Investing in a UHC Essential Package of Health Services in Pakistan

Pakistan is the first country in the world to invest in a national UHC Essential Package of Health Services (UHC EPHS) based on the DCP3 Universal Health Coverage packages. The development and implementation of the EPHS is an important step towards achieving the goal of Universal Health Coverage by 2030. Assuming steady-state implementation, the Pakistan EPHS is estimated to avert an additional 46.7 million disability-adjusted life years (DALYs) over a period of five years, and reduce stunting by 10%, under-five mortality by 30%, neonatal mortality by 33%, and maternal mortality by 35%*.

The process of developing the UHC EPHS was locally led by the Ministry of National Health Services, Regulations & Coordination, with key support from the DCP3 Secretariat at the London School of Hygiene and Tropical Medicine, Aga Khan University, World Bank, World Health Organization, UNICEF, and other key partners. Out of the 218 health interventions proposed by the DCP3 Essential UHC package, 117 were selected across five delivery platforms (community, health centre, first level hospital, tertiary care, and population based) as having the highest impact on DALYs averted in the context of Pakistan; 88 of them have been approved for immediate implementation at the district level (community, health centre, and first level hospital platforms). Over 48% of the interventions target reproductive, maternal, neonatal, child and adolescent health, 15% non-communicable diseases, 13% infectious diseases, and 24% health services.

Large investments of an additional PKR 179 billion ($1.1 bn) per year will be required to implement the EPHS package of 117 interventions. This investment would put Pakistan on track to achieve key targets of the Sustainable Development Goal 3. In particular, it would help achieve the maternal mortality target of 70 maternal deaths per 100,000 livebirths by 2030, and under-five and neonatal mortality rates of 25 child deaths and 12 neonatal deaths per 1,000 livebirths in some provinces.

Until Pakistan’s fiscal space is expanded to allow full implementation of the EPHS, the National Advisory Committee endorsed a more limited national package of 88 high-impact interventions, at per capita cost of $12.98. The package is estimated to avert 40 million DALYs in five years, and is being used as a model for provincial adaptation and implementation. Four district-level provincial packages have been developed, which allowed provinces to further prioritise and adjust costs to consider local prices and capacity. The implementation cost per capita of the four provincial packages range from US$13.5 in Punjab to $21.5 in Balochistan.

Following a number of deliberative processes, Pakistan is implementing the first phase of the UHC EPHS, focusing initially on 12 districts. The second phase is planned to start in January 2023, and will cover up to 40 districts. Read more about Pakistan’s EPHS here.

*Source: draft report of the Pakistan Investment Case report 2020