Abstract：
BACKGROUND: Pakistan developed its first national Essential Package of Health Services (EPHS) as a key step towards accelerating progress in achieving Universal Health Coverage (UHC). We describe the rationale, aims, the systematic approach followed to EPHS development, methods adopted, outcomes of the process, challenges encountered, and lessons learned.
METHODS: EPHS design was led by the Ministry of National Health Services, Regulations & Coordination. The methods adopted were technically guided by the Disease Control Priorities 3 Country Translation project and existing country experience. It followed a participatory and evidence-informed prioritisation and decision-making processes.
RESULTS: The full EPHS covers 117 interventions delivered at the community, health centre and first-level hospital platforms at a per capita cost of US$29.7. The EPHS also includes an additional set of 12 population-based interventions at US$0.78 per capita. An immediate implementation package (IIP) of 88 district-level interventions costing US$12.98 per capita will be implemented initially together with the population-based interventions until government health allocations increase to the level required to implement the full EPHS. Interventions delivered at the tertiary care platform were also prioritised and costed at US$6.5 per capita, but they were not included in the district-level package. The national EPHS guided the development of provincial packages using the same evidence-informed process. The government and development partners are in the process of initiating a phased approach to implement the IIP.
CONCLUSIONS: Key ingredients for a successful EPHS design requires a focus on package feasibility and affordability, national ownership and leadership, and solid engagement of national stakeholders and development partners. Major challenges to the transition to implementation are to continue strengthening the national technical capacity, institutionalise priority setting and package design and its revision in ministries of health, address health system gaps and bridge the current gap in financing with the progressive increase in coverage towards 2030.
METHODS: EPHS design was led by the Ministry of National Health Services, Regulations & Coordination. The methods adopted were technically guided by the Disease Control Priorities 3 Country Translation project and existing country experience. It followed a participatory and evidence-informed prioritisation and decision-making processes.
RESULTS: The full EPHS covers 117 interventions delivered at the community, health centre and first-level hospital platforms at a per capita cost of US$29.7. The EPHS also includes an additional set of 12 population-based interventions at US$0.78 per capita. An immediate implementation package (IIP) of 88 district-level interventions costing US$12.98 per capita will be implemented initially together with the population-based interventions until government health allocations increase to the level required to implement the full EPHS. Interventions delivered at the tertiary care platform were also prioritised and costed at US$6.5 per capita, but they were not included in the district-level package. The national EPHS guided the development of provincial packages using the same evidence-informed process. The government and development partners are in the process of initiating a phased approach to implement the IIP.
CONCLUSIONS: Key ingredients for a successful EPHS design requires a focus on package feasibility and affordability, national ownership and leadership, and solid engagement of national stakeholders and development partners. Major challenges to the transition to implementation are to continue strengthening the national technical capacity, institutionalise priority setting and package design and its revision in ministries of health, address health system gaps and bridge the current gap in financing with the progressive increase in coverage towards 2030.
摘要：
背景：巴基斯坦开发了其第一个国家基本卫生服务包（EPHS），这是朝着加快实现全民健康覆盖（UHC）进展迈出的关键一步。我们描述了基本原理，目标,EPHS开发遵循的系统方法，采用的方法，过程的结果，遇到的挑战,和吸取的教训。
方法：EPHS设计由国家卫生部领导，法规与协调。所采用的方法在技术上受到疾病控制优先事项3国家翻译项目和现有国家经验的指导。它遵循了参与性和循证的优先次序和决策过程。
结果：完整的EPHS涵盖了社区提供的117项干预措施，医疗中心和一级医院平台，人均费用为29.7美元。EPHS还包括另外一套12种基于人口的干预措施，人均0.78美元。立即实施一揽子措施（IIP），其中包括88项地区干预措施，人均费用为12.98美元，将与基于人口的干预措施一起实施，直到政府卫生拨款增加到实施全面EPHS所需的水平。在三级护理平台上提供的干预措施也得到了优先考虑，费用为人均6.5美元，但它们不包括在地区一级的一揽子计划中。国家EPHS使用相同的循证流程指导省级一揽子计划的开发。政府和发展伙伴正在采取分阶段的方法来实施IIP。
结论：成功的EPHS设计的关键要素需要关注包装的可行性和可负担性，国家自主权和领导权，国家利益攸关方和发展伙伴的坚定参与。向执行过渡的主要挑战是继续加强国家技术能力，将优先级设置和包装设计及其在卫生部的修订制度化，解决卫生系统的差距，弥合目前的融资缺口，逐步扩大覆盖面，到2030年。
方法：EPHS设计由国家卫生部领导，法规与协调。所采用的方法在技术上受到疾病控制优先事项3国家翻译项目和现有国家经验的指导。它遵循了参与性和循证的优先次序和决策过程。
结果：完整的EPHS涵盖了社区提供的117项干预措施，医疗中心和一级医院平台，人均费用为29.7美元。EPHS还包括另外一套12种基于人口的干预措施，人均0.78美元。立即实施一揽子措施（IIP），其中包括88项地区干预措施，人均费用为12.98美元，将与基于人口的干预措施一起实施，直到政府卫生拨款增加到实施全面EPHS所需的水平。在三级护理平台上提供的干预措施也得到了优先考虑，费用为人均6.5美元，但它们不包括在地区一级的一揽子计划中。国家EPHS使用相同的循证流程指导省级一揽子计划的开发。政府和发展伙伴正在采取分阶段的方法来实施IIP。
结论：成功的EPHS设计的关键要素需要关注包装的可行性和可负担性，国家自主权和领导权，国家利益攸关方和发展伙伴的坚定参与。向执行过渡的主要挑战是继续加强国家技术能力，将优先级设置和包装设计及其在卫生部的修订制度化，解决卫生系统的差距，弥合目前的融资缺口，逐步扩大覆盖面，到2030年。
