Introduction Zanzibar’s policy is in line with the UHC goals which aims to ensure that essential health services are delivered free of charge to the entire population. The Essential Health Care Package (EHCP) developed in 2007, however, for a number of internal and external factors the EHCP has not had much impact on the health system in Zanzibar.

Objective The overall objective of this paper is to describe steps used in the revision of the EHCP with specific focus on stakeholders’ engagement.

Method The revision of Zanzibar’s EHCP was done in 2019 of which the process is described in this paper. A roadmap that has been approved by the management of the MOH was developed by a team of experts, and technical input were received from various organisations including WHO and other international and national experts. TWG workshops and a series of consensus building meetings were conducted to discuss the concept of EHCP, roadmap for the revision, scope, criteria and methodological approach. A list of 586 interventions was first prepared and evidence was collected from national guidelines and documents.

Results Through deliberative process six criteria for selecting interventions were agreed which are: Financial Risk Protection, Cost-effectiveness, Priority to the Worse off, Disease Burden, Budget impact and Public and Political Acceptability. Further, a total of 224 interventions were agreed with 22 program areas and categorized as Low (5%), Medium (18%) and High (77%). Each of the interventions was linked to its respective delivery platform. Cost and effectiveness of the EHCP was analysed using the FairChoices tool.

Discussion The process of revising EHCP varies from country to country, however, there are many similarities. Institutionalization of the process and public participation are the areas that need to be strengthened.