RT Journal Article SR Electronic T1 Supporting the development of a health benefits package in Malawi JF BMJ Global Health FD BMJ Publishing Group Ltd SP e000607 DO 10.1136/bmjgh-2017-000607 VO 3 IS 2 A1 Jessica Ochalek A1 Paul Revill A1 Gerald Manthalu A1 Finn McGuire A1 Dominic Nkhoma A1 Alexandra Rollinger A1 Mark Sculpher A1 Karl Claxton YR 2018 UL http://gh.bmj.com/content/3/2/e000607.abstract AB Malawi, like many low-income and middle-income countries, has used health benefits packages (HBPs) to allocate scarce resources to key healthcare interventions. With no widely accepted method for their development, HBPs often promise more than can be delivered, given available resources. An analytical framework is developed to guide the design of HBPs that can identify the potential value of including and implementing different interventions. It provides a basis for informing meaningful discussions between governments, donors and other stakeholders around the trade-offs implicit in package design. Metrics of value, founded on an understanding of the health opportunity costs of the choices faced, are used to quantify the scale of the potential net health impact (net disability adjusted life years averted) or the amount of additional healthcare resources that would be required to deliver similar net health impacts with existing interventions (the financial value to the healthcare system). The framework can be applied to answer key questions around, for example: the appropriate scale of the HBP; which interventions represent ‘best buys’ and should be prioritised; where investments in scaling up interventions and health system strengthening should be made; whether the package should be expanded; costs of the conditionalities of donor funding and how objectives beyond improving population health can be considered. This is illustrated using data from Malawi. The framework was successfully applied to inform the HBP in Malawi, as a core component of the country’s Health Sector Strategic Plan II 2017–2022.