Summary:

Design, content and financing of an essential national package of health services.

A minimum package of public health and clinical interventions, which are highly cost-effective and deal with major sources of disease burden, could be provided in low-income countries for about US$ 12 per person per year, and in middle-income countries for about $22. Properly delivered, this package could eliminate 21% to 38% of the burden of premature mortality and disability in children under 15 years and 10-18% of the burden in adults. The cost would exceed what governments now spend on health in the poorest countries but would be easily affordable in middle-income countries. Governments should ensure that, at the least, poor populations have access to these services. Additional public expenditure should then go either to extending coverage to the non-poor or to expansion beyond the minimum collection of services to an essential national package of health care, including somewhat less cost-effective interventions against a larger number of diseases and conditions.

PIP: A minimum package of highly cost-effective public health and clinical interventions could be provided in low-income countries for about US$ 12 per person per year and in middle-income countries for about $22. This package could eliminate 21% to 38% of the burden of premature mortality and disability in children under 15 years old and 10-18% of the burden in adults. The two estimates of the package were calculated in two ways and then compared. One approach was based on the cost of specific activities, estimated from existing studies in many countries of service delivery costs by type of intervention. In the other approach, costs were estimated for a prototype district health system able to deliver the minimum package, consisting of a district hospital, health clinics, and outreach activities. In communities with moderate or high mortality, a few causes typically account for a large share of deaths. In 1990 an estimated 55% of the burden of disease was concentrated in children under 15 years old, with 660 million disability-adjusted life years (DALYs) lost. Just 10 disease conditions cause 71% of this loss. Except for congenital malformations, all these causes correspond to very cost-effective interventions, at less than $100 per DALY. Protein-energy malnutrition and vitamin-A deficiency can produce death or disability directly or through other diseases with a total loss 5-6 times larger when their indirect effect is included. The cost of the package would exceed what governments now spend on health in the poorest countries but would be easily affordable in middle-income countries. Governments should ensure that poor populations have access to these services with additional public expenditures either to extending coverage to the non-poor or to expansion beyond the minimum to an essential national package of health care, including somewhat less cost-effective interventions against a larger number of diseases.

Authors: Bobadilla, J. L.; Cowley, P.; Musgrove, P.; Saxenian, H.

Journal: Bull World Health Organ. 1994;72(4):653-62.