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Abstract：
BACKGROUND: The Disease Control Priorities 3 (DCP3) project provides long-term support to Pakistan in the development and implementation of its universal health coverage essential package of health services (UHC-EPHS). This paper reports on the priority setting process used in the design of the EPHS during the period 2019-2020, employing the framework of evidence-informed deliberative processes (EDPs), a tool for priority setting with the explicit aim of optimising the legitimacy of decision-making in the development of health benefit packages.
METHODS: We planned the six steps of the framework during two workshops in the Netherlands with participants from all DCP3 Pakistan partners (October 2019 and February 2020), who implemented these at the country level in Pakistan in 2019 and 2020. Following implementation, we conducted a semi-structured online survey to collect the views of participants in the UHC benefit package design about the prioritisation process.
RESULTS: The key steps in the EDP framework were the installation of advisory committees (involving more than 150 members in several Technical Working Groups [TWGs] and a National Advisory Committee [NAC]), definition of decision criteria (effectiveness, cost-effectiveness, avoidable burden of disease, equity, financial risk protection, budget impact, socio-economic impact and feasibility), selection of interventions for evaluation (a total of 170), and assessment and appraisal (across the three dimensions of the UHC cube) of these interventions. Survey respondents were generally positive across several aspects of the priority setting process.
CONCLUSIONS: Despite several challenges, including a partial disruption because of the COVID-19 pandemic, implementation of the priority setting process may have improved the legitimacy of decision-making by involving stakeholders through participation with deliberation, and being evidence-informed and transparent. Important lessons were learned that can be beneficial for other countries designing their own health benefit package such as on the options and limitations of broad stakeholder involvement.
METHODS: We planned the six steps of the framework during two workshops in the Netherlands with participants from all DCP3 Pakistan partners (October 2019 and February 2020), who implemented these at the country level in Pakistan in 2019 and 2020. Following implementation, we conducted a semi-structured online survey to collect the views of participants in the UHC benefit package design about the prioritisation process.
RESULTS: The key steps in the EDP framework were the installation of advisory committees (involving more than 150 members in several Technical Working Groups [TWGs] and a National Advisory Committee [NAC]), definition of decision criteria (effectiveness, cost-effectiveness, avoidable burden of disease, equity, financial risk protection, budget impact, socio-economic impact and feasibility), selection of interventions for evaluation (a total of 170), and assessment and appraisal (across the three dimensions of the UHC cube) of these interventions. Survey respondents were generally positive across several aspects of the priority setting process.
CONCLUSIONS: Despite several challenges, including a partial disruption because of the COVID-19 pandemic, implementation of the priority setting process may have improved the legitimacy of decision-making by involving stakeholders through participation with deliberation, and being evidence-informed and transparent. Important lessons were learned that can be beneficial for other countries designing their own health benefit package such as on the options and limitations of broad stakeholder involvement.
摘要：
背景：疾病控制优先事项3（DCP3）项目为巴基斯坦制定和实施其全民健康覆盖基本卫生服务包（UHC-EPHS）提供了长期支持。本文报告了2019-2020年期间EPHS设计中使用的优先级设置过程，采用了循证审议过程（EDP）的框架，一个确定优先事项的工具，其明确目的是优化制定健康福利一揽子计划的决策合法性。
方法：我们在荷兰的两次研讨会上计划了框架的六个步骤，参与者来自所有DCP3巴基斯坦合作伙伴（2019年10月和2020年2月），他们在2019年和2020年在巴基斯坦国家一级实施了这些措施。实施后，我们进行了一项半结构化的在线调查，以收集UHC福利包设计参与者对优先程序的意见。
结果：EDP框架中的关键步骤是建立咨询委员会（涉及多个技术工作组[TWG]和国家咨询委员会[NAC]的150多名成员），决策标准的定义(有效性，成本效益，可避免的疾病负担，股本，金融风险保护，预算影响，社会经济影响和可行性)，选择评估干预措施(共170种)，以及这些干预措施的评估和评价(跨越UHC立方体的三个维度)。调查答复者在优先事项确定过程的几个方面总体上是积极的。
结论：尽管面临一些挑战，包括由于COVID-19大流行造成的部分中断，通过让利益攸关方参与审议，实施优先事项确定过程可能提高了决策的合法性，证据知情和透明。吸取了重要的经验教训，这些经验教训可能有益于其他国家设计自己的健康福利一揽子计划，例如关于广泛利益攸关方参与的选择和局限性。
方法：我们在荷兰的两次研讨会上计划了框架的六个步骤，参与者来自所有DCP3巴基斯坦合作伙伴（2019年10月和2020年2月），他们在2019年和2020年在巴基斯坦国家一级实施了这些措施。实施后，我们进行了一项半结构化的在线调查，以收集UHC福利包设计参与者对优先程序的意见。
结果：EDP框架中的关键步骤是建立咨询委员会（涉及多个技术工作组[TWG]和国家咨询委员会[NAC]的150多名成员），决策标准的定义(有效性，成本效益，可避免的疾病负担，股本，金融风险保护，预算影响，社会经济影响和可行性)，选择评估干预措施(共170种)，以及这些干预措施的评估和评价(跨越UHC立方体的三个维度)。调查答复者在优先事项确定过程的几个方面总体上是积极的。
结论：尽管面临一些挑战，包括由于COVID-19大流行造成的部分中断，通过让利益攸关方参与审议，实施优先事项确定过程可能提高了决策的合法性，证据知情和透明。吸取了重要的经验教训，这些经验教训可能有益于其他国家设计自己的健康福利一揽子计划，例如关于广泛利益攸关方参与的选择和局限性。
