Revision of the Ethiopian Essential Health Service Package: An Explication of the Process and Methods Used

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.

Is Universal Health Coverage Affordable? Estimated Costs and Fiscal Space Analysis for the Ethiopian Essential Health Services Package

“…24,25 The service package remained the same across scenarios, and the difference in costs between scenarios was driven by target coverage to be reached by 2030. 3,4 We developed three cost projection scenarios by varying the target coverages of the interventions and classifying them as low, medium, and high. In the low scenario, we assumed a 30% target coverage for most NCD interventions and an 80% coverage for most RMNCH and infectious disease interventions.…”

“…In terms of priority, 58% were categorized as high priority, 21% as medium priority, and 21% as low priority interventions. , 3,4 Estimating the resources required for the implementation of the EHSP is vital in examining its feasibility and affordability. 2 Some of the critical questions for implementers of the EHSP are: What are the total financial resources needed to scale up the EHSP?…”

Contextualization of cost-effectiveness evidence from literature for 382 health interventions for the Ethiopian essential health services package revision

“…The detailed steps used to select the interventions are presented elsewhere [ 6 , 22 ]. From the total of 1018 unique interventions that were considered in the Ethiopian EHSP, the cost-effectiveness ratio was calculated using primarily the WHO-CHOICE GCEA approach for 144 interventions [ 23 ].…”

“…From the total of 1018 unique interventions that were considered in the Ethiopian EHSP, the cost-effectiveness ratio was calculated using primarily the WHO-CHOICE GCEA approach for 144 interventions [ 23 ]. Additionally, we collected cost-effectiveness evidence for 771 interventions from the literature, excluding 64 multisector nutrition interventions and 39 emergency and critical care interventions [ 22 ]. A detailed breakdown of the number of interventions by evidence synthesis method is presented in Table 1 .…”

The journey to UHC: how well are vertical programmes integrated in the health benefits package? A scoping review

“…In a recent review of Ethiopia's Essential Health Services Package, the prioritisation process started from consideration of 1749 interventions using the WHO intervention compendium and the DCP3. 37 It could be that some of the earlier HBPs adopted a narrower focus for this reason.…”