UHC Country Translation

Achievements in Pakistan

Pakistan is the first country in the world to align its UHC Benefit Package with the DCP3 recommended high impact interventions. Read more about the process of developing and implementing a national Essential Package of Health Services and other achievements in Pakistan here.

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The UHC Country Translation Project

The Disease Control Priorities 3 (DCP3) - UHC Country Translation project is a multi-year project designed to respond to the increasing needs of low and middle-income countries (LMICs) for technical guidance and support in priority setting and in accelerating progress towards universal health coverage (UHC).

In 2018, with the support of the Bill & Melinda Gates Foundation, the DCP3 Secretariat currently hosted at the London School of Hygiene and Tropical Medicine used the evidence and model UHC packages developed through DCP3 to further achieve the following objectives:

  1. Increasing the use of DCP3 evidence and resources in LMICs through piloting in selected countries to develop UHC Essential Packages of Health Services or Health Benefit Packages (HBPs)
  2. Improving the global evidence and resources to support best practices in priority setting and development of UHC Health Benefit Packages
  3. Strengthening the capacity of national decision makers and institutions in LMICs to conduct priority setting and develop and sustain Health Benefit Packages
  4. Developing a fast-track sub-package of highest priority basic health services for use in polio high-risk areas

The strategic goal of this project is to enable decision makers in LMICs in allocating often tightly constrained budgets so that health system objectives are maximally achieved, in the pursuit of UHC.

DCP3 is the 3rd edition of the Disease Control Priorities series launched in 2017, which aims to provide an up-to-date review of the efficacy, effectiveness, and cost-effectiveness of priority health interventions with the goal of influencing program design and resource allocation at country level. The findings of DCP3 have been published in 9 volumes and present 21 Packages of Health Interventions for achieving UHC. DCP3 builds on the work started in 1993, when the World Bank published its World Development Report focusing on ‘Disease Control Priorities in Developing Countries’ (DCP1) with the objective of systematically assessing the cost-effectiveness of interventions addressing major causes of disease burden to support resource allocation decision making, particularly in resource constrained settings¹. In 2006, the second edition (DCP2) was released, highlighting cost-effective interventions based on evidence review and health systems analysis and providing policy recommendations.
 
The DCP products have undergone a comprehensive independent evaluation which assessed the extent to which they are relevant and applicable to low- and middle-income countries and how much they add to existing evidence and information sources. The evaluation saw DCP3 as credible and additive sources of evidence and considered DCP3’s packages to have a unique value for decision making, especially when translated to local contexts, and “filling a gap in technical guidance not currently met”².  The DCP3-UHC Country Translation project is now implementing and refining the process of using the DCP3 evidence and packages for LMICs. 
 

[1] World Bank. World Development Report 1993: Investing in Health. https://openknowledge.worldbank.org/handle/10986/5976

[2] Dalberg. Evaluation of the DCP Series. March 2018. http://dcp-3.org/sites/default/files/resources/DCP%20Evaluation%20Report_vFinal.pdf?issu

 

Achieving the ambitious goal of UHC by 2030 requires greater investments in expanding population coverage, providing access to high-quality health services and protecting against financial risk. Shortfalls in access, quality, efficiency, and equity in health care have been documented extensively throughout the world, and DCP3 is helping low- and middle-income countries accelerate progress towards UHC by providing them with guidance on priority health interventions for UHC in the form of a set of model UHC Packages. The packages include an Essential UHC Package (EUHC), a high priority package (HPP), and an Intersectoral Package, which could be adapted to reflect country-specific needs, health system capacities, financing structures, available resources and other local circumstances.

The Essential UHC Package (EUHC) has 218 health interventions, and is grouped into five health care delivery platforms to serve as a guide and a starting point for country specific analysis of priorities. Assuming steady-state implementation by 2030, EUHC in lower-middle-income countries would reduce premature deaths by an estimated 4.2 million per year.

The five health delivery platforms provide:

  • population-based health interventions
  • health interventions delivered at the community level
  • health services delivered at the health center level
  • health services delivered at the first level hospitals, and
  • health interventions delivered at the referral and specialized hospitals.

In countries in which the fiscal space for health does not allow the implementation of the full EUHC package, a subset of 108 health service interventions termed the highest-priority package (HPP) has been proposed for early implementation.

Consistent with the concept and definition of UHC, preventive and health promotion services that are implemented in partnership with sectors other than health are an integral part of improved health coverage. Therefore, another package developed by DCP3 covers a similar concept for 71 intersectoral policies, of which 29 are core priorities for early implementation.

The intersectoral package covers:

  • fiscal policies
  • regulatory policies
  • built infrastructure interventions, and
  • health promotion and information interventions.

The DCP3 findings in its 9 volumes and the UHC packages aim to support countries in their efforts to achieve full access to essential health care. DCP3 packages can be adapted to reflect local disease burden, health care needs, national financing structures and local evidence on costs.

 

The DCP3-UHC Country Translation work focuses on four areas:

  1. Increasing the use of DCP3 evidence and resources in LMICs
    DCP3 DCP3 is providing comprehensive technical support to two pilot countries in priority setting and development of UHC benefit packages. In the first pilot country, Pakistan, the Ministry of National Health Services Regulations and Coordination (MNHSRC) and DCP3 Secretariat developed a national EPHS, and work is underway to begin a phased implementation process of the UHC EPHS at the district level. Additional countries will be invited to join the project in the first quarter of 2021.
  1. Improving the global evidence and resources to support best practices in priority setting
     DCP3 is providing technical guidance to LMICs in setting and revising health benefit packages. This work will bring together a broad range of partners, including the WHO, who will be the lead agency responsible for providing technical support to countries on implementing DCP3-based economic evaluations and priority setting for UHC. The guidance will draw on lessons learned from Pakistan and other partners working on priority setting and costing of the implementation of UHC.
     
  2. Strengthening the capacity of national decision makers and institutions
    DCP3 is strengthening the capacity of national decision makers and institutions in the pilot countries to conduct priority setting and develop and sustain health benefit packages (HBPs). This is an essential component of the project, due to the nature of HBP being a living document that will evolve and develop as countries progress towards UHC. Ensuring capacity within pilot countries is integral to the sustainability of HBP.
  1. Developing a fast-tack polio sub-package
    DCP3 is developing a fast-track sub package of highest priority basic health services in polio high-risk areas, where lack of such services is contributing to community resistance to vaccination and impeding the global eradication of polio. This area of work responds to the needs in the first pilot country Pakistan, where community resistance to vaccination develops when repeated door to door polio campaigns are not accompanied with similar interest in responding to the community health needs which are considered by them more essential than the polio vaccine.  

What has been achieved?

The DCP3- UHC Country Translation project has successfully delivered on several key aspects of the project and is glad to be able to share these accomplishments. The project has been piloted in Pakistan, where the Ministry of National Health Services, Regulations and Coordination (MNHSR&C) in collaboration with the DCP3 Secretariat and other partners developed an Essential Package of Health Services containing  107 health interventions.  The package focuses on primary health care and the district-level system, covering services provided through the community, health centre and first-level hospital platforms. This package has been further prioritized into a district-level package of 88 health interventions for immediate implementation. 

The project has also strengthened the capacity and skills of staff in the Ministry of Health and other national partners, including Aga Khan University, in public health leadership, priority setting, policy decision making, and in designing the national health benefits package. This has been achieved through training courses in Pakistan and abroad, technical meetings and working group sessions, regular consultations and advice from DCP3 staff, and hands-on practice. 

DCP3-UHC Country Translation project has also compketed work on objective four, which included the development of a fast-track sub-package of highest priority basic health services in high-risk polio areas. The sub-package includes both high priority health and basic water, sanitation, and hygiene services and has been implemented in 40 high risk polio-endemic councils in Pakistan.

What we will be doing next?

During the first half of 2021, the DCP3 Secretariat will reach out to LMIC governments who are interested in partnering as the second pilot country, undertaking a similar process to Pakistan. The partnership intends to provide comprehensive technical support in priority setting and development of UHC benefit packages, specific to the country context. Through consultations, appropriate capacity building plans will be implemented to support Ministry of Health staff and relevant local partners to ensure sustainability of the process and implementation of packages.

Latest News

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