International Journal of Health Policy and Management

International Journal of Health Policy and Management

Costing Interventions for Developing an Essential Package of Health Services: Application of a Rapid Method and Results From Pakistan

Document Type : Original Article

Authors
Wajeeha Raza 1
Wahaj Zulfiqar 2
Mashal Murad Shah 3
Maryam Huda 3
Syeda Shehirbano Akhtar 2
Urooj Aqeel 2
Saira Kanwal 2
Muhammad Khalid 2
Raza Zaidi 2
Maarten Jansen 4
Nichola Kitson 5
Leon Bijlmakers 4
Sameen Siddiqi 3
Ala Alwan 6
Anna Vassall 5
Sergio Torres-Rueda 5
1 Centre for Health Economics, University of York, York, UK
2 Ministry of National Health Services, Regulations and Coordination, Islamabad, Pakistan
3 Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
4 Department of Health Evidence, Radboud Institute of Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
5 Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, UK
6 DCP3 Country Translation Project, London School of Hygiene and Tropical Medicine, London, UK
10.34172/ijhpm.2023.8006
Abstract
Background 
The Federal Ministry of National Health Services, Regulations and Coordination (MNHSR&C) in Pakistan has committed to progress towards universal health coverage (UHC) by 2030 by providing an Essential Package of Health Services (EPHS). Starting in 2019, the Disease Control Priorities 3rd edition (DCP3) evidence framework was used to guide the development of Pakistan’s EPHS. In this paper, we describe the methods and results of a rapid costing approach used to inform the EPHS design process.
 
Methods 
A total of 167 unit costs were calculated through a context-specific, normative, ingredients-based, and bottom-up economic costing approach. Costs were constructed by determining resource use from descriptions provided by MNHSR&C and validated by technical experts. Price data from publicly available sources were used. Deterministic univariate sensitivity analyses were carried out.
 
Results 
Unit costs ranged from 2019 US$ 0.27 to 2019 US$ 1478. Interventions in the cancer package of services had the highest average cost (2019 US$ 837) while interventions in the environmental package of services had the lowest (2019 US$ 0.68). Cost drivers varied by platform; the two largest drivers were drug regimens and surgery-related costs. Sensitivity analyses suggest our results are not sensitive to changes in staff salary but are sensitive to changes in medicine pricing.
 
Conclusion 
We estimated a large number of context-specific unit costs, over a six-month period, demonstrating a rapid costing method suitable for EPHS design.
Keywords
Costing
UHC
Benefit Package
Pakistan 
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  • Received Date 03 March 2023
  • Revised Date 22 September 2023
  • Accepted Date 26 November 2023
  • First Published Date 27 November 2023
  • Published Date 01 December 2024