Introduction Honduras is a LMIC with a fragmented health system with less than 100 US$ per capita per year to meet its health needs. Under its commitment with UHC, the government decided to design one common health benefits package (HBP) for the population.

Methods The design of the HBP was carried out in five distinctive steps: i)The fundamental characteristics of the HBP (key goals, structure, scope, target population) were defined together with an interinstitutional team of the Honduran Ministry of Health and the Social Security Institute. ii) The universe of the potential candidates for inclusion were identified by taking advantage of previous work carried out in the country and the HBPs developed by the Disease Control Priorities Project. iii) Prioritization criteria (equity, efficiency and financial protection) and decision rules were discussed and operationalized. iv) A ‘bottom-up’ approach was used to cost the HBP with the current low coverage and with different targets of improved coverage levels. v) Fiscal impact analyses were elaborated and alternative expansion paths were discussed with the government putting forward ethical criteria on the road towards UHC.

Results The resulting HBP includes 74 essential health interventions. Honduras is currently allocating $29 USD annually for the services included in the HBP while a 100% coverage would require an additional $44 USD, an amount that accounts for over 50% the current health budget and that cannot be realistically reallocated from elsewhere. A progressive expansion path was suggested instead whereby marginal increases in the health budget would be allocated to the HBP.

Discussion Designing a HBP is a multistep context-specific process that goes beyond the implementation of health technology assessment methods. It requires time intensive technical and participatory work, and substantial pragmatism to adapt the technical recommendations from the literature to the data and time restrictions on the ground.