The Use of Evidence-Informed Deliberative Processes for Designing the Essential Package of Health Services in Pakistan

Document Type : Original Article


1 Department of Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands

2 Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA

3 Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, UK

4 Ministry of National Health Services, Regulations and Coordination, Islamabad, Pakistan

5 Centre for Health Economics, University of York, York, UK

6 Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan

7 DCP3 Country Translation Project, London School of Hygiene and Tropical Medicine, London, UK


The Disease Control Priorities 3 (DCP3) project provides long-term support to Pakistan in the development and implementation of its universal health coverage essential package of health services (UHC-EPHS). This paper reports on the priority setting process used in the design of the EPHS during the period 2019-2020, employing the framework of evidence-informed deliberative processes (EDPs), a tool for priority setting with the explicit aim of optimising the legitimacy of decision-making in the development of health benefit packages.

We planned the six steps of the framework during two workshops in the Netherlands with participants from all DCP3 Pakistan partners (October 2019 and February 2020), who implemented these at the country level in Pakistan in 2019 and 2020. Following implementation, we conducted a semi-structured online survey to collect the views of participants in the UHC benefit package design about the prioritisation process.

The key steps in the EDP framework were the installation of advisory committees (involving more than 150 members in several Technical Working Groups [TWGs] and a National Advisory Committee [NAC]), definition of decision criteria (effectiveness, cost-effectiveness, avoidable burden of disease, equity, financial risk protection, budget impact, socio-economic impact and feasibility), selection of interventions for evaluation (a total of 170), and assessment and appraisal (across the three dimensions of the UHC cube) of these interventions. Survey respondents were generally
positive across several aspects of the priority setting process.

Despite several challenges, including a partial disruption because of the COVID-19 pandemic, implementation of the priority setting process may have improved the legitimacy of decision-making by involving stakeholders through participation with deliberation, and being evidence-informed and transparent. Important lessons were learned that can be beneficial for other countries designing their own health benefit package such as on the options and limitations of broad stakeholder involvement.


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Articles in Press, Corrected Proof
Available Online from 24 October 2023
  • Receive Date: 03 March 2023
  • Revise Date: 30 August 2023
  • Accept Date: 07 October 2023
  • First Publish Date: 09 October 2023