Incorporating Equity and Financial Protection Criteria Into Essential Benefits Package Design: A Case Study of...

Inequalities represent a major challenge on the path toward universal health coverage in low- and middle-income countries. The design of essential benefits packages (EBP) creates an opportunity in selecting priority interventions through established criteria including equity considerations. We examine the distributional health and financial protection impact of interventions targeting infectious diseases to be selected in an EBP for Ethiopia.

We sourced data on health benefits and program costs of priority interventions from the Ethiopian Essential Health Services Package database. Population and disease prevalence estimates were extracted from the Global Burden of Disease study, household surveys, and the literature. Health benefits of interventions were distributed across income quintiles using a risk index combining disease prevalence and intervention coverage inputs. Financial protection was estimated in terms of cases of catastrophic health expenditures (CHE) averted. For each of 30 priority interventions, we estimated the distributional health and financial protection benefits resulting from an incremental coverage annual increase of 10 percentage points.

A total of 390 000 health-adjusted life-years would be gained and 65 000 CHE cases averted. 22% and 20% of health benefits would accrue among the poorest and richest income quintiles, respectively. A third of CHE cases would be averted among the poorest.

Despite current coverage gaps, access to certain interventions would improve overall health, equity, and financial protection, with differing impacts across those dimensions depending on the intervention. Examining the trade-offs and weighing each outcome will enable tailored prioritization of interventions in the EBP.