On Wednesday, January 20, USAID’s Office of Health Systems (GH/OHS) and the Health Finance & Governance (HFG) Project hosted a technical briefing session to explore essential packages of health services (EPHS) in the 24 USAID Ending Preventable Child and Maternal Deaths (EPCMD) priority countries. An EPHS is a public policy tool for governing the health sector; it comprises those health care services that the government is providing or is aspiring to provide to its citizens in an equitable manner. Jodi Charles (USAID/GH/OHS), Jeremy Kanthor (HFG), and Jenna Wright (HFG) presented HFG’s recently completed analysis of the 24 EPCMD countries’ EPHS and government strategies for guaranteeing those health services. The technical briefing presented the cross-cutting themes identified through the analysis and included a discussion about how EPHS contributes to better governance of the health sector. The briefing, which was held at USAID and made available via webinar, drew a large audience of more than 75 participants, including USAID staff, implementing partners, and ministry of health staff from partner countries. “This is a tremendously rich data set because it helps us to see the gaps, and it will help us to target our efforts toward those gaps,” said Karen Cavanaugh, Director of USAID’s Office of Health Systems, during the question and answer session. The technical briefing presentation and country snapshots are available on the HFG website.

2. Abt Associates Inc.
In collaboration with:
Avenir Health | Broad Branch Associates | Development Alternatives Inc. (DAI) | Johns Hopkins Bloomberg School of Public Health (JHSPH) |
Results for Development Institute (R4D) | RTI International | Training Resources Group, Inc. (TRG)
A Landscape Analysis of 24 EPCMD Countries
Essential Packages of Health Services
Presented by:
Jenna Wright and Jeremy Kanthor
Health Finance & Governance Project

3. Topics for today’s briefing
What is an EPHS, and how is it related to good
governance?
Landscape analysis description and methodology
Which RMNCH priority interventions are included in EPHS?
How do policymakers govern the health sector using
EPHS?
Ongoing EPHS efforts in EPCMD countries

4. WHAT IS AN ESSENTIAL PACKAGE
OF HEALTH SERVICES?

5. A working definition of EPHS
The EPHS comprises those health care services that the
government is providing or is aspiring to provide to its citizens
in an equitable manner. Equity involves equal coverage
across population groups, adequate physical access to
services for all, and adequate financial protection, particularly
for the poor.
-Health Finance & Governance Project/USAID (adapted from WHO, World
Bank)

6. EPHS relates to good governance
EPHS is a public policy tool for governing the health sector
An explicit statement by the government of its health care
priorities
Expected to achieve multiple goals:
 Improved efficiency
 Equity
 Political empowerment
 Accountability
Source: WHO 2015

7. LANDSCAPE ANALYSIS
DESCRIPTION AND METHODOLOGY

8. Landscape Analysis of EPHS in EPCMD
countries1
24 country snapshots
 Identify the country’s EPHS
 Identify gaps of priority reproductive, maternal, newborn and
child health (RMNCH) interventions2
1 Countries include: Afghanistan, Bangladesh, DR Congo, Ethiopia, Ghana, Haiti, India, Indonesia, Kenya, Liberia, Madagascar, Malawi, Mali, Mozambique, Nepal, Nigeria,
Pakistan, Rwanda, Senegal, South Sudan, Tanzania, Uganda, Yemen, Zambia
2 Partnership for Maternal, Newborn and Child Health, 2011
ESSENTIALPACKAGEOFHEALTHSERVICES
COUNTRYSNAPSHOT: AFGHANISTAN
May 2015
This publication was produced for review by the United States Agency for International Development.
It was prepared by the Health Finance and Governance Project.
DISCLAIMER: The author’s views expressed in this publication do not necessarily reflect the views of the United
States Agency for International Development (USAID) or the United States Government.
 Review the policy goals of the EPHS (how
the government uses it)
www.hfgproject.org/ephs-epcmd-country-snapshots-series/

9. Methodology
Reviewed government documents and gray literature
Analyzed inclusion of priority RMNCH interventions in
EPHS2
Analyzed health equity using indicators from the Global
Health Observatory and Health Equity Country Profiles3
2 Partnership for Maternal, Newborn and Child Health, 2011
3 World Health Organization, 2014-2015

10. 23 of 24 countries have defined an EPHS
Mozambique has not yet defined an EPHS
One of the four provinces in Pakistan (Punjab) has an EPHS
18 countries defined the EPHS under an official name
EPHS not yet defined
(Mozambique)
EPHS defined

11. 23 of 24 countries have defined an EPHS
Mozambique has not yet defined an EPHS
One of the four provinces in Pakistan (Punjab) has an EPHS
18 countries defined the EPHS under an official name
No official name
Official name for
the EPHS

12. How we compared priority interventions to
the EPHS
Priority RMNCH
Interventions
Partnership for Maternal,
Newborn and Child Health
Essential
Package of
Health Services
Country X

13. How we compared priority interventions to
the EPHS
Low-dose aspirin to prevent pre-eclampsia
Included Unspecified Implicitly
excluded
Explicitly
excluded
(Intervention is not
mentioned, but is
clinically relevant
to a service in the
EPHS)
(Intervention is not
mentioned, and is
not clinically
relevant to a service
in the EPHS)
(Intervention is
mentioned as not
included in the
EPHS)

14. Certain interventions are rarely found in an
EPHS, while others are found frequently
22
21
21
21
2
2
1
0 2 4 6 8 10 12 14 16 18 20 22
Nutrition counselling
Family planning (advice, hormonal and barrier methods)
Family planning (hormonal, barrier and selected surgical methods)
Family planning advice and contraceptives
Use of surfactant (respiratory medication) to prevent respiratory
distress syndrome in preterm babies
Continuous positive airway pressure (CPAP) to manage babies with
respiratory distress syndrome
Low-dose aspirin to prevent pre-eclampsia
MostIncludedInterventions-LeastIncludedInterventions
Number of Countries (N=22)

15. WHAT RMNCH PRIORITY SERVICES
ARE INCLUDED IN EPHS?

16. In general, governments include RMNCH
priority interventions in the EPHS
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Average of Lower Middle Income Countries (N=9)
Average of Low Income Countries (N=13)
Proportion of 60 interventions included, excluded
and unspecified in/from EPHS
Included Unspecified Implicitly excluded Explicitly excluded

17. Interventions for prevention and
management of malaria included in EPHS
20
18
0 2 4 6 8 10 12 14 16 18 20 22
Prevention and case management of childhood
malaria
Prevention and management of malaria
(pregnant women) with insecticide treated nets
and antimalarial medicines
Number of Countries (N=22)

18. Interventions for family planning included
in EPHS
21
21
21
18
0 2 4 6 8 10 12 14 16 18 20 22
Family planning for adolescents (advice,
hormonal and barrier methods) (community,
primary and referral level)
Family planning for adolescents (hormonal,
barrier and selected surgical methods) (primary
and referral level)
Family planning advice and contraceptives,
postnatal
Family planning for adolescents (surgical
methods) (referral level)
Number of Countries (N=22)

19. Interventions for newborn health included
in EPHS
17
11
10
2
2
0 2 4 6 8 10 12 14 16 18 20 22
Initiation of early breastfeeding (within the first
hour)
Extra support for feeding small and preterm
babies
Case management of neonatal sepsis,
meningitis and pneumonia
Use of surfactant (respiratory medication) to
prevent respiratory distress syndrome in
preterm babies
Continuous positive airway pressure (CPAP) to
manage babies with respiratory distress
syndrome
Number of Countries (N=22)

20. Interventions for child health included in
EPHS
20
18
8
7
0 2 4 6 8 10 12 14 16 18 20 22
Exclusive breastfeeding for 6 months
Continued breastfeeding and complementary
feeding from 6 months
Case management of meningitis
Routine immunization plus H.influenzae,
meningococcal, pneumococcal and rotavirus
vaccines
Number of Countries (N=22)

21. Interventions for prevention and management of
sexually transmitted infections included in EPHS
20
19
18
15
0 2 4 6 8 10 12 14 16 18 20 22
Prevent and manage sexually transmitted
infections, HIV in adolescence and pre-
pregnancy
Prevention and management of sexually
transmitted infections and HIV, including with
antiretroviral medicines
Comprehensive care of children infected with,
or exposed to, HIV
Screening for and treatment of syphilis
Number of Countries (N=22)

22. Interventions most often excluded from
EPHS
11
11
9
7
5
12
4
2
2
0 2 4 6 8 10 12 14 16 18 20 22
Social support during childbirth
Women’s groups
Safe abortion
Home visits for women and children across the continuum
of care
Interventions for cessation of smoking
Routine immunization plus H.influenzae, meningococcal,
pneumococcal and rotavirus vaccines
Safe abortion
Screen for and initiate or continue antiretroviral therapy for
HIV
Vitamin A supplementation from 6 months of age
Implicitlyexcluded-Explicitlyexcluded
Number of Countries (N=22)

23. HOW DO POLICYMAKERS GOVERN
THE HEALTH SECTOR USING EPHS?

24. Similar service delivery mechanisms
across countries
All 23 governments deliver some EPHS services through
community health workers, public sector health facility
network

25. EPHS can guide provision of care by
private sector
Afghanistan: EPHS seeks to standardize provision through
non-governmental organizations where public facilities are
unavailable
Zambia, Churches Health Association of Zambia (CHAZ)
facilities required to provide the EPHS where public
facilities are unavailable

26. Governments seek to address equity
through EPHS-related policies
 All 23 country governments specified strategies to improve
access to the EPHS for specific sub-populations:
 Adolescents (14 countries)
 The indigent (15 countries)
 Rural residents (22 countries)
 Women (23 countries)

27. All governments provided some financial
protection, but mechanisms/extent varied
Government sponsored health insurance
 civil servants (12 countries)
 formal sector employees (11 countries)
 informal sector employees (8 countries)
Community-based insurance (17 countries)
User fees legally exempt for:
 some services in the EPHS (10 countries)
 all services in the EPHS (6 countries)

28. ONGOING EPHS EFFORTS IN EPCMD
COUNTRIES

29. EPHS are under development or revision
in several countries
Country images: CDC.gov

30. We found a range of applications of EPHS
Country images: CDC.gov

31. The country snapshots provide context and
background of the EPHS
 Nepal
 Highly specific EPHS
 Government updates EPHS regularly to reflect changing
demographics and financial realities
 EPHS links to national UHC strategy
 Costed
 Ghana
 Government defines and applies its EPHS differently
 Defined a several distinct packages; implemented
through vertical programs (e.g. National Health
Insurance Scheme)
 Community-Based Health Program and Services (CHPS)
is main strategy to increase access to “basic health
interventions”
 Ghana Health Service specified “key areas of essential
newborn care,” among other packages

32. Future topics
How well do policymakers, civil society and providers
understand the purpose of their country’s EPHS?
What additional policies/program should accompany an
EPHS in order to ensure its effectiveness?
In countries with national-level benefit plan, how does it
relate/compare with the published EPHS?

33. Abt Associates Inc.
In collaboration with:
Avenir Health | Broad Branch Associates | Development Alternatives Inc. (DAI) | Johns Hopkins Bloomberg School of Public Health (JHSPH) |
Results for Development Institute (R4D) | RTI International | Training Resources Group, Inc. (TRG)
Thank you
www.hfgproject.org/ephs-epcmd-country-
snapshots-series/
www.hfgproject.org