Evidence-Informed Deliberative Processes for UHC: Progress, Potential and Prudence; Comment on “Evidence-Informed Deliberative Processes for Health Benefit Package Design – Part II: A Practical Guide”

Document Type : Commentary


Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway


In their recent article on evidence-informed deliberative processes (EDPs) for health benefit package decisions, Oortwijn et al examine how the different steps of EDP play out in eight countries with relatively mature institutions for using health technology assessment (HTA). This commentary examines how EDP addresses stakeholder involvement in decision-making for equitable progress towards universal health coverage (UHC). It focuses on the value of inclusiveness, the need to pay attention to trade-offs between desirable features of EDP and the need to broaden the scope of processes examined beyond those specifically tied to producing and using HTAs . It concludes that EDPs have contributed to significant progress for health benefit design decisions worldwide and holds much potential in further application. At the same time, this commentary calls for prudence: investments in EDPs should be efficiently deployed to enhance the pre-existing legislative, institutional and political framework that exist to promote fair and legitimate healthcare decisions.


  1. Daniels N, Sabin J. Limits to health care: fair procedures, democratic deliberation, and the legitimacy problem for insurers. Philos Public Aff. 1997;26(4):303-350. doi:1111/j.1088-4963.1997.tb00082.x
  2. Daniels N. Just Health: Meeting Health Needs Fairly. Cambridge University Press; 2007.
  3. Rumbold B, Weale A, Rid A, Wilson J, Littlejohns P. Public reasoning and health-care priority setting: the case of NICE. Kennedy Inst Ethics J. 2017;27(1):107-134. doi:1353/ken.2017.0005
  4. Maluka S, Kamuzora P, San Sebastián M, Byskov J, Ndawi B, Hurtig AK. Improving district level health planning and priority setting in Tanzania through implementing accountability for reasonableness framework: perceptions of stakeholders. BMC Health Serv Res. 2010;10:322. doi:1186/1472-6963-10-322
  5. Kapiriri L, Martin DK. Successful priority setting in low and middle income countries: a framework for evaluation. Health Care Anal. 2010;18(2):129-147. doi:1007/s10728-009-0115-2
  6. Oortwijn W, Jansen M, Baltussen R. Evidence-informed deliberative processes for health benefit package design - part II: a practical guide. Int J Health Policy Manag. 2022;11(10):2327-36. doi:34172/ijhpm.2021.159
  7. Mansbridge J, Bohman J, Chambers S, et al. A systemic approach to deliberative democracy. In: Parkinson J, Mansbridge J, eds. Deliberative Systems: Deliberative Democracy at the Large Scale. Cambridge: Cambridge University Press; 2012. p. 1-26.
  8. Dryzek JS, Niemeyer S. Discursive representation. Am Polit Sci Rev. 2008;102(4):481-493. doi:1017/s0003055408080325
  9. Greer SL, Méndez CA. Universal health coverage: a political struggle and governance challenge. Am J Public Health. 2015;105(Suppl 5):S637-639. doi:2105/ajph.2015.302733
  10. Donya Razavi S, Kapiriri L, Abelson J, Wilson M. Barriers to equitable public participation in health-system priority setting within the context of decentralization: the case of vulnerable women in a Ugandan district. Int J Health Policy Manag. 2022;11(7):1047-57. doi:34172/ijhpm.2020.256
  11. Fredriksson M, Tritter JQ. Disentangling patient and public involvement in healthcare decisions: why the difference matters. Sociol Health Illn. 2017;39(1):95-111. doi:1111/1467-9566.12483
  12. Dryzek JS, Bächtiger A, Chambers S, et al. The crisis of democracy and the science of deliberation. Science. 2019;363(6432):1144-1146. doi:1126/science.aaw2694
  13. Bijlmakers L, Jansen M, Boer B, et al. Increasing the legitimacy of tough choices in healthcare reimbursement: approach and results of a citizen forum in the Netherlands. Value Health. 2020;23(1):32-38. doi:1016/j.jval.2019.07.015
  14. Kapiriri L, Baltussen R, Oortwijn W. Implementing evidence-informed deliberative processes in health technology assessment: a low income country perspective. Int J Technol Assess Health Care. 2020;36(1):29-33. doi:1017/s0266462319003398
  15. Kantamaturapoj K, Kulthanmanusorn A, Witthayapipopsakul W, et al. Legislating for public accountability in universal health coverage, Thailand. Bull World Health Organ. 2020;98(2):117-125. doi:2471/blt.19.239335
  • Receive Date: 16 July 2022
  • Revise Date: 28 December 2022
  • Accept Date: 31 December 2022
  • First Publish Date: 01 January 2023