Presented by Egbert Sondorp of KIT Royal Tropical Institute, Netherlands. Part of a session - 'Context, gender and sustainability in introducing and scaling-up essential health care packages in fragile and crisis-affected countries' - at the Fifth Global Symposium for Health Systems Research in October 2018. The essential package of health services is a mechanism for expanding equitable coverage of primary health care and essential hospital services in countries recovering from conflict. The session explored the evidence-base on such healthcare packages in different contexts and prioritized areas for strengthening research.

1. Thematic Working Group
Health Systems in Fragile
and Conflict Affected States
TWG Session
5th Global Symposium on Health
Systems Research,
Liverpool, Oct 10th 2018

2. Context, gender and sustainability in
introducing and scaling-up essential health
care packages in fragile and crisis-affected
countries
Egbert Sondorp
Senior Health Advisor
KIT Royal Tropical Institute
Amsterdam, Netherlands
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Introduction

3. Essential health care packages
What are ‘essential health care packages’?
Or: ‘Basic packages of health services’
Or: ‘Minimal packages of health services’
Or: ‘Health Benefit packages’
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4. Universal Health Coverage
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5. UHC cube – Netherlands and Yemen
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Population Coverage Population Coverage
FinancialProtection
FinancialProtection

6. Essential Health Packages – a definition
• An Essential Package of Health Services (EPHS) can be defined as the
package of services that the government is providing or is aspiring to
provide to its citizens in an equitable manner.
• Typically comes with elements of:
• Burden of disease
• Interventions which provide the best 'value for money‘
• New DCP3, Volume 9
• Guaranteed minimum
• But frequently the package is more ‘aspirational’
• Enhance equity
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Disease Control Priorities,
Third Edition (Volume 9)

7. Essential health packages in FCAS
• Increasingly popular to use EHPs in post-conflict and other fragile contexts
as a tool
• Afghanistan 2003-18 being the Mother of wide scale BPHS use
• Linked with contracting out service provision to NSP (NGOs)
• Other ‘post’-conflict countries
• E.g. South Sudan, Liberia, Somalia
• More recent interest in EHP for protacted humanitarian crises
• E.g. Yemen, North Syria, Sudan (Darfur)
• Comes with debate on utility of costing the packages
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8. Essential health services packages
• Some reflections on the use of EHSP in a range of lower income ‘post’-
conflict countries
• Afghanistan
• South Sudan
• Liberia
• Somalia
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9. Afghanistan
• BPHS, contracted out to NGOs under Government stewardship
• Allowed for standardization in highly fragmented environment
• Managed to rapidly increase basic services to good part of population
• High degree of alignment between government, donors, NGOs
• Improved health outcomes
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10. South Sudan
• 2005 Comprehensive Peace Agreement
• Basic Package of Health Services formulated
• highly ‘aspirational’
• NGOs contracted to assist County Health Departments to deliver (small
subset of) BPHS
• Limited involvement of Government/MoH
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11. Liberia
• 2003 CPA; 2006 new government
• Formulation of
“THE BASIC PACKAGE OF HEALTH AND SOCIAL WELFARE
SERVICES”
• “realistic package”
• Key role for district authorities to run health services,
with varying degrees of assistance from (contracted) NGOs
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12. Somalia
• EPHS formulated in 2008 as ‘stand alone’ activity, initially not
linked to implementation
• ‘Aspirational’ EPH
• Implementation years later
through contracting in some
areas
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13. Goal of the Essential packages?
13 Glassman et al.: Defining a Health Benefits Package
Health Systems & Reform, (2016)