The Use of Evidence-Informed Deliberative Processes for Designing the Essential Package of Health Services in Pakistan

Background  The Disease Control Priorities ۳ (DCP۳) project provides long-term support to Pakistan in the development and implementation of its universal health coverage essential package of health services (UHC-EPHS). This paper reports on the priority setting process used in the design of the EPHS during the period ۲۰۱۹-۲۰۲۰, employing the framework of evidence-informed deliberative processes (EDPs), a tool for priority setting with the explicit aim of optimising the legitimacy of decision-making in the development of health benefit packages.Methods  We planned the six steps of the framework during two workshops in the Netherlands with participants from all DCP۳ Pakistan partners (October ۲۰۱۹ and February ۲۰۲۰), who implemented these at the country level in Pakistan in ۲۰۱۹ and ۲۰۲۰. Following implementation, we conducted a semi-structured online survey to collect the views of participants in the UHC benefit package design about the prioritisation process.Results  The key steps in the EDP framework were the installation of advisory committees (involving more than ۱۵۰ members in several Technical Working Groups [TWGs] and a National Advisory Committee [NAC]), definition of decision criteria (effectiveness, cost-effectiveness, avoidable burden of disease, equity, financial risk protection, budget impact, socio-economic impact and feasibility), selection of interventions for evaluation (a total of ۱۷۰), and assessment and appraisal (across the three dimensions of the UHC cube) of these interventions. Survey respondents were generallypositive across several aspects of the priority setting process.Conclusion  Despite several challenges, including a partial disruption because of the COVID-۱۹ pandemic, implementation of the priority setting process may have improved the legitimacy of decision-making by involving stakeholders through participation with deliberation, and being evidence-informed and transparent. Important lessons were learned that can be beneficial for other countries designing their own health benefit package such as on the options and limitations of broad stakeholder involvement.

Keywords:

Pakistan , Universal Health Coverage , Benefit Package , Priority Setting , Evidence-Informed Deliberative Process