HBP design: principles, practice and experience

  • Ochalek, J. M. (Organiser)
  • Amanda Glassman (Invited speaker)
  • Gerald Manthalu (Invited speaker)
  • Joshua Salomon (Invited speaker)

Activity: Participating in or organising an eventConference


In many low- and middle-income countries (LMICs), particularly those largely dependent upon overseas development aid, a major tool for resource
allocation decisions over the choice of health care interventions continues to be the use of health benefits packages (HBPs). These are used as central
components of national health plans, to which both Governments and their development partners providing additional funding can commit, and they
detail which interventions are to be prioritized from the limited resources available.

The design of HBPs draws heavily on the tools of economic evaluation (especially cost-effectiveness analysis) but, remarkably given their prominence
within the health care systems of many countries, there is very little academic literature to guide their development. HBPs offer the promise of gearing a
country’s limited health system resources towards activities likely to generate greatest gains in beneficial outcomes (e.g. population health improvement).
However, there is a sense they have frequently failed to achieve their stated aims and the evidence for their improving resource allocation in countries is
weak. For instance, in Malawi – by some measures the world’s poorest nation – a health benefits package (termed the Essential Health Package; EHP) has
been developed with the intention of it being a central feature of national health plans since 2004. However, its design (it currently costs $65 per person,
per year) does not reflect the reality of the limited resources available ($35 per person, per year for all health care); fundamental weaknesses in the health
system prevail and coverage gaps for even the most cost-effective interventions remain very high.

To appropriately inform policy, HBPs need to be designed in ways that suitably reflect the realities and challenges faced within real-world health systems
and gain the political traction to ensure their implementation. Particular challenges relate to: how HBPs should be used for extended periods of time (for
example, in Malawi, this is typically within 5 year health plans) given situations may change rapidly; how HBPs can inform the dual challenges of both
generating and allocating resources; limited information; how to exclude interventions that do not appear cost-effective; how resource allocation
decisions should be undertaken in systems that often have fractured funding arrangements with various partners funding different components of health
care delivery; and in weak systems that too often fail in delivering health care to those who most need it.
This session aims to bring together researchers and policymakers at the forefront at developing methods for HBP design and implementing these within
countries. Amanda Glassman, chief operating officer and senior fellow at the Center for Global Development, is co-editor of the forthcoming book What’s
In, What’s Out: Designing a Health Benefits Plan for Universal Health Coverage, a wide-ranging collection of the current state of research on this topic. As
chair and presenter she will bring a breadth of knowledge around resource allocation and financing mechanisms in health care systems globally, and
encourage participation from the range of audience members beyond those with experience in countries and specific themes discussed in the session

Jessica Ochalek, a research fellow in the Centre for Health Economics at the University of York, brings experience in the design of a novel framework for
the revision of Malawi’s EHP, which offers the potential to be a blueprint for other countries. Gerald Manthalu, Deputy Director of Planning in the Ministry
of Health, Malawi, has been a leader with others in the Ministry driving the incorporation of the EHP into the Health Sector Strategic Plan, and can speak to the process elements and political challenges of utilizing the framework in practice. Dr. Josh Salomon, professor of global health in the Department of
Global Health and Population at the Harvard School of Public Health, has a range of expertise in disease modelling, epidemiology and economics applied
to priority setting in LMICs, particularly HBP design in Mexico.

The aim in this session is to encourage discussion based on experiences in designing and implementing health benefits packages. Following the abstract
presentations, Dr. Salomon will begin the discussion by summarizing several examples of attempts to develop health benefits packages, and reflecting on
some general lessons that may be drawn from these experiences. He will discuss the relevance and limitations of decision analytic approaches based on
cost-effectiveness, in light of other considerations such as affordability and aspects of delivery and implementation. Following these brief remarks, the
audience will be invited to engage in an organized discussion, moderated by the session chair.
Period8 Jul 201711 Jul 2017
Event typeOther
LocationBoston, United States, MassachusettsShow on map
Degree of RecognitionInternational