Building implementable packages for universal health coverage

• Published in: BMJ global health Vol. 8; no. Suppl 1; p. e010807
• Main Authors: Reynolds, Teri, Wilkinson, Thomas, Bertram, Melanie Y, Jowett, Matthew, Baltussen, Rob, Mataria, Awad, Feroz, Ferozuddin, Jama, Mohamed
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 01.05.2023; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Design; Health economics; Health Services; Health services research; Health systems; Humans; National health insurance; Package design; Practice; Public Health; Universal Health Insurance; Health systems; Public Health; Health economics; Health services research
• ISSN: 2059-7908; 2059-7908
• DOI: 10.1136/bmjgh-2022-010807

Since no country or health system can provide every possible health service to everyone who might benefit, the prioritisation of a defined subset of services for universal availability is intrinsic to universal health coverage (UHC). Creating a package of priority services for UHC, however, does not in itself benefit a population—packages have impact only through implementation. There are inherent tensions between the way services are formulated to facilitate criteria-driven prioritisation and the formulations that facilitate implementation, and service delivery considerations are rarely well incorporated into package development. Countries face substantial challenges bridging from a list of services in a package to the elements needed to get services to people. The failure to incorporate delivery considerations already at the prioritisation and design stage can result in packages that undermine the goals that countries have for service delivery. Based on a range of country experiences, we discuss specific choices about package structure and content and summarise some ideas on how to build more implementable packages of services for UHC, arguing that well-designed packages can support countries to bridge effectively from intent to implementation.