UHC and Benefits Package Design - Afghanistan expereince

1. Dr. Najibullah Safi, HSEP/UHS, EMRO
UHC and Benefits Package Design
Afghanistan Experience

2. Background
 Overall, the national health policy guide the health sector
 The policy is intended to improve the health of all Afghans in line with the
Sustainable Development Goal 3 “Ensure healthy lives and promote wellbeing for all
at all ages,” by responding to health needs promptly and effectively
 The Basic Package of Health Services (BPHS) and the Essential Package of
Hospital Services (EPHS) are contracted-out to NGOs since 2003 and 2005
 NGOs are selected through a competitive bidding process
 After the collapse of the government in August 2021, UNICEF manages all
NGOs contracts

3.  Health indicators
remain stagnant over
the last few years
 Changes in diseases
epidemiology, the
triple burden of
diseases
• Communicable
diseases
• Non-communicable
diseases
• Injuries (war and road
traffic)
Why move from BPHS/EPHS to IPEHS?

4.  Use the latest local and global evidence on the burden of diseases and the
cost-effectiveness of interventions
 Review of evidence by nine working groups and initial selection of
interventions
 Review and adjustment of the list of interventions, using well-defined
selection criteria by an expert committee
• Selection criteria
• Effectiveness
• Local feasibility
• Affordability
• Equity
Development of IPEHS

5.  Creation of an expert
committee
 Establishment of 9
technical working groups
in MoPH
 Assess the current burden
of diseases
 Identify potential and
existing interventions and
assess their cost-
effectiveness
 Develop a long list of
priority interventions
(MoPH)
 Select a short list of
priority interventions
(MoPH + Expert
Committee)
 Check the consistency of the IPEHS
across interventions (WHO/MoPH)
 Cost the revised package (MoPH with
UCL) and estimate the cost under
different funding scenarios
 Identify the latest clinical and public
health guidelines to help the MoPH in
future implementation (LSHTM)
 Develop a list of essential medicines
in relation to the IPEHS (WHO and
LSHTM)
Phase A
Nov 2017 – May 2018
Phase B
May - Sep 2018
Phase C
Jan – August 2021
Process of the development of IPEHS

6. IPEHS service delivery domains
 Reproductive, Maternal, and Newborn Health
 Child and Adolescent Health and Development
 Infectious Diseases
 Chronic Non-Communicable Diseases
 Mental, Neurological, and Substance Use Disorders
 Emergency Care
 Surgical Interventions
 Palliative Care
 Rehabilitation

7. The IPEHS was officially launched by the Minister of Public
Health and DG WHO during his visit to Kabul in January 2019
However, the implementation of the IPEHS was challenged by:
Existing contracts for BPHS and EPHS till June 2021
Deteriorating security situation
Collapse of government on 15th August 2021
Pausing of donor fund
Emerging priorities
Sustain BPHS/EPHS through humanitarian support
Implementation of IPEHS

8. Financing arrangements for benefits package implementation
 BPHS and EPHS are financed by EU, USAID and WB through Afghanistan
Reconstruction Trust Fund (ARTF)
 Projections of the fiscal space between 2018 and 2030 conducted on
different scenarios
 Th cost of EPHS and BPHS is roughly USD 5 per capita per year
 IPEHS is costed at USD 6.9 per capita per year

9. Service delivery arrangement for benefit package implementation
Secondary
District Hospital
Tertiary
Provincial Hospitals
Regional/teaching hospitals
(Supported by ICRC)
UN and NGOs Partnership
Primary
Health Post
BHC/CHC
 The engagement of the UN is guided by the UN
transitional engagement framework
 The current commitment of donors will end in
June 2024
 Future implementation is directly linked with
the availability of donor fund

10. Key challenges
 Absence of a recognized government and lack of political commitment
 Inadequate national capacity in design and implementation
 Little engagement of the MoF
 Absence of full engagement of key donors and stakeholders
 Changes of the key staff and MoPH leadership
 Dependency on donor fund
 Absence of a clear implementation plan
 Political instability and insecurity
 Restriction on women’s education, work, and movements without MAHRAM

11.  Need for inclusive engagement and well-structured policy dialogue
 Political commitment beyond MoPH
 Need for the formulation of the comprehensive implementation plan
 Allocation of domestic resources
 Need for capacity building for the implementation of new interventions
 Independent, frequent & rigorous M&E to remain focus on results
 Closely monitor the trend of diseases and adjust the IPEHS (or BPHS & EPHS) as
required
 Health systems are complex & adaptive - innovation needs to be encouraged
Lessons learned

12. Acknowledgment
 Thanks to BMGF, WHO, DCP3 Secretariate, LSHTM, UCL, and Geneva Centre of Humanitarian Studies
for the technical and financial support

13. Thanks