Building implementable packages for universal health coverage

Abstract

Since no country or health system can provide every possible health service to everyone who might benefit, the prioritisation of a defined subset of services for universal availability is intrinsic to universal health coverage (UHC). Creating a package of priority services for UHC, however, does not in itself benefit a population-packages have impact only through implementation. There are inherent tensions between the way services are formulated to facilitate criteria-driven prioritisation and the formulations that facilitate implementation, and service delivery considerations are rarely well incorporated into package development. Countries face substantial challenges bridging from a list of services in a package to the elements needed to get services to people. The failure to incorporate delivery considerations already at the prioritisation and design stage can result in packages that undermine the goals that countries have for service delivery. Based on a range of country experiences, we discuss specific choices about package structure and content and summarise some ideas on how to build more implementable packages of services for UHC, arguing that well-designed packages can support countries to bridge effectively from intent to implementation.

Keywords: Health economics; Health services research; Health systems; Public Health.

Figure 1

Example of services and platforms from the WHO Universal Health Coverage Service Package Delivery and Implementation (SPDI) tool (access at UHCC.who.int). TB, Tuberculosis.

Figure 2

Example from the Islamic Republic of Afghanistan Ministry of Public Health (MoPH) Integrated Package of Essential Health Services (IPEHS) 2019.

Figure 3

Example from the essential package of health services, Somalia, 2020. *Additional services are the interventions that, added to the services in the core package, constitute the extended package, to be progresively implemented when more resources become available. UHC, universal health coverage; NTD, Neglected tropical diseases; HBD is high-burden disease; DCP-H, Disease Control Priorities highest priority package.

Figure 4

Example of services for a high-burden disease from the WHO Universal Health Coverage Service Package Delivery and Implementation (SPDI) tool (access at UHCC.who.int). NTD, Neglected tropical diseases; HBD, high-burden disease.

Figure 5

Number of cost-effectiveness analyses versus disease burden for selected diseases: (A) Latin American and the Caribbean and (B) North Africa and the Middle East. Adapted from Do et al. DALY, Disability-adjusted life years.