Shaping Health Packages And Researching Priorities (SHARP)

Achieving Universal Health Coverage (UHC) requires countries to set priorities and define the services that populations are entitled to. Low and middle-income countries (LMIC) are faced with new interventions including drugs, devices, or other services that can be used to improve the health of the populations they serve. Government and other funders need to make choices about which of these services to fund against a background of severely constrained health resources. The World Health Organisation (WHO) recommends that governments and insurers set and communicate health sector priorities by defining guaranteed or 'essential' health benefit packages (HBPs). Many countries in Africa and elsewhere have begun adopting HBP processes that consider a range of evidenced criteria for service selection including value for money, equity, and feasibility. This approach is broadly known as evidence-informed priority setting (EIPS). The establishment of HBPs typically also involves the creation of national institutionalised structures and processes that allow for transparent expert review of evidence and stakeholder engagement, including patient representation and aiming for public accountability. Defining evidence informed HBPs within health systems is thus expected to have substantial impact on the health of the populations and improve the legitimacy of domestic health sector decisions. There is an emerging body of evidence that describes progress and use of HBPs in LMICs which identifies several key challenges to their success. These include: evidence assessment against multiple decision criteria given limited availability of high quality local data; effective engagement of communities in complex processes; and health systems constraints to eventual HBP implementation. Moreover, there has been little rigorous evaluation reflecting more broadly whether HBPs successfully impact resource allocation and achieve their stated aims given political and economic constraints. The goal of our consortium is to inform and improve the design and implementation of HBPs throughout the African continent. Our research will i) inform, design and test novel modes of evidence assessment, patient and community involvement, and consideration of implementation constraints in EIPS based processes for HBP definition; ii) evaluate HBP procedures and outcomes, unpacking both health system and political economy determinants. We aim to strengthen capacity across health systems researchers in Rwanda and Kenya; support stakeholders and policy makers reflect within ongoing processes of the design and implementation of HBPs in Rwanda and Kenya; sharing lessons across the region, working with Africa CDC and regional networks. We will employ both formative and evaluative health system research methods. Our formative research will: apply health economics methods to understand the risk associated with evidence uncertainty under data, time, and capacity constraints; use participatory methods to inform improved patient, community, and public engagement; and apply health systems modelling to inform HBP implementation. Our evaluative research will adapt existing HBP evaluative frames and complement them with economic and political economy analyses. Our research will be integrated within HBP design in Kenya and Rwanda, in policy relevant time frames; including self-reflective evaluation. We will disseminate our work locally and regionally in partnership with Africa CDC.