Redefining Ethiopia's Essential Healthcare Package on the Path Towards Universal Health Coverage: The What and How

Authors: Addis Woldemariam, Mahlet Kifle Habtemariam, Samuel Darge, Mengistu Bekele, Feven Girma, Stéphane Verguet, Ole Norheim

Ethiopia has come a long way in improving the health of the population over the last 20 years starting off from a very low baseline. To achieve these gains, the health sector has developed and implemented well-tailored series of strategic plans, leveraged the potential of other government sectors and development partners and adopted and introduced innovative service delivery strategies particularly for the essential healthcare services packages in 2005. With the transition from MDGs to a more ambitious SDG for health, the sector needs to shift gear to increase the scope of package of services, maximize efficiency and effectiveness of delivery platforms and re-examine the financing mechanisms. Revising, expanding and financing the essential healthcare package is arguably the most important step in this process. The existing package, defined in 2005, needs updating to reflect actual expansions that have happened already, including the changing demography and epidemiology with a relatively aging population and rise of non-communicable diseases (NCDs) and injuries, technological advances, economic growth and increased public expectations in both rural and urban areas of the country. 
With the process established to support health priority setting in Ethiopia, including assessing the burden of disease, evidence of intervention effectiveness, and cost-effectiveness of selected health sector interventions, packages, and platforms, Disease Control Priorities-Ethiopia (DCPE) will help to provide evidence for scaling up health interventions, packages and policies toward UHC. These economic evaluations will highlight the health and economic benefits and equity impact of moving towards UHC for Ethiopia. It will identify critical trade-offs at stake in such highly resource-constrained setting (e.g. equity vs. efficiency) using all axes of universal health coverage (UHC) including financial risk protection (FRP).
This paper synthesizes evidence and comes up with recommendations on how to set priorities to redefine the Essential Healthcare Package (EHCP) on the path towards UHC. To achieve UHC, countries must advance along three important dimensions: expanding priority services, including more beneficiaries, and FRP including reducing out-of-pocket payments. Balancing between all these three dimensions with due emphasis on quality and equity of the health services provided is essential to achieve UHC in Ethiopia. In this paper, we first discuss extensively the background in which the essential health services package in Ethiopia sits in, and second we propose some guiding principles for the revision of the essential package in Ethiopia, taking into account the three criteria of (i) value for money, (ii) equity and fairness, and (iii) financial risk protection.

Woldemariam, A.T., M. Kifle, S. Darge, M. Bekele, F. Girma, and others. 2017. "Redefining Ethiopia's Essential Healthcare Package on the Path Towards Universal Health Coverage: The What and How." DCP3 Working Paper Series. Working Paper no. 18.