with WHO or any other international organization in similar or higher capacity will be an added advantage

o Demonstrated analytical and writing skills

o Team player with good interpersonal, communication, report writing, analytical and presentation skills are required.

o Fluent (Read - Write - Speak) in English

Level of Effort

15 working days for each of the consultant