Adaptive health technology assessment to facilitate priority setting in low- and middle-income countries

Nemzoff, Cassandra; Ruiz, Francis; Chalkidou, Kalipso; Mehndiratta, Abha; Guinness, Lorna; Cluzeau, Françoise; Shah, Hiral

doi:10.1136/bmjgh-2020-004549

Cited by 32 publications

(37 citation statements)

References 16 publications

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“… 77 Further, adaptive health technology assessment models have been suggested in the context of public health emergencies like COVID-19. 162 However, given the evolving nature of digital technologies in public health, it is recommended that adaptive research and evaluation methods should the standard. 162 Further, for pragmatic policies to be made and implemented appropriately, public health policy makers, practitioners, and researchers will require continued education on new working methods in a digital environment.…”

Section: Discussionmentioning

confidence: 99%

“… 162 However, given the evolving nature of digital technologies in public health, it is recommended that adaptive research and evaluation methods should the standard. 162 Further, for pragmatic policies to be made and implemented appropriately, public health policy makers, practitioners, and researchers will require continued education on new working methods in a digital environment. Considering low public trust in digital technologies generally, there is a need for proactive communication and engagement strategies to foster the growth of digital public health.…”

Section: Discussionmentioning

confidence: 99%

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Challenges in the development of digital public health interventions and mapped solutions: Findings from a scoping review

Iyamu

Gómez-Ramírez

et al. 2022

DIGITAL HEALTH

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Background “Digital public health” has emerged from an interest in integrating digital technologies into public health. However, significant challenges which limit the scale and extent of this digital integration in various public health domains have been described. We summarized the literature about these challenges and identified strategies to overcome them. Methods We adopted Arksey and O’Malley's framework (2005) integrating adaptations by Levac et al. (2010). OVID Medline, Embase, Google Scholar, and 14 government and intergovernmental agency websites were searched using terms related to “digital” and “public health.” We included conceptual and explicit descriptions of digital technologies in public health published in English between 2000 and June 2020. We excluded primary research articles about digital health interventions. Data were extracted using a codebook created using the European Public Health Association's conceptual framework for digital public health. Results and analysis Overall, 163 publications were included from 6953 retrieved articles with the majority (64%, n = 105) published between 2015 and June 2020. Nontechnical challenges to digital integration in public health concerned ethics, policy and governance, health equity, resource gaps, and quality of evidence. Technical challenges included fragmented and unsustainable systems, lack of clear standards, unreliability of available data, infrastructure gaps, and workforce capacity gaps. Identified strategies included securing political commitment, intersectoral collaboration, economic investments, standardized ethical, legal, and regulatory frameworks, adaptive research and evaluation, health workforce capacity building, and transparent communication and public engagement. Conclusion Developing and implementing digital public health interventions requires efforts that leverage identified strategies to overcome diverse challenges encountered in integrating digital technologies in public health.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Challenges in the development of digital public health interventions and mapped solutions: Findings from a scoping review

Iyamu

Gómez-Ramírez

et al. 2022

DIGITAL HEALTH

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Section: Discussionmentioning

confidence: 99%

“…India is building a strong basis for HTA through the HTAIn programme and academic centres of excellence are developing health economics capacity across the country, 46 using innovative approaches such as adaptive HTA. 47 An important aspect of the NCG Guidelines programme is its link with the AB-PMJAY Scheme and the significant contribution it can make to its quality agenda. In the context of redesigning the healthcare system, NCG guidelines help standardise cancer care through implementing the health benefits packages and the use of strategic purchasing contracting and provider payments, helping India to achieve UHC.…”

Section: Recommendation Option Definitionmentioning

confidence: 99%

Ensuring quality in contextualised cancer management guidelines for resource-constraint settings: using a systematic approach

et al. 2022

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To address the wide variation in access to cancer care in India requires strengthening of infrastructure, trained oncology workforce, and minimisation of out-of-pocket expenditures. However, even with major investments, it is unlikely to achieve the same level of infrastructure and expertise across the country. Therefore, a resource stratified approach driven by evidence-based and contextualised clinical guidelines is the need of the hour. The National Cancer Grid has been at the forefront of delivery of standardised cancer care through several of its initiatives, including the resource-stratified guidelines. Development of new guidelines is resource and time intensive, which may not be feasible and can delay the implementation. Adaptation of the existing standard guidelines using the transparent and well-documented methodology with involvement of all stakeholders can be one of the most reasonable pathways. However, the adaptation should be done keeping in mind the context, resource availability, budget impact, investment needed for implementation and acceptability by clinicians, patients, policymakers, and other stakeholders. The present paper provides the framework for systematically developing guidelines through adaptation and contextualisation. The process can be used for other health conditions in resource-constraint settings.

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“…iDSI core partners have supported collaborations between Thailand and Kenya [ 88 ], and Norway and Ghana [ 73 , 74 ] in relation to strengthening value for money decisions (and the capacity to make them) as part of UHC, a key emphasis is on building relationships that focus on people, policy, and process for implementing HTA [ 7 ]. HTA methods and processes can be adapted to inform policy decisions while accounting for uncertainty considerations and context-specific practicality constraints in LMIC [ 89 , 90 ].…”

Section: Discussionmentioning

confidence: 99%

Health technology assessment in sub-Saharan Africa: a descriptive analysis and narrative synthesis

Hollingworth

Fenny

et al. 2021

Cost Eff Resour Alloc

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Background Countries in Sub-Saharan Africa (SSA) are moving towards universal health coverage. The process of Health Technology Assessment (HTA) can support decisions relating to benefit package design and service coverage. HTA involves institutional cooperation with agreed methods and procedural standards. We systematically reviewed the literature on policies and capacity building to support HTA institutionalisation in SSA. Methods We systematically reviewed the literature by searching major databases (PubMed, Embase, etc.) until June 2019 using terms considering three aspects: HTA; health policy, decision making; and SSA. We quantitatively extracted and descriptively analysed content and conducted a narrative synthesis eliciting themes from the selected literature, which varied in study type and apporach. Results Half of the 49 papers identified were primary research studies and mostly qualitative. Five countries were represented in six of ten studies; South Africa, Ghana, Uganda, Cameroon, and Ethiopia. Half of first authors were from SSA. Most informants were policy makers. Five themes emerged: (1) use of HTA; (2) decision-making in HTA; (3) values and criteria for setting priority areas in HTA; (4) involving stakeholders in HTA; and (5) specific examples of progress in HTA in SSA. The first one was the main theme where there was little use of evidence and research in making policy. The awareness of HTA and economic evaluation was low, with inadequate expertise and a lack of local data and tools. Conclusions Despite growing interest in HTA in SSA countries, awareness remains low and HTA-related activities are uncoordinated and often disconnected from policy. Further training and skills development are needed, firmly linked to a strategy focusing on strengthening within-country partnerships, particularly among researchers and policy makers. The international community has an important role here by supporting policy- relevant technical assistance, highlighting that sustainable financing demands evidence-based processes for effective resource allocation, and catalysing knowledge-sharing opportunities among countries facing similar challenges.

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Adaptive health technology assessment to facilitate priority setting in low- and middle-income countries

Cited by 32 publications

References 16 publications

Challenges in the development of digital public health interventions and mapped solutions: Findings from a scoping review

Challenges in the development of digital public health interventions and mapped solutions: Findings from a scoping review

Ensuring quality in contextualised cancer management guidelines for resource-constraint settings: using a systematic approach

Health technology assessment in sub-Saharan Africa: a descriptive analysis and narrative synthesis

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