Original Research

Mental health services in Gauteng, South Africa: A proxy evaluation using pharmaceutical data

Lesley J. Robertson, Jade C. Bouwer
South African Journal of Psychiatry | Vol 30 | a2157 | DOI: https://doi.org/10.4102/sajpsychiatry.v30i0.2157 | © 2024 Lesley J. Robertson, Jade C. Bouwer | This work is licensed under CC Attribution 4.0
Submitted: 08 August 2023 | Published: 31 March 2024

About the author(s)

Lesley J. Robertson, Department of Psychiatry, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and, District Specialist Mental Health Team, Sedibeng District Health Services, Vereeniging, South Africa
Jade C. Bouwer, Department of Psychiatry, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; and, Valkenberg Psychiatric Hospital, Department of Health and Wellness, Cape Town, South Africa


Background: South African legislation advocates for equitable access to mental healthcare services integrated into general healthcare settings. Mental, neurological, and substance use (MNS) disorders are often comorbid. Pharmacoepidemiology provides indirect evidence of service provision for conditions amenable to medicine treatment.

Aim: The study aims to evaluate medicine procurement for MNS disorders at different service levels in the health system.

Setting: The Public health sector, Gauteng province formed the setting for the study.

Method: A secondary analysis of the Gauteng pharmaceutical database was conducted using Anatomic Therapeutic Chemical (ATC) and defined daily dose (DDD) methodology. Anatomic Therapeutic Chemical classes of medicines for MNS disorders were included. Defined daily doses and costs were calculated per 1000 population served by each facility and service level. Statistical comparisons were made using chi-square testing.

Results: General healthcare settings accounted for 90% (R118 638 248) and specialised hospitals for 10% (R13 685 032) of expenditure on medicines for MNS disorders, procuring 94% (n = 49 442 474) and 6% (n = 3 311 528) of DDDs, respectively. Although district clinics procured 60% of DDDs, they procured the least per 1000 population served, whereas district hospitals procured the most. For almost all ATC classes, procurement differed significantly between municipalities at every service level and between specialised hospitals.

Conclusion: In Gauteng province, most medicines for MNS disorders are procured by general healthcare services, but access to care may not be equitable. While population coverage at district clinics appears low, district hospitals may experience the greatest care burden. Research regarding quality of care at each service level is recommended.

Contribution: This study provides insight into service provision for MNS disorders.


mental health systems; access to mental and neurological healthcare; public mental health; pharmacoepidemiology; ATC and DDD system; essential medicines; South Africa

Sustainable Development Goal

Goal 3: Good health and well-being


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