Disease Control Priorities 4 (DCP-4) Volume 1 Released on 6 March 2025

DCP-4 Volume 1 will be released on 6 March 2025 and made publicly available on this web page at no cost.

Below, Pakwanja Twea (pictured; BCEPS PhD Research Fellow), one of the Volume 1 editors, shares her perspective on the insights gained from DCP-4 Volume 1.

Photo:

BCEPS

Navigating the Path to Universal Health Coverage: Insights from the Disease Control Priorities-4 Project

All countries are concerned with maximizing the health of their populations in the most cost-efficient manner possible, given existing resource limitations. This concern is shared by global governing bodies, such as the World Bank and the World Health Organization, which have long provided guidance on advancing Universal Health Coverage (UHC) goals. The Disease Control Priorities (DCP) project is a global initiative aimed at helping countries make evidence-based decisions on resource allocation for the greatest possible health impact. I had the privilege of contributing to the first of four volumes in the DCP-4 book series as both an author and an editor. As Volume 1: “Country-Led Priority-Setting for Health” is published, I would like to share key insights from the volume.

This first volume is structured into three parts, each offering experiences from a range of countries on the path to UHC. The countries included range from low-income to upper-middle-income nations, making it a valuable learning tool for a broad audience. Volume 1 also examines countries facing different realities—some in times of peace, others experiencing civil unrest or political shifts that have led to significant policy changes and, in some cases, policy reversals that have influenced or hindered UHC progress. The volume explores various approaches to achieving UHC goals, showing how strategies differ by country income level. It also includes countries that have used DCP-3 guidance to develop and review health benefit packages (HBPs) and those that have taken alternative approaches. Ultimately, the volume highlights that while there is no single path to UHC, common elements offer valuable lessons for all nations.

Part I synthesizes the processes followed in different UHC approaches, highlighting key lessons, challenges, and recommendations. While countries' general paths are often similar, they face common challenges and adopt unique solutions to address them. These shared challenges raise questions that require broader discussion. For example, how can low-income countries address the common challenge of gaps in context-specific evidence? How can countries address the unaffordability of HBPs relative to available resources during HBP design? What strategies ensure the successful transition from HBP design to implementation? How can we establish a continuous link between design, implementation, monitoring, and evaluation? And how can all health providers be meaningfully included in the decision-making process?

Part II explores these, and other pressing questions faced by countries that have defined positive lists in their HBPs. One of the primary challenges in HBP design and implementation—the unaffordability of most packages relative to resource availability—is examined through the lens of the three health financing functions, with examples from multiple countries and corresponding recommendations. Similarly, the issue of making HBPs "implementable" from the design stage is discussed, highlighting best practices that facilitate this process. This section also outlines the HBP development process, drawing on country experiences and offering a step-by-step guide for policymakers.

Another critical topic addressed in Part II is private sector engagement in UHC design and implementation, a subject that is scarcely researched. Given that most countries operate within mixed health systems, the private sector can play a meaningful role in contributing to health sector goals. Part II also explores challenges and best practices in integrating private sector contributions into national UHC strategies. Additionally, it addresses a key issue in HBP implementation—the continuum from design to monitoring and evaluation. This part also provides experiences and recommendations based on country experiences regarding the process of establishing effective HBP monitoring and evaluation systems. The volume also includes a comparative analysis of analytical methods and tools used by different countries in HBP design, offering a valuable resource for policymakers seeking data-driven approaches.

Part III focuses on continuity, tracing the evolution of recommendations from DCP-1 to DCP-3, with an emphasis on school health and nutrition, surgery, and non-communicable diseases. This section reviews new evidence that has emerged since DCP-3 was published, analyses progress in implementation through case studies and surveys and offers recommendations for additional interventions and procedural improvements for the future.

My key takeaway from DCP-4 Volume 1 is that the path to UHC is not “one-size-fits-all”—each country’s journey is shaped by its unique challenges and opportunities. However, the breadth of experiences captured in this volume offers lessons that other countries can apply in their own UHC strategies. The volume reinforces the importance of evidence-based decision-making in shaping effective health policies. I look forward to further discussions and seeing how these insights contribute to real-world improvements in health system decision-making.