An Essential Health Benefit (EHB) is a policy intervention designed to direct resources to priority areas of health service delivery to reduce disease burdens and ensure equity in health. Mainland Tanzania’s most recent benefit package – the National Essential Health Care Interventions Package-Tanzania (NEHCIP-TZ) – describes the EHB as a minimum or “limited list of public health and clinical interventions.” The package identifies where priorities are set for improved public health. This report shows the challenges of turning a policy ‘wish list’ and package into a reality of services that can be accessed across different facility levels. This report describes the evolution of mainland Tanzania’s EHB; the motivations for developing the EHBs, the methods used to develop, define and cost them; how it is being disseminated, communicated, and used; and the facilitators (and barriers) to its development, uptake or use. Findings presented in this report are from three stages of analysis: literature review, key informant perspectives and a national consultative meeting. The case study on Tanzania was implemented in a research programme of the EQUINET through Ifakara Health Institute and Training and Research Support Centre. The programme is being implemented in association with the East Central and Southern African Health Community, supported by IDRC (Canada).
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The Essential Health Benefit (EHB) policy interventions aim to optimize efficiency while extending coverage by increasing equity of access to the defined benefits. Uganda’s EHB is referred to as the Uganda National Minimum Healthcare Package (UNMHCP) introduced in the 1999 Health Policy. The UNMHCP is composed of cost efficient interventions against diseases or conditions most prevalent in the country. This report compiles evidence from published, grey literature and key informants on the UNMHCP since its introduction in Uganda’s health system, and findings were further validated during a one day national stakeholder meeting. It includes information on the motivations for developing the EHBs, the methods used to develop, define and cost them, and how it has been disseminated, used in budgeting, resourcing and purchasing health services and in monitoring health system performance for accountability. It was implemented in an EQUINET research programme through Ifakara Health Institute and Training and Research Support Centre, in association with the ECSA Health Community, supported by IDRC (Canada).
This case study report compiles evidence on the experience of the Essential Health Benefit (EHB) in Zambia. The paper aims to contribute to national and regional policy dialogue regarding the role the EHB plays in budgeting, resourcing and purchasing of health services as well as monitoring health system performance for accountability. It outlines the motivations for developing the EHBs in Zambia, the barriers encountered in the process, the methods used to develop EHBs, and issues related to dissemination and communication of its content. The paper was done under the auspices of an EQUINET research programme through Ifakara Health Institute (IHI) and Training and Research Support Centre (TARSC), in association with the ECSA Health Community, supported by IDRC (Canada), and with the permission of the Ministry of Health of Zambia.
The Essential Health Benefit (EHB) is known as Essential Health Care Package (EHCP) in Swaziland. This desk review provides evidence on the experience of EHCPs in Swaziland and includes available policy documents and research reports. It was implemented in an EQUINET research programme through Ifakara Health Institute (IHI) and Training and Research Support Centre (TARSC), in association with the ECSA Health Community, supported by IDRC (Canada). The desk review presents the motivations for and methods used to develop, define and cost EHCP. It includes key informant input from a multi-disciplinary national task team through a workshop of key stakeholders with technical support from the World Health Organisation (WHO). It outlines how the EHCP has been disseminated and used in the budgeting and purchasing of health services and in monitoring health system performance for accountability. The paper also reports on the facilitators and barriers to development, uptake and use of the EHCP. In guiding the provision of services for all, the EHCP was envisaged to contribute towards the alleviation of poverty and as a tool for universal health coverage. Its implementation calls for a health service Infrastructure that is in good condition, competent health personnel, readiness to undergo training in new medical technology, supporting laws and capacity in the health financing unit. The EHCP in Swaziland was intended to guide the provision of health services. However, its costs were beyond the national resources to fund it. The adoption of a more restricted health service package currently being assessed in ten clinics in all four regions of the country suggests that a phased approach to delivery of an EHB may be more affordable financially for the country.
An Essential Health Benefit (EHB) is a policy intervention defining the service benefits (or benefit package) in order to direct resources to priority areas of health service delivery to reduce disease burdens and ensure health equity. Many east and southern African (ESA) countries have introduced or updated EHBs in the 2000s. Recognising this in 2015-2017, the Regional Network for Equity in Health in East and Southern Africa (EQUINET), through Ifakara Health Institute (IHI) and Training and Research Support Centre (TARSC), with ministries of health in Swaziland, Tanzania, Uganda and Zambia, implemented desk reviews and country case studies, and held a regional meeting to gather and share evidence and learning on the role of EHBs in resourcing, organising and in accountability on integrated, equitable universal health systems. This report synthesises the learning across the full programme of work. It presents the methods used, the context and policy motivations for developing EHBs; how they are being defined, costed, disseminated and used in health systems, including for service provision and quality, resourcing and purchasing services and monitoring and accountability on service delivery and performance, and for learning, useful practice and challenges faced. This research pointed to the evidence within the region for policy dialogue on universal health systems. It raised the usefulness of designing, costing, implementing and monitoring an EHB as a key entry point and operational strategy for realising universal health coverage and systems and for making clear the deficits to be met.
This discussion paper is produced by the Centre for Human Rights and Development (CEHURD) as part of the theme work on health rights and law of the Regional Network for Equity in Health in East and Southern Africa (EQUINET). The paper examines the implementation of constitutional provisions on the right to healthcare in Kenya and Uganda, two countries in East Africa. It aims to identify factors and mechanisms that have facilitated implementation of constitutional provisions on the right to healthcare, including how the constitutions were developed and framed. It compares implementation in Kenya, where the right to healthcare is explicit in their 2010 Constitution, and in Uganda, where the right to healthcare is implicit in the National Objectives and Directive Principles of State Policy. The paper draws on two EQUINET case studies on implementation of constitutional provisions on the right to health, one each in Kenya and Uganda, published in 2018, a 2017 regional workshop that discussed the implementation of constitutional provisions on the right to health, and additional review of published literature. It presents a thematic analysis of the findings from the two case studies in terms of the judicial, political and popular implementation mechanisms, exploring further the factors and mechanisms that have facilitated or blocked their implementation. As the two constitutions address the right to healthcare differently, this analysis of their application provides insights into the factors and mechanisms for practice that may be useful in other settings.
This discussion paper is produced by the Centre for Human Rights and Development (CEHURD) as part of the theme work on health rights and law of the Regional Network for Equity in Health in East and Southern Africa (EQUINET). The paper examines the implementation of constitutional provisions on the right to healthcare in Kenya and Uganda, two countries in East Africa. It aims to identify factors and mechanisms that have facilitated implementation of constitutional provisions on the right to healthcare, including how the constitutions were developed and framed. It compares implementation in Kenya, where the right to healthcare is explicit in their 2010 Constitution, and in Uganda, where the right to healthcare is implicit in the National Objectives and Directive Principles of State Policy. The paper draws on two EQUINET case studies on implementation of constitutional provisions on the right to health, one each in Kenya and Uganda, published in 2018, a 2017 regional workshop that discussed the implementation of constitutional provisions on the right to health, and additional review of published literature. It presents a thematic analysis of the findings from the two case studies in terms of the judicial, political and popular implementation mechanisms, exploring further the factors and mechanisms that have facilitated or blocked their implementation. As the two constitutions address the right to healthcare differently, this analysis of their application provides insights into the factors and mechanisms for practice that may be useful in other settings.
EQUINET commissioned this desk review paper. It aims to contribute to a regional understanding of the positive and negative implications of the different domestic health financing options being explored, advocated and implemented in the East and Southern African (ESA) region. It presents issues to be addressed in the implementation of these financing options from the perspective of equitable progression towards universal health coverage (UHC), to inform policy dialogue and decisions on domestic health financing in ESA countries. The paper considers only one aspect of health financing reform, namely, revenue collection. It distinguishes between policy instruments, i.e., the sources of finance, and policy strategies, i.e., how these instruments are deployed to achieve various objectives or to address contextual features. Non-contributory sources (essentially tax-financed) and contributory (employment-based) options are explored. The paper presents: a. A typology of domestic revenue instruments and strategies; b. Domestic financing trends and options in place, or under consideration, in ESA countries; c. A review of low- and middle-income country experiences of domestic financing options; and d. Conclusions on the findings and lessons for ESA countries.
his study explored the possibility of joint health worker and community activism at a primary care level in South Africa, and the human resource requirements needed for the effective treatment and care of HIV/AIDS within the public health service. The study used participatory approaches and involved five SAMWU shop stewards in the design, data collection and analysis of the research. The study was implemented between October and November 2005 in five primary health care (PHC) clinics in the Western Cape, Free State and KwaZulu Natal. Twenty-four health workers (fifteen of which were interviewed in depth) and eighteen health committee members were interviewed across the five different sites using a semi-structured interview guide.
In 2004, the Tanzanian government launched its Tanzania National Voucher Scheme (TNVS). The scheme aimed to subsidise the cost of anti-malaria nets for pregnant women and children across the country. But has the implementation of the scheme so far been equitable? This study used a case study approach to analyse the power relations between key implementers of the scheme and the mothers served in four rural district health facilities in Namtumbo and Mbinga districts. The study found that despite the scheme’s impact in reducing severe malaria cases, inadequate national prioritisation of malaria is affecting implementation, leading to inadequate funding, felt most severely at facility level. No resources were allocated specifically for voucher distribution, resulting in periodic shortages, while health workers involved in the scheme had other competing demands on their time. A top-down managerial approach to implementation allowed health workers to exercise unfair power over mothers and pregnant women seeking nets and treatment and women were asked to pay for vouchers in some areas, when they are actually entitled to get them free. The study, building on previous studies in Tanzania and elsewhere, demonstrated that a top-down approach to policy intervention is contributing to implementation gaps. The voucher scheme is not just a tool for ensuring access and equity in health care delivery – it must be carefully considered in the context of those entrusted with the task of overseeing its implementation.