Addressing the UHC Challenge Using the Disease Control Priorities 3 Approach: Lessons Learned and an Overview of the Pakistan Experience
نویسندگان
1 Ministry of National Health Services, Regulations and Coordination, Islamabad, Pakistan
2 Ministry of National Health Services, Regulations and Coordination, Islamabad, Pakistan
3 Department of Health Evidence, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
4 Centre for Health Economics, University of York, York, UK
5 Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, UK
6 Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, UK
7 DCP3 Country Translation Project, London School of Hygiene and Tropical Medicine, London, UK
8 Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
9 Ministry of National Health Services, Regulations and Coordination, Islamabad, Pakistan
10 Department of Health Evidence, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
11 DCP3 Country Translation Project, London School of Hygiene and Tropical Medicine, London, UK
12 Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
13 Ministry of National Health Services, Regulations and Coordination, Islamabad, Pakistan
doi
10.34172/ijhpm.2023.8003چکیده
Background Pakistan developed its first national essential package of health services (EPHS) as a key step towards accelerating progress in achieving universal health coverage (UHC). We describe the rationale, aims, the systematic approach followed to EPHS development, methods adopted, outcomes of the process, challenges encountered, and lessons learned. Methods EPHS design was led by the Ministry of National Health Services, Regulations & Coordination (MNHSR&C). The methods adopted were technically guided by the Disease Control Priorities 3 (DCP3) Country Translation project and existing country experience. It followed a participatory and evidence-informed prioritisation and decision-making processes. Results The full EPHS covers 117 interventions delivered at the community, health centre and first-level hospital platforms at a per capita cost of US$ 29.7. The EPHS also includes an additional set of 12 population-based interventions at US$ 0.78 per capita. An immediate implementation package (IIP) of 88 district-level interventions costing US$ 12.98 per capita will be implemented initially together with the population-based interventions until government health allocations increase to the level required to implement the full EPHS. Interventions delivered at the tertiary care platform were also prioritised and costed at US$ 6.5 per capita, but they were not included in the district-level package. The national EPHS guided the development of provincial packages using the same evidence-informed process. The government and development partners are in the process of initiating a phased approach to implement the IIP. Conclusion Key ingredients for a successful EPHS design include a focus on package feasibility and affordability, national ownership and leadership, and solid engagement of national stakeholders and development partners. Major challenges to the transition to implementation are to continue strengthening the national technical capacity, institutionalise priority setting and package design and its revision in ministries of health, address health system gaps and bridge the current gap in financing with the progressive increase in coverage towards 2030.
