The Disease Control Priorities 3 (DCP3) UHC Country Translation project is a multi-year project designed to respond to the increasing need of low and middle-income countries (LMICs) for technical guidance and support in priority setting and in accelerating progress towards Universal Health Coverage (UHC). The project is supported by the Bill & Melinda Gates Foundation and aims to enable decision makers in LMICs in allocating often tightly constrained budgets so that health system objectives are maximally achieved.
The DCP3 UHC Country Translation project has been piloted in Pakistan, which became the first country to translate the DCP3 evidence into a national Essential Package of Health Services or UHC Health Benefit package. An Essential Package of Health Services (EPHS) containing 107 health interventions was developed by the Ministry of National Health Services, Regulations and Coordination (MoNHSR&C) in collaboration with the DCP3 Secretariat at LSHTM and a number of other national and international partners.
The original DCP3 project concluded in 2018, producing 9 volumes of evidence and a 21 packages of Health Interventions for achieving UHC. For more information on the DCP3 research including access to the 9 volumes and more in depth information on DCP3 Country Translation implementation, please follow link below.
Based on the evidence from the 3rd edition of the Disease Control Priorities (DCP3) series launched in 2017, the Disease Control Priorities 3 (DCP3) UHC Country Translation project aims to:
- Increase the use of DCP3 evidence and resources in LMICs through the development of UHC Essential Packages of Health Services (EPHS) or Health Benefit Packages (HBPs) in pilot countries
- Improve the global evidence and resources to support best practices in priority setting and development of UHC Health Benefit Packages
- Strengthening the capacity of national decision makers and institutions in LMICs to conduct priority setting and develop and sustain UHC Health Benefit Packages
- Developing a fast-track sub-package of highest priority basic health services for use in polio high-risk areas.
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 settings¹. 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 findings of the third edition (DCP3) 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. External evaluations found that the DCP3 packages have a unique value for decision making, especially when translated to local contexts, and that they fill “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.
For more in depth information on the DCP3 Country Translation work, including information on the UHC Health Benefit Packages, current work, achievements and further information for interested pilot countries please head to our main website at: http://dcp-3.org/translation.
The DCP3-UHC Country Translation work focuses on four areas:
- Increasing the use of DCP3 evidence and resources in LMICs
DCP3 DCP3 is providing comprehensive technical support to two pilot countries in priority setting and development of UHC benefit packages. In the first pilot country, Pakistan, the Ministry of National Health Services Regulations and Coordination (MoNHSRC) and DCP3 Secretariat developed a national EPHS, and work is underway to begin a phased implementation process of the UHC EPHS at the district level. Additional countries will be invited to join the project in the first and second quarter of 2021.
- Improving the global evidence and resources to support best practices in priority setting
DCP3 is providing technical guidance to LMICs in setting and revising health benefit packages. This work will bring together a broad range of partners, including the WHO, who will be the lead agency responsible for providing technical support to countries on implementing DCP3-based economic evaluations and priority setting for UHC. The guidance will draw on lessons learned from Pakistan and other partners working on priority setting and costing of the implementation of UHC.
- Strengthening the capacity of national decision makers and institutions
DCP3 is strengthening the capacity of national decision makers and institutions in the pilot countries to conduct priority setting and develop and sustain health benefit packages (HBPs). This is an essential component of the project, due to the nature of HBP being a living document that will evolve and develop as countries progress towards UHC. Ensuring capacity within pilot countries is integral to the sustainability of HBP.
- Developing a fast-tack polio sub-package
DCP3 is developing a fast-track sub package of highest priority basic health services in polio high-risk areas, where lack of such services is contributing to community resistance to vaccination and impeding the global eradication of polio. This area of work responds to the needs in the first pilot country Pakistan, where community resistance to vaccination develops when repeated door to door polio campaigns are not accompanied with similar interest in responding to the community health needs which are considered by them more essential than the polio vaccine.
For more information head to: http://dcp-3.org/translation.
In 2018, the DCP3 Secretariat, the Ministry of National Health Services, Regulations and Coordination (MoNHSR&C), and WHO established a collaboration to develop a national Essential Package of Health Services (EPHS) based on the DCP3 evidence and guided by its model essential UHC package. Following the decision of the Inter-ministerial Health & Population Forum, Pakistan became the first country to translate the DCP3 evidence into a national Essential Package of Health Services or UHC Health Benefit package. The process of developing and setting the EPHS was country-owned and executed, and followed a number of steps. In 2020, a UHC EPHS for Pakistan containing 107 interventions was approved by the Steering Committee and the Inter-ministerial Health & Population Forum. The package is context appropriate, affordable and meets the most pressing health needs of the Pakistani population. It aims to address the current disparities and inequalities in access to health care, and establish and clarify health priorities and direct resource allocation in Pakistan. The EPHS became a cornerstone of the 12th Five Year Plan (2018-2023) Health chapter and the National Action Plan (2019-2023) for Pakistan's health sector. The implementation process of the UHC EPHS will follow a phased approach, and a decision was taken to implement the EPHS in Islamabad and pilot districts in four provinces.
Designing and costing the UHC Essential Package of Health Services, together with capacity building in the Ministry of Health and external institutions, provided valuable learning experiences moving forward. It is hoped that Pakistan’s experience in developing and implementing a national UHC EPHS is harnessed to help other low- and middle-income countries accelerate progress towards UHC by adapting the DCP3 packages to their country context.
In addition to coordinating the implementation of the EPHS, the DCP3 Secretariat is supporting national partners in:
- conducting sensitization, planning and localization workshops in the Khyber Pakhtunkhwa and Balochistan provinces, including technical support to provincial Departments of Health in setting priorities and adapting the UHC benefit package;
- developing a Monitoring & Evaluation framework in collaboration with the University of Manitoba and the Health Services Academy, including technical expertise for the development of implementation plans;
- conducting a review of the experience and lessons learned in developing the national EPHS, and sharing the experience through a series of publications, media, and high-level meetings;
- finalizing a multisectoral analysis on the current status of the DCP3 core intersectoral policies and assessing priority needs in Pakistan, including developing a national package for high level discussion with government sectors and other partners;
- engaging with the World Bank in the development of a health financing strategy for Pakistan, including technical support in reviewing available data on fiscal space and health financing;
- developing a sub-package of health and basic water, sanitation, and hygiene services for implementation in 40 high-risk polio-endemic union councils, including supporting pilot implementation at the provincial level.
For more information on the Pakistan experience, including relevant resources please head to http://dcp-3.org/translation/pakistan.
Islamabad, 11 March 2021 — Pakistan is the first country in the world to develop an Essential Package of Health Services based on DCP3 model interventions. On 23 November 2020, the National Advisory Committee endorsed a package of 107 UHC EPHS interventions for implementation at the district level, and a more limited package of 88 interventions for implementation in selected provinces.
In order to promote a more effective implementation of the district and provincial UHC EPHS, the Ministry of National Health Services, Regulation, and Coordination (MoNHSR&C), DCP3 Secretariat, Health Services Academy and the University of Manitoba have partnered to develop a national Monitoring & Evaluation (M&E) framework/package that can be adapted for use at provincial and district levels.
On 11 March 2021, the partners organized a national consultation on monitoring progress towards UHC held in Islamabad, Pakistan. The meeting brought together DCP3 advisors and UHC focal points from the MoNHSR&C and the provincial health departments. The consultation aimed to review global UHC monitoring recommendations and lessons learnt, propose indicators and methodologies that can be adapted by provinces and regions, identify data gaps, and propose a set of district level indicators to assess capacity and readiness to implement the EPHS. The inputs from the consultation will be used to finalize the M&E framework.
Islamabad, 24 February 2021 — On 23 February, the Ministry of National Health Services, Regulations and Coordination (MoNHSR&C), in collaboration with the DCP3 Secretariat at the London School of Hygiene and Tropical Medicine and World Health Organization held a national workshop on Intersectoral Policies for Health in Islamabad, Pakistan. The workshop brought together over 30 delegates from federal and provincial Health Departments, Ministry of Planning Development & Reforms, Ministry of Climate Change, Health Services Academy, and development partner organizations.
The workshop aimed at providing a brief overview of the package of high-priority intersectoral policies, reviewing the current status of these policies, discussing prioritization criteria, and developing specific recommendations for the implementation of the proposed inter-sectoral policies. The workshop featured keynote speeches from Dr Razia Safdar, Director Institutions, MoNHSR&C, Dr Nausheed Hamid, Parliamentary Secretary for Health, and Dr Safi Muhammad Malik, former DG Health MoNHSR&C. It also included presentations by national and international experts on selected topics relevant to the situation in Pakistan, including Dr Ala Alwan (DCP3 Secretariat/LSHTM), Drs Dean Jamison and Charles Mock (University of Washington), Dr Wafa Aftab (CHS-AKU), Dr Francesco Branca (WHO/HQ), Dr Ajay Pillarisetti (Emory University), and Drs Roberto Iglesias, Fatimah El-Awa and Shahzad Alam Khan (WHO/EMRO).
The workshop is part of a strategic collaboration between the DCP3 Secretariat and the Government of Pakistan to accelerate progress towards UHC through the development and implementation of a national package of high priority intersectoral policies for health. It builds on a series of meetings held in Pakistan in 2020, which resulted in the selection of 29 core intersectoral policies for early implementation in Pakistan, covering four areas, such as taxes and subsidies, regulations and related enforcement mechanisms, built environment, and information. A review of these 29 interventions was carried out by the Aga Khan University and DCP3 Secretariat, with support from WHO, and was discussed and further prioritized during the workshop’s working group sessions. Participants also explored actions needed to support the implementation of the high priority intersectoral policies.
The information and recommendations generated during the workshop will be used to update the review document and develop a multi-sectoral strategic work plan. Multisectoral groups will also be created to recommend actions for endorsing and implementing the prioritized policies, and a series of workshops and high-level meetings will be organized to review progress and recommend further action.