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Sustainable financing for global mental health: the role of external funding for mental health in low- and middle-income countries

Iemmi, Valentina (2020) Sustainable financing for global mental health: the role of external funding for mental health in low- and middle-income countries. PhD thesis, London School of Economics and Political Science.

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Identification Number: 10.21953/lse.00004235


Over 1 billion people live with mental disorders globally. Three out of four of these live in low- and middle-income countries (LMICs) where mental disorders fail to attract enough resources to mitigate against the effects on opportunity, social inclusion and quality of life. In the context of increasing economic pressure brought by COVID-19 response and future recovery, external actors could unlock additional funds. This thesis therefore aims to identify who those external actors are in global mental health and to understand their roles so as to inform policy planning and sustainable financing. I use a multimethod research design. The first empirical chapter presents a new typology of external actors in global health, which is used to structure a systematic mapping of the evidence on external actors investing in mental health in LMICs. Findings reveal the existence of a large ecosystem of external organisations and individuals. Cognisant of the increased influence of philanthropy in global health, the second empirical chapter analyses trends in philanthropic development assistance for mental health (DAMH) in 156 countries between 2000 and 2015. Results suggest philanthropy plays a critical role, but my findings also highlight substantial inequalities. The third empirical chapter analyses factors at recipient country-level potentially associated with DAMH allocation, using a two-part regression model applied to a time series cross-sectional dataset for 142 LMICs between 2000 and 2015. The analyses show that external actors’ disbursements are not well aligned with mental health needs of recipient countries, and contextual factors might be playing more prominent roles in resource allocation. Finally, the fourth empirical chapter uses 35 elite interviews and documentary analyses to explore how and why external organisations have invested in mental health in LMICs over the last three decades and changes over time. Findings uncover numerous activities supported by external organisations, and factors shaping their decisions at four levels (organisations, source and recipient countries, global landscape). Overall, this thesis underscores the important roles of external actors in sustainable mental health financing in LMICs.

Item Type: Thesis (PhD)
Additional Information: © 2020 Valentina Iemmi
Library of Congress subject classification: H Social Sciences > HC Economic History and Conditions
H Social Sciences > HG Finance
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Sets: Departments > Social Policy
Supervisor: Knapp, Martin and Coast, Ernestina and Wenham, Clare

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