Revision of the Ethiopian Essential Health Service Package: An Explication of the Process and Methods Used.

To make progress toward universal health coverage, countries should define the type and mix of health services that respond to their populations' needs. Ethiopia revised its essential health services package (EHSP) in 2019. This paper describes the process, methodology and key features of the new EHSP. A total of 35 consultative workshops were convened with experts and the public to define the scope of the revision, develop a list of health interventions, agree on the prioritization criteria, gather evidence and compare health interventions. Seven prioritization criteria were employed: disease burden, cost effectiveness, equity, financial risk protection, budget impact, public acceptability and political acceptability. In the first phase, 1,749 interventions were identified, including existing and new interventions, which were regrouped and reorganized to identify 1,442 interventions as relevant. The second phase removed interventions that did not match the burden of disease or were not relevant in the Ethiopian setting, reducing the number of interventions to 1,018. These were evaluated further and ranked by the other criteria. Finally, 594 interventions were classified as high priority (58%), 213 as medium priorities (21%) and 211 as low priority interventions (21%). The current policy is to provide 570 interventions (56%) free of charge while guaranteeing the availability of the remaining services with cost-sharing (38%) and cost-recovery (6%) mechanisms in place. In conclusion, the revision of Ethiopia's EHSP followed a participatory, inclusive and evidence-based prioritization process. The interventions included in the EHSP were comprehensive and were assigned to health care delivery platforms and linked to financing mechanisms.

Socioeconomic inequality in self-reported oral health status: the experience of Thailand after implementation of the universal coverage policy.

OBJECTIVES: This study aimed to quantify the extent to which socioeconomic-related inequality in self-reported oral health status among Thais is present after the country implemented the Universal Coverage policy and to decompose the determinants and their associations with inequality in self-reported oral health status in particular with the worse condition. DESIGN AND METHOD: The study employed a concentration index to measure socioeconomic-related inequality in self-reported oral health status, and the decomposition method to identify the determinants and their associations with inequality in oral health-related measures. Data from 32,748 Thai adults aged 15-75 years from the nationally representative Health &Welfare Survey and Socio-Economic Survey 2006 were used in analyses. RESULTS: Reports of worse oral health status of the lower socioeconomic-status group were more common than their higher socioeconomic-status counterparts. The concentration index (equaling -0.208) corroborates the finding of pro-poor inequality in self-reported worse oral health. Decomposition analysis demonstrated certain demographic-, socioeconomic-, and geographic characteristics are particularly associated with poor-rich differences in self-reported oral health status among Thai adults. CONCLUSIONS: This study demonstrated socioeconomic-related inequality in oral health is discernable along the entire spectrum of socioeconomic status. Inequality in perceived oral health status among Thais is present even while the country has virtually achieved universality of health coverage. The study also indicates population subgroups, particularly the poor, should receive consideration for improving oral health status as revealed by underlying determinants.