In the Quest for UHC, What’s Essential?

With the United Nations’ Sustainable Development Goal to achieve universal health coverage (UHC) just seven years away, many countries are working to meet the standard by rolling out what policymakers call essential packages of health services, or EPHS. These packages define core health services the governments can work to make universally accessible to all citizens. But just naming EPHS isn’t enough to deliver on the promise of universal health, says Gavin Yamey, professor of public policy and global health and director of DGHI’s Cener for Policy Impact in Global Health.

Yamey is part of a group of global health researchers led by Ala Alwan, former regional director with the World Health Organization, who have studied EPHS rollouts in six countries. They recently published a collection of seven essays in BMJ Global Health, summarizing what’s working and where countries need more effort to reach the high bar of universal health coverage.

Yamey spoke with DGHI graduate student Judith Mwobobia to share insights on the project and lessons for other countries seeking to roll out EPHS.

Tell us a little about the project.

In seven policy papers, we have compiled the experiences of six countries in developing their own national EPHS.  These six countries—Afghanistan, Ethiopia, Pakistan, Somalia, Sudan, and Zanzibar Tanzania­—are all low-income or lower middle-income countries chosen because they developed essential packages of health services using their own national expertise and networks, demonstrating their knowledge and experience in the process.

What did the experiences entail?

The collection of papers focuses on various aspects of the experience with EPHS. The researchers who wrote the policy papers have examined country readiness, decision-making processes, the importance of costing these packages, the role of budgets and budget appropriation, and the design of the package with implementation in mind. The private sector's role has also been considered, as in many countries, the public sector alone cannot deliver these packages. The seventh paper focuses on the crucial aspect of monitoring and evaluating the implementation of these packages.

We hope that the lessons learned from these papers will be valuable to all countries as they work towards achieving UHC.

How did the team go about collecting the experiences?

The research team spoke with officials, academics and policymakers in the countries being studied, conducted in-country surveys, and gathered information from 60 experts from around the world through three meetings in Geneva and London between September 2021 and March 2022.

In your estimation, what is the one overarching challenge countries across the globe face in achieving UHC?

According to the findings of our research, the one major challenge that countries face in achieving UHC is securing political commitment and prioritization. Achieving UHC requires support from high-level political officials, particularly in the Ministry of Finance and the Ministry of Health. Additionally, there must be a well-established plan for long-term sustainable funding and access to necessary resources, such as technical and managerial skills. Simply designing an essential package of health services is not enough to achieve UHC. It requires sustained effort and resources from all levels of government.

With the papers already published, is the project now complete?

The project is not complete yet. In February 2023, and again in March 2023, the team will hold meetings in London to further develop a consortium that can provide technical support and guidance to countries on their path towards UHC. This next phase of the project will aim to create a network that provides technical assistance to countries as they work towards UHC.