通过健康福利套餐支持优先级：趋势和从积极项目中吸取的经验教训（英）

THROUGH HEALTH BENEFIT PACKAGES: Trends and lessons learned from active projects Carolina Kern,Kent Ranson, Alice Renaud,andVictoria FanGlobal Health Financing Program KEY MESSAGESPublic Disclosure Authorized •Prioritization support is a major focus inWorld Bank active health projects, withalmost 80 percent supporting healthbenefit packages.There is an opportunity todraw lessons from and share this experienceto strengthenitsongoing and future projects. •Prioritization is essential for achievinguniversal health coverageand criticalgiven persistent financial constraints andgrowing demands on health sectorsworldwide. •The World Bank has deep experience inand unique capacity to support effectiveprioritization in the health sector.Itcontinues to co-develop key resources andtools and to guide countries as they design,refine, and deliver health benefit packages.Public Disclosure Authorized •Addressing implementation challenges isa priority for enhanced country support.These challenges include weak capacity,political economy considerations, financing,and the institutionalization of priority setting. Prioritization in health refers to the essential process of making strategic choices about whichhealth services and products to deliver, to whom, and at what cost, given finite resources.These choices can be made implicitly by, for example, basing decisions on what has been fundedtraditionally, or explicitly by defining a health benefit package (HBP) and institutionalizing processessuch as health technology assessment (HTA). While any form of prioritization aims to maximizehealth outcomes, the underlying criteria as well as the quality and performance of the processdetermine whether the results are efficient, equitable, and sustainable. With health systems stillrecovering from the COVID-19 pandemic, facing ongoing fiscal constraints, and now experiencing adecline in donor funding, effective and explicit prioritization in health is more relevant than ever. Making strategic and fair choices in the face oflimitedresources is an inherently complex process.It is particularly challenging in the health sector, where decisions can profoundly impactlives and well-being. Technical, institutional, and political obstacles include limited–or poor quality–local data, lack of a legal or policy framework, low orvariable political buy-in, and limited technicalcapacity. In some cases, decision-makers may feel prioritization requires choosing a particular tool orapproach, yet the number or complexity of the available options can be overwhelming.While existingliterature, such as Megiddo et al. (2023) and Fan and Ahazie (2023), provides comprehensive reviewsof these tools, the process remains one of balancing the often-competing interests of diverse groups.While unavoidable, the political economy landscape means that the relative influence of these groupsoften determines the outcome, potentially skewing prioritization away from objective-based decision-making. Service delivery of any health package of services requires evidence-informed prioritization todetermine what is covered and implemented.Continued client demand forsuch processesnecessitates a renewed focus on delivering streamlined, efficient solutions. To meet this challenge,refinement and scale-up of effective approaches across World Bank operations is important. This isparticularly crucial given growing attention being paidto this agenda, not only be countriesthemselves but also by other global health actors including global health initiatives, regional healthagencies, donors, and think tanks.For instance, the World Bank-supportedGlobal Financing Facilitymodelputs prioritization front and center by driving the development of country-owned “investmentcases” that lay out a pathway to scale universal access to a basic package of reproductive, maternal,newborn, child, and adolescent health and nutrition services. This Knowledge Brief explores key trends, challenges, and opportunities in World Bankanalytics and operations that support prioritization processes in the health sector.It is largelyaimed at supporting World Bank project design, highlighting operational experiences and lessons tosupport better country-owned, evidence-informed prioritization in the health sector. The brieffocuses exclusively on support to explicit HBPs–that is, a defined and affordable set of services thatis clear on entitlements, facilitates implementation, and promotes equity (see Box 1). Generally,countries are encouraged to pursue explicit HBPs based on clear decision-making criteria that are evidence informed and to use fair (that is, equal, impartial) decision-making processes that areconsistent over time (World Bank 2023).1 BOX 1. Prioritization in health: Definition of key terms Health benefit package:A health benefit package transparently defines the health services that areguaranteed to populations, and which are funded from public revenues and/or are publicly mandated. It alsodefines