DCP3 Country Translation Project

Achievements in Pakistan

Pakistan is the first country in the world to align its UHC Benefit Package with the DCP3 recommended high impact interventions. Read more about the process of developing and implementing a national Essential Package of Health Services and other achievements in Pakistan here.

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DCP3 Country Translation Project

The Disease Control Priorities 3 (DCP3) Country Translation project is a multi-year initiative designed to respond to the increasing needs of low and middle-income countries (LMICs) for technical guidance and support in priority setting and developing universal health coverage (UHC) essential packages of health services (EPHS). It works with countries to build local capacity in the areas of priority setting and evidence-based decision making on resource allocation and support the development of EPHS that espouse key principles of UHC and are implementable within the available government resource envelope. 

In 2018, with the support of the Bill & Melinda Gates Foundation, the DCP3 Secretariat at the London School of Hygiene & Tropical Medicine used the evidence and model UHC packages developed through DCP3 to further achieve the following objectives:

  1. Increase the use of DCP3 evidence and resources in LMICs through piloting in selected countries to develop UHC EPHS;
  2. Improve the global evidence and resources to support best practices in priority setting and development of UHC EPHS;
  3. Strengthen the capacity of national decision makers and institutions in LMICs to conduct priority setting and develop and sustain UHC EPHS;
  4. Develop a fast-track sub-package of highest priority basic health services for use in polio high-risk areas.

The strategic goal of this project is to enable decision makers in LMICs in allocating often tightly constrained budgets so that health system objectives are maximally achieved, in the pursuit of UHC.

DCP3 is the 3rd edition of the Disease Control Priorities series launched in 2017, which aims to provide an up-to-date review of the efficacy, effectiveness, and cost-effectiveness of priority health interventions with the goal of influencing program design and resource allocation at country level. The findings of DCP3 have been published in 9 volumes and present 21 Packages of Health Interventions for achieving UHC. DCP3 builds on the work started in 1993, when the World Bank published its World Development Report focusing on ‘Disease Control Priorities in Developing Countries’ (DCP1) with the objective of systematically assessing the cost-effectiveness of interventions addressing major causes of disease burden to support resource allocation decision making, particularly in resource constrained settings. In 2006, the second edition (DCP2) was released, highlighting cost-effective interventions based on evidence review and health systems analysis and providing policy recommendations.
 
The DCP products have undergone a comprehensive independent evaluation which assessed the extent to which they are relevant and applicable to low- and middle-income countries and how much they add to existing evidence and information sources. The evaluation saw DCP3 as a credible and additive source of evidence and considered the DCP3’s model packages to have a unique value for decision making, especially when translated to local contexts. DCP3 was deemed to be “filling a gap in technical guidance not currently met”.  The DCP3-UHC Country Translation project is now implementing and refining the process of using the DCP3 evidence and packages for LMICs. 

Achieving the ambitious goal of UHC by 2030 requires greater investments in expanding population coverage, providing access to high-quality health services and protecting against financial risk. Shortfalls in access, quality, efficiency, and equity in health care have been documented extensively throughout the world, and DCP3 is helping low- and middle-income countries accelerate progress towards UHC by providing them with guidance on priority health interventions for UHC in the form of a set of model UHC Packages.

The packages include an Essential UHC Package (EUHC), a high priority package (HPP), and an intersectoral package, which could be adapted to reflect country-specific needs, health system capacities, financing structures, available resources and other local circumstances.

The Essential UHC Package (EUHC) has 218 health interventions and is designed for lower-middle income countries. Assuming steady-state implementation by 2030, EUHC has the potential to reduce premature deaths by an estimated 4.2 million per year in lower-middle-income countries.

The highest-priority package (HPP) is composed of 108 interventions and is designed for countries in which the fiscal space for health does not allow the implementation of the full EUHC package.

The package of intersectoral policies consists of 71 interventions to be implemented in partnership with sectors other than health. Out of 71 policies, 29 are core priorities for early implementation. These intersectoral policies that promote or protect health and when implemented as part of a coherent plan, can constitute a whole-of-government approach to health. The package covers fiscal policies, regulatory policies, built infrastructure interventions, and health promotion and information interventions.

The DCP3 findings in its 9 volumes and the UHC packages support countries in their efforts to achieve full access to essential health care. DCP3 packages can be adapted to reflect local disease burden, health care needs, national financing structures and local evidence on costs.

 

The DCP3-UHC Country Translation work focuses primarily on four areas:

  1. Increasing the use of DCP3 evidence and resources in LMICs
    DCP3 is providing comprehensive technical support to two pilot countries in priority setting and development of UHC essential packages of health services EPHS). In the first pilot country, Pakistan, the Ministry of National Health Services Regulations and Coordination (MNHSR&C) and the DCP3 Secretariat developed a national EPHS, and work is underway to begin a phased implementation of the EPHS at the district level. In the second country, Liberia, DCP3 is collaborating with the Ministry of Health and development partners in updating the existing Essential Package of Health Services. 
  1. Improving the global evidence and resources to support best practices in priority setting
    DCP3 is providing technical guidance to LMICs in priority setting for UHC and developing or revising EPHS. This work brings together a broad range of partners, including the WHO, the World Bank, USAID, and others. Drawing on the experience and lessons learned from Pakistan and other countries that used DCP3 evidence in setting up their packages, the DCP3 Country Translation Secretariat is working with a network of professionals to develop a set of publications which will serve as a guidance for other low- and lower-middle-income countries in developing feasible and implementable UHC EPHS.
  2. Strengthening the capacity of national decision makers and institutions
    DCP3 is strengthening the capacity of national decision makers and institutions in Pakistan and Liberia to conduct priority setting and develop and sustain essential packages of health services. This is an essential component of the project, as ensuring capacity within pilot countries is integral to the sustainability of the EPHS.
  1. Developing a fast-tack polio sub-package
    DCP3 developed a sub-package of highest priority basic health services for polio high-risk areas in Pakistan, where lack of such services is driving community resistance to vaccination and is impeding the global eradication of polio. The sub-package is responding to the immediate health needs of the communities in these high-risk polio areas.  

What has been achieved?

The DCP3 Country Translation project has successfully delivered on several key aspects of the project. The project has been piloted in Pakistan, where the Ministry of National Health Services, Regulations and Coordination (MNHSR&C) in collaboration with the DCP3 Secretariat and other partners developed an Essential Package of Health Services containing 117 health interventions, out of which 88 interventions are for immediate implementation. Four provincial packages were also developed through a process similar to the design of the federal package. The implementation of the package will follow a phased approach, with implementation starting in 12 districts before being scaled up to 40 districts.  

The project has also completed work on objective four, which included the development of a fast-track sub-package of highest priority basic health services in high-risk polio areas. The sub-package includes both high priority health and basic water, sanitation, and hygiene services and has been implemented in 40 high risk polio-endemic councils in Pakistan.

In Liberia, the Ministry of Health and DCP3 worked with partners to update the existing EPHS through evidence-informed processes, using the DCP3 evidence and model UHC packages. The work included evidence collection, fiscal space analysis, mapping of existing services, training on resource optimisation analyses to inform health intervention prioritisation, setting decision criteria for the prioritisation of interventions, conducting a prioritisation workshop, and developing and discussing funding scenarios. A UHC package of health services, focused on primary health care, is being adopted for implementation.

In both countries, the project has also strengthened the capacity and skills of staff in the Ministry of Health and other national partners, in public health leadership, priority setting, policy decision making, and in designing the national health benefits package. This has been achieved through training, technical meetings and working group sessions, regular consultations and advice from DCP3 staff, and hands-on practice.

What we will be doing next?

DCP3 will continue providing comprehensive technical support to MoH and relevant local partners to ensure sustainability of the process and implementation of the UHC Essential Packages of Health Services. A strategy is also being developed to reinforce technical support to low and middle-income countries in priority setting and in the development and implementation of affordable UHC packages of health services.  

Latest News

On 25-27 April 2022, the DCP3 team conducted an applied training on Health Interventions and Prioritisation Tool (HIPtool) in Buchanan, Liberia. The three-day workshop was attended by 12 senior technical personnel from the Ministry of Health of Liberia and partner organisations. The training...
On 30 March 2022, the DCP3 Review network of experts gathered in London to review lessons learned from six countries in developing Universal Health Coverage (UHC) Essential Packages of Health Services (EPHS). The meeting is part of the DCP3 Country Translation global guidance initiative, which...
On 28-29 March, 2022, the Ministry of Health of Liberia and DCP3 organized a workshop to assess the existing health services in Liberia against the DCP3 recommended essential Universal Health Coverage package. The workshop is part of the Ministry’s collaboration with the DCP3 Country Translation...

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