To make progress towards UHC, countries should prioritize and clearly define the type and mix of health services that should be provided in response to population needs. To ensure that the package can be funded and provided as planned, the resources needed to implement the package should be estimated and compared to available funding. In Ethiopia, an evidence based process was followed to develop the essential health service package (EHSP), using explicit criteria. The analysis resulted in a list of over 1,000 interventions. A range of partners worked with the Ministry of Health to support evidence generation that is relevant for the local context, and to estimate the financial resources required to implement the Ethiopian EHSP from 2020–2030, to assess the affordability and fiscal sustainability of the package.
WHO conducted workshops and trainings to support the process. Dr Hailu, Postdoctoral researcher at Bergen Center for Ethics and Priority Setting (BCEPS) and Senior Advisor at Health Economics and Financial Analysis Team at Ministry of Health of Ethiopia, comments on the process as follows - "Starting from the preparation of the roadmap until final validation of the report, the role of the World Health Organization (WHO) was enormous in terms of guiding the analysis framework, identifying health interventions, critically evaluating and appraising intervention, and estimating budget impact. And the partnership between WHO and Bergen Center for Ethics and Priority Setting (BCEPS) is quite exemplary and that is what we want to see more in global health"
Below are links to two publications that summarize the experience:
This paper describes the process and methodology used in Ethiopia to revise the essential health services package (EHSP) in 2019. Seven prioritization criteria were employed to select relevant interventions: disease burden, cost effectiveness, equity, financial risk protection, budget impact, public acceptability and political acceptability. An initial set of 1749 interventions were identified, evaluated, and reduced to a list of 1018 interventions, which were then further classified into groups of high, medium and low priority interventions.
Is Universal Health Coverage Affordable? Estimated Costs and Fiscal Space Analysis for the Ethiopian Essential Health Services Package
An analysis by Dr Hailu et al used the OneHealth Tool to estimate the financial resources required to implement the Ethiopian EHSP from 2020 to 2030. Costs were compared to the projected available fiscal space for health, taking into account likely scenarios for the diverse effects of COVID-19 on the economy and health needs. The study highlights potential financing gaps and points to the need for reliable mechanisms to increase the budget allocated to health from the government and other sources, to improve overall efficiency and reduce costs.