Abstract
ABSTRACT To make progress toward universal health coverage, countries should define the type and mix of health services that respond to their populations’ needs. Ethiopia revised its essential health services package (EHSP) in 2019. This paper describes the process, methodology and key features of the new EHSP. A total of 35 consultative workshops were convened with experts and the public to define the scope of the revision, develop a list of health interventions, agree on the prioritization criteria, gather evidence and compare health interventions. Seven prioritization criteria were employed: disease burden, cost effectiveness, equity, financial risk protection, budget impact, public acceptability and political acceptability. In the first phase, 1,749 interventions were identified, including existing and new interventions, which were regrouped and reorganized to identify 1,442 interventions as relevant. The second phase removed interventions that did not match the burden of disease or were not relevant in the Ethiopian setting, reducing the number of interventions to 1,018. These were evaluated further and ranked by the other criteria. Finally, 594 interventions were classified as high priority (58%), 213 as medium priorities (21%) and 211 as low priority interventions (21%). The current policy is to provide 570 interventions (56%) free of charge while guaranteeing the availability of the remaining services with cost-sharing (38%) and cost-recovery (6%) mechanisms in place. In conclusion, the revision of Ethiopia’s EHSP followed a participatory, inclusive and evidence-based prioritization process. The interventions included in the EHSP were comprehensive and were assigned to health care delivery platforms and linked to financing mechanisms.
Highlights
In 2015, all United Nations Member States adopted the Sustainable Development Goals (SDGs) to guide policies and actions across all sectors that are impor tant to development
The World Health Organization (WHO) defines uni versal health coverage (UHC) as a condition in which “all people and communities can use the promotive, pre ventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while ensuring that the use of these services does not expose the user to financial hardship.”[2]. To make tangible progress toward UHC, countries should clearly define the essential health services that they can deliver to their population within the available budget and without financial risk whilst clearly defining how they plan to scale up coverage, reduce direct costs and expand the range of health interven tions in the future.[3,4,5,6,7]
Recognizing the importance of clearly defined health intervention priorities to achieving UHC, the Ministry of Health (MoH) of Ethiopia revised the essential health services package (EHSP) from May 2018 through November 2019.19 This paper describes the revision process, the key methodology, the involvement of stakeholders and experts and the most important features of the new Ethiopian EHSP
Summary
In 2015, all United Nations Member States adopted the Sustainable Development Goals (SDGs) to guide policies and actions across all sectors that are impor tant to development. Con sidered were the criteria for the prioritization of health services recommended by WHO’s Consultative Group on Equity and Universal Health Coverage, including maximizing the total health gains for a given investment, giving priority to health services that target or benefit the less fortunate and providing financial risk protection, to the poor.[13] Broadly, such a prioritization approach is based on three elements: data, dialogue and decision.[27] Ten consultations and deliberative meetings were held on the proposed criteria with global and local experts, public representatives and professional associations. In the revi sion of the Ethiopian EHSP, the equity criterion was applied in a way that gives high priority for health interventions targeting diseases, conditions or risk factors which mainly affects the worse off. The final decision was taken by the executive committee (EC) of the MoH, which is the higher-level decisionmaking body in the sector
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