Health care benefits package design to improve outcomes in resource-constrained settings: suggestions for Tajikistan.

The Tajik health system is characterized by improving health outcomes over the last 20 years, but also major inefficiencies in health care delivery and large difficulties for people to access affordable essential health care. The benefits package (BP) is a key tool for prioritizing state budget allocations toward health interventions that most effectively enhance health system performance. This article suggests directions for a new BP, which is envisioned in the currently ongoing reforms. Using a universal health coverage framework, the article examines how the public budget is prioritized in the current BP and investigates the main performance challenges addressed in the government's ongoing health reform efforts from a BP perspective. Criteria for a new BP are outlined, along with suggestions for their application. The article explains how BP design can improve health system performance in a budget-constrained setting by focusing on primary health care interventions and eliminating user fees for child and maternal health services, without requiring additional budget resources. The main strength of the current BP is the provision of free family doctor and nurse consultations for all. However, its narrow scope and high user fees for essential interventions hinder both the effective management of highly prevalent chronic non-communicable diseases and the efficient use of public resources. The user fee exemptions for vulnerable population groups are neither rational in design nor possible to evaluate due to the absence of data.