Supporting the Development of Health Benefits Packages (HBPs): Principles and Initial Assessment for Malawi

In many low- and middle-income countries (LMICs), particularly those heavily dependent upon overseas development aid, a major tool for resource allocation decisions over the choice of health care interventions are health benefits packages (HBPs). These are a critical element to achieving Universal Health Coverage, but with no widely accepted method for their development; they have historically promised more than could feasibly be delivered given resource constraints. An analytical framework was developed to guide the design of HBPs and to support the revision of Malawi’s essential health package (EHP). The framework is founded on an explicit and evidence-based assessment of health opportunity costs. This enables metrics of value to be reported which reflect the scale of the potential health impact of including an intervention in the package net of associated health opportunity costs, and of ensuring that it is fully implemented. It can be used to identify interventions that are “best buys” for the health care system. It also provides a method for quantifying the health opportunity cost of including other interventions, whether they achieve some other aims or are included in response to stakeholder or donor demands.