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Vaccinate children against measles and mumps or pay for the costs of dialysis treatment for kidney disease patients? Pay for cardiac patients to undergo lifesaving surgery, or channel money toward efforts to prevent cardiovascular disease in the first place?

For universal health care (UHC) to become a reality, policymakers looking to make their money go as far as possible must make tough life-or-death choices like these.

Many low- and middle-income countries now aspire to achieve universal health coverage, where everyone can access quality health services without the risk of impoverishment. But for universal health care to work in practice, the health services offered must be consistent with the available funds, and this implies very difficult decisions—particularly for low- and middle-income countries that are resource-constrained, but where demand for high-quality health services and technologies is increasing rapidly.

In collaboration with iDSI, the Center for Global Development are launching a new book: What’s In, What’s Out: Designing Benefits for Universal Health Coverage. It shows how a defined list of services that will be funded with public monies (called a “health benefits package” or HBP—known in the US as “essential benefits”) can help bridge the gap between the aspirational rhetoric of universal health care and the real budgetary limitations that many countries face.

Leading experts and policymakers from more than 15 countries contributed to the book. Together, they consider the many dimensions of governance, budgets, methods, political economy, and ethics that are needed to decide “what’s in and what’s out” of a HBP in a way that is fair, evidence-based, and sustainable over time.

Rather than a technical manual for conducting health technology assessments or cost-effectiveness analysis, this book puts HBP development and design methods into a broader context and considers how these methods may be applied to coverage decisions in low- and middle-income countries. It offers a collection of views and perspectives, and also provides real-life examples of HBP design and adjustment in order to show the diverse approaches to priority-setting around the world.

CGD have uploaded a policy brief to the iDSI Knowledge Gateway that includes key messages from the book for donors and advocates. For advocates, the brief highlights important considerations for effective HBP design cost-effectiveness as the starting point for designing a health benefits package, and encourages transparency, citizen participation and embedding ethics in the design and implementation process; in order to equitably promote the health and welfare of the whole population.

For donors, the policy briefs focuses on practical ways donors can aid HBP design:

• Support HBP design with technical and financial resources
• Respect local cost-effectiveness thresholds and resource constraints

Read the full policy brief to find out how donors can help in more detail and explore the iDSI Knowledge Gateway for more resources on making cost-effective, evidence-based decisions in global health.