Shaping Health Packages and Researching Priorities (SHARP) Research Consortium
Governments' funding decisions for Universal Health Coverage include choosing health services among a wide range of options that vary in costs, health, and societal impacts, within a limited budget envelope. Collating locally relevant evidence on these services and involving key local stakeholders can help governments and national insurers prioritise the health services they fund and provide legitimacy to these choices.
One approach to decide which services to fund is to define ‘health benefit packages’ (HBPs). HBPs list the services to be publicly funded and guaranteed to the population. Several countries in Africa and elsewhere have begun adopting processes to assess and review a range of evidence to prioritise their HBPs, considering whether services provide value for money, improve equity, and are feasible to deliver at scale. Informing this process is challenging given the extent of evidence required, the complexity of engaging various stakeholders, and the challenge of ensuring HBPs are adopted by healthcare providers.
Over a period of 4 years, our NIHR funded project will investigate these challenges in more detail. The project will explore how evidence is produced and used under real data, time, and capacity constraints and with the involvement of relevant stakeholders including patients and the community as well as the political economy of HBP design and implementation. This research will be embedded in HBP revision processes in Rwanda and Kenya, with the aim of informing the wider African region.
Our research will be undertaken by a partnership comprising University of Rwanda, University of Nairobi, KEMRI, London School of Hygiene and Tropical Medicine and Radboud University.
LSHTM
- Lorna Guinness (Co-PI)
- Francis Ruiz
- Olimpia Lamberti
KEMRI-Wellcome Trust
- Edwine Barasa (Co-PI)
- Jacob Kazungo
- Evelyn Kabia
- Dennis Waithaka
University of Rwanda
- James Humuza
- Jean Marie Sindambiwe
- Yvonne Delphine Nsaba Uwera
University of Nairobi
- Julius Korir
- Daniel Mwai
Radboud University Nijmegen Medical Center
- Rob Baltussen
- Cassie Nemzoff
Strengthening multi-stakeholder approaches to health benefit package design in Rwanda and Kenya that account for data, time and capacity constraints
Adopting a range of mixed methods approaches including literature reviews, modelling, stakeholder interviews and workshops, our research aims to:
- inform and design an approach to selecting the best evidence assessment method for evidence informed priority setting for health benefits packages (HBPs) in Rwanda and Kenya
- inform and design strategies for effective patient and community involvement in HBP revision through the identification of the key stakeholders, and determining their interests and preferences
- develop an approach to selecting which health systems functions and costs should be considered in HBP design to identify the implications of HBPs for the health system
- assess whether HBPs achieve the procedural aims of evidence-informed priority setting processes in Rwanda and Kenya
- assess the consequentialist outcomes of evidence-informed priority setting processes in HBP design in Rwanda and Kenya
- understand how HBPs impact the allocation of resources and power between key actors
- pilot a self-reflective evaluation for stakeholders involved in evidence-informed priority setting and HBPs to determine 1) how and why priority setting processes succeed or fail; 2) how success or failure relates to underlying interests; and 3) what lessons other countries can learn from Rwanda and Kenya
- strengthen training and capacity, and foster community engagement and involvement for HBP design processes in Rwanda and Kenya
Health Benefit Packages (HBPs) seek to define health sector priorities and improve population health
HBPs are a policy instrument aimed at defining health sector priorities aiming to improve population health. Moreover, by ensuring a transparent and inclusive approach to priority setting, HBPs aim to improve the legitimacy of health sector priority setting. HBPs require institutional development of health sector processes and structures, including capacity strengthening and the engagement of a wide number of stakeholders. As such, we conceptualise HBPs as both a technocratic and political mechanism to navigate contested interests around health service priorities, where the characteristics of these interests, and the capacity of the health system, both constrain and enable HBP institutionalisation.
Our framework brings together several previous frameworks used to understand HBPs and evidence-informed priority setting. We have used it to define a set of research work packages organised into two categories. Work packages 1.1-1.3 concern research to inform HBP design and includes enhancing procedural and methods aspects (Formative Research). Work packages 2.1-2.3 relate to whether the evidence-informed priority setting process has achieved its intended outcomes, and involves self-reflective research by the consortium (Evaluative Research).
The SHARP project formally launched with an in-person consortium meeting in Nairobi, Kenya. This milestone marks the start of a regional effort, bringing together partners from around the world to shape better health systems.
