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Terms of Reference DRHR M&E Mechanism

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Terms of Reference DRHR M&E Mechanism TOWARDS UNIVERSAL HEALTH COVERAGE INTERVENTIONS’ DESCRIPTION OF ESSENTIAL PACKAGE OF HEALTH SERVICES/ UHC BENEFIT PACKAGE OF PAKISTAN Oct 2020 1 | P a g e Interventions’ Description of Essential Package of Health Services/ UHC Benefit Package of Pakistan PAKISTAN Interventions’ Description of Essential Package of Health Services / UHC Benefit Package of Pakistan @October 2020 Interventions’ Description of Essential Package of Health Services (EPHS)/ UHC Benefit Package of Pakistan based on Disease Control Priorities – Edition 3 Produced by: Ministry of National Health Services, Regulations and Coordination and Provincial/ Area Departments of Health Assessment done by: Health Planning, System Strengthening and Information Analysis Unit (HPSIU), Ministry of National Health Services, Regulations and Coordination Supported by: World Health Organization DCP3 Secretariat/ London School of Hygiene & Tropical Medicine (LSHTM)-UK & University of Radboud-Netherlands Aga Khan University, Karachi Health Services Academy, Islamabad For more information, please visit: Web: http://www.nhsrc.gov.pk/ ii | P a g e Interventions’ Description of Essential Package of Health Services/ UHC Benefit Package of Pakistan EXECUTIVE SUMMARY Government of Pakistan is committed that all individuals and communities should have equitable access to their needed health care, in good quality, without suffering financial hardship. The same has been expressed in the National Health Vision which is: ‘To improve the health of all Pakistanis, particularly women and children by providing universal access to affordable, quality essential health services which are delivered through a resilient and responsive health system, capable of attaining the Sustainable Development Goals and fulfilling its other global health responsibilities’ Development of Essential Package of Health Services/ UHC benefit package offers a futuristic vision in the health sector to set strategic direction and accordingly implement prioritized interventions in order to make progress on achieving universal health coverage/ health-related Sustainable Development Goals. The Disease Control Priorities 3 (DCP3) secretariat and World Health Organization (WHO) organized an international workshop in Islamabad during August 2018, which was also attended by provincial/ area Departments of Health (DOH), UN agencies and other partners. Participants were sensitized on the concept and evidence described in the nine volumes of DCP3 published by the secretariat. Soon after that the Inter-Ministerial Health & Population Forum (meeting held on 14 September 2018) decided that Pakistan should go ahead with requesting WHO & DCP3 secretariat to select Pakistan for adaptation of the DCP3 recommendations as a Universal Health Coverage Benefit Package (UHC BP) of Pakistan. Ministry of National Health Services, Regulations and Coordination (NHSR&C) sent a joint request to the DCP3 secretariat and proposed to select Pakistan for the adaptation of DCP3 recommended interventions as UHC benefit package. The proposal was confirmed by the secretariat in October 2019. Thus, Pakistan became the first country in the world to use DCP3 evidence to inform the definition of its UHC benefit package. Later on, providing UHC benefit package became a cornerstone of the health chapter of 12th Five Year Plan (2018-23) and National Action Plan (2019-23) for health sector of Pakistan. Second joint WHO-EMRO and DCP3 secretariat mission visited Pakistan during 16-18th January 2019 and a ‘Roadmap for the development of UHC benefit package for Pakistan’ was produced. By April 2019, the Ministry of NHSR&C completed review of essential health services based on DCP3 recommended interventions in Pakistan. Third joint WHO-EMRO and DCP3 secretariat mission visited the country during 1-3rd of July 2019, when along with further sensitization, processes and needs were defined and steps were agreed for formal partnership of the DCP3-UHC project (LSHTM) and WHO with the Health Planning, System Strengthening and Information Analysis Unit (HPSIU) of the ministry, Department of Community Health Sciences of Aga Khan University (AKU) and Health Services Academy (HSA). Soon after that WHO and DCP3-UHC project funded by the Bill & Melinda Gates Foundation (BMGF) started technical support through the London School of Hygiene and Tropical Medicine (LSHTM)-UK. iii | P a g e Interventions’ Description of Essential Package of Health Services/ UHC Benefit Package of Pakistan For evidence-based decisions on what should be priority interventions in the essential package of health services, it is critical to describe each intervention to explain briefly the process of interaction with patient/ client for each intervention along with platform and identification of major direct and indirect cost heads. This helps not only in developing an understanding on what is required to be implemented but also to ensure appropriate estimation of cost required to implement the same. Interventions were described by a core team at HPSIU with support of technical working groups, programme managers, subject experts and other stakeholders. National/ provincial guidelines, curriculum and protocols were used as priority reference document. After that preference was given to WHO guidelines and protocols followed by academic reference document and Delphi. Relevant analysis and evidence generated for each intervention was also gathered with support of DCP3 secretariat and were shared with stakeholders to have further deliberation and to produce an evidence based EPHS for Pakistan. Costing of all prioritized interventions was also carried out by the department of community health sciences, AKU and LSHTM, to estimate cost implication against the fiscal space for health in the country. As the EPHS / UHC benefit package for Pakistan has been developed, now the implementation of the same will start at district level to generate evidence on its effectiveness and feasibility in the context of Pakistan. This document presents description of all interventions that were reviewed for prioritization and inclusion in the generic EPHS / UHC benefit package of Pakistan. iv | P a g e Interventions’ Description of Essential Package of Health Services/ UHC Benefit Package of Pakistan Table of Contents Executive Summary ……………………………………………………………………… iii Table of Contents …………………………………………………………………………. v Acronyms ……………………………………………………………………………………… vi Background ……………………………………………………………………………….…. 1 Purpose and Principles …………………………………………………………………. 5 Process and Institutional Arrangements ………………………………………. 6 Description of EPHS Interventions ………………………………………………. 10 • Community & PHC Centre Level …………………………………………. 11 • First Level Hospital Level ……………………………………………………. 151 • Referral Hospital Level ………………………………………………………… 245 • Population Level …………………………………………………………………. 281 v | P a g e Interventions’ Description of Essential Package of Health Services/ UHC Benefit Package of Pakistan Acronyms AIDS Acquired Immune Deficiency Syndrome AJK Azad Jammu & Kashmir AKU Aga Khan University ARV Anti-Retro-Viral therapy BEmONC Basic Emergency Obstetrical and Neonatal Care BOD Burden of Disease CEmONC Comprehensive Emergency Obstetrical and Neonatal Care CKD Chronic Kidney Disease COPD Chronic Obstructive Pulmonary Disease CVD Cardio Vascular Diseases DALYs Disability Adjusted Life Years DCP3 Disease Control Priorities – Edition 3 DFID UK’s Department for International Development DOH Department of Health EIP Early Inter-sectoral Prevention Policies EPHS Essential Package of Health Services EUHC Essential Universal Health Coverage GAVI Global Alliance on Vaccine & Immunizations GB Gilgit Baltistan GDP Gross Domestic Product GFATM Global Alliance to fight against AIDS, TB and Malaria GNI Gross National Income GPEI Global Polio Eradication Initiative HIV Human Immuno-Deficiency Virus HPP Highest Priority Package HPV Human Papilloma Virus ICPD International Conference on Population & Development IP Inter-sectoral Prevention Policies IHR International Health Regulations IMCI Integrated Management of Childhood Illnesses JEE Joint External Evaluation KP Khyber Pakhtunkhwa LMIC Low-income and middle-income countries LSHTM London School for Hygiene and Tropical Medicine MCH Maternal and Child Health MDGs Millennium Development Gaols MDR Multi Drug Resistance M/o NHSR&C Ministry of National Health Services, Regulation & Coordination NTD Neglected Tropical Diseases PMTCT Prevention of Mother-to-Child transmission RH Reproductive Health RUTF Ready to Use Therapeutic Food SDGs Sustainable Development Goals STI Sexually Transmitted Infections TB Tuberculosis UHC Universal Health Coverage UN United Nations UNICEF United Nations Children Fund WASH Water, Sanitation & Hygiene WB World Bank WHO World Health Organization vi | P a g e Interventions’ Description of Essential Package of Health Services/ UHC Benefit Package of Pakistan ESSENTIAL PACKAGE OF HEALTH SERVICES / UHC BENEFIT PACKAGE OF PAKISTAN Universal Health Coverage (UHC) is based on the principle that all individuals and communities have equitable access to their needed health care, in good quality, without suffering financial hardship. A set of policy choices about benefits and their rationing are among the critical decisions in the reform of health financing system towards universal coverage. Choices need to be made about proceeding along each of the three dimensions, in many combinations, in a way that best fits their objectives as well as the financial, organizational and political contexts.
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