Applying Design Thinking for Health Benefit Package Expansion: A Framework and Comparative Review of Current Tools

Countries moving towards universal health coverage are challenged about what new health benefits and interventions they will add to their national health programs. Currently, there are three general approaches that countries use to expand their benefit packages: essential services or essential package list; health technology assessment agency driven approaches; and technical assistance and consultancies. Countries need comprehensive, easy-to-use tools to plan the pathway of adding interventions, which we call benefit package expansion. Such tools can complement approaches to benefit package expansion driven by agencies or technical assistance. We propose a new framework organized in three layers (Inner Core, Outer Core, and Mantle, or IOM framework) that outlines the features or characteristics to consider when designing and building a tool for benefit package expansion planning. The layers of the IOM framework refer to: (1) Inner Core—scoping the set of interventions; (2) Outer Core—cost and benefit information of the interventions; and (3) Mantle—additional considerations such as accessibility and documentation. In this study, we use this IOM framework to identify and review four existing tools that may support benefit package expansion. Based on our review applying a decision-matrix method (a modified Pugh method) that is standard in design thinking, we describe and compare the functionality and usability of these tools, their scope of interventions, information on interventions and services, and customizability for local country contexts. Compared to other tools, HIPtool was more comprehensive in terms of interventions and rated higher on Mantle dimensions of user accessibility, whereas OneHealth tool rated well on intervention costs and benefits. There remains a need for a central coordinating entity in the global health architecture to serve as a repository of tools for designing benefit packages for universal health coverage as well as reinforcing the importance of benefit package design as a crucial part of progressing towards universal health coverage.