Health benefit packages: moving from aspiration to action for improved access to quality SRHR through UHC reforms.

Healthcare Priority-Setting in Essential Health Packages for Sexual Reproductive Health: Going Beyond the Commonly Prioritised Services

“…A review of progress on the inclusion of SRH services in EHPs in Africa using the Guttmacher-Lancet commission's proposed package, found services around maternal health, HIV and STIs were included in EHPs. However, services relating to gender-based violence, comprehensive sexuality education and infertility were omitted or not captured completely, and inclusion of safe abortion services varied depending on the legal and social environment (Pillay et al, 2020;SIDA, 2019). This evidence has further been reinforced by Ravindran and Govender who examined EHPs across twenty-six LMICs EHPs.…”

“…Evidence on SRH services in EHPs in low to middle-income countries (LMICs) indicates a systematic exclusion of some selected key interventions (Love-Koh et al, 2020;Ravindran & Govender, 2020). Within the category of SRH services, pregnancy-related care, family planning and HIV/AIDS have been prioritized alongside other disease program areas in EHPs (Huchko et al, 2015;Pillay et al, 2020). However, gender-based violence, safe abortion, reproductive cancers, infertility services, comprehensive sexuality education, sexuality services, and STI's other than HIV, have received limited prioritization in EHPs (Gilby et al, 2021;Lim et al, 2020;Starrs et al, 2018).…”

“Imagining the world anew”: a transformative, rights-based agenda for UHC and SRHR in 2021 and beyond

“…8,9 The constraints imposed by restrictive legal and social environments may be mitigated, and comprehensive SRH services included in EHSPs or HBPs, as Pillay et al recommend, through " … fair and transparent priority setting process [es] [which] consider the best available evidence, burden of disease, and cost effectiveness … underpinned by ethical values such as equity, gender equality and right to health". 8 However, this integral recommendation is challenging to put into practice. Successful follow-through first and foremost requires political will and greater investment in strengthening institutions and capacities of those voices who are often sidelined in policy and technical fora.…”

“…The extent of their exclusion is very much dependent on prevailing legal and social environments. 8 , 9 …”

“…Another key lesson that emerges in the themed issue is that, while the inclusion of comprehensive SRH services in HBPs is necessary, and investing in the health system to strengthen its capacity to ensure services are in place to deliver the package is equally critical, 8 , 11 these may not be sufficient for ensuring translation of services into accessible and quality services that meet the needs of those at the tail end of society’s pecking order. 12 If anything, the challenge for quality of care persists even in contexts in which considerable progress towards UHC has been made.…”