Strengthening health technology assessment systems in the global south: a comparative analysis of the HTA journeys of China, India and South Africa

MacQuilkan, Kim; Baker, Peter; Downey, Laura; Ruiz, Francis; Chalkidou, Kalipso; Prinja, Shankar; Zhao, Kuaile; Wilkinson, Thomas; Glassman, Amanda; Hofman, Karen

doi:10.1080/16549716.2018.1527556

Cited by 61 publications

(59 citation statements)

References 45 publications

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“…Although HTA remains relatively under-developed in SSA, there is growing political commitment and policy interest 14,15 . Priority setting is inevitable: the question is not whether, but rather how, to set them.…”

Section: Discussionmentioning

confidence: 99%

Health technology assessment capacity at national level in sub-Saharan Africa: an initial survey of stakeholders

et al. 2020

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Background: Health technology assessment (HTA) is an effective tool to support priority setting (PS) in health. Stakeholder groups need to understand HTA appropriate to their role and to interpret and critique the evidence produced. We aimed to rapidly assess current health system priorities and policy areas of demand for HTA in Sub-Saharan Africa, and identify key gaps in data and skills to inform targeted capacity building. Methods: We revised an existing survey, delivered it to 357 participants, then analysed responses and explored key themes. Results: There were 51 respondents (14%) across 14 countries. HTA was considered an important and valuable PS tool with a key role in the design of health benefits packages, clinical guideline development, and service improvement. Medicines were identified as a technology type that would especially benefit from the application of HTA. Using HTA to address safety issues (e.g. low-quality medicines) and value for money concerns was particularly highlighted. The perceived availability and accessibility of suitable local data to support HTA varied widely but was mostly considered inadequate and limited. Respondents also noted a need for training support in research methodology and data gathering. Conclusions: While important in raising awareness of HTA as a tool for PS, this study had a low response rate, and that respondents were self-selected. A more refined survey will be developed to support engagement strategies and capacity building.

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Section: Discussionmentioning

confidence: 99%

Health technology assessment capacity at national level in sub-Saharan Africa: an initial survey of stakeholders

et al. 2020

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“…Nevertheless, there are many challenges resulting from the technology itself, end-users and environments that continue to undermine efforts to provide UHC in this regard. Research in three BRICS and Global South countries, China, India and South Africa, showed similar barriers to strengthening and developing health technology assessment systems such as lack of expertise, weak health data infrastructure, rising healthcare costs, fragmentation of healthcare systems and growth in noncommunicable diseases [60].…”

Section: Medical Products Vaccines and Technologiesmentioning

confidence: 96%

Public health system challenges in the Free State, South Africa: a situation appraisal to inform health system strengthening

Malakoane

Heunis

Chikobvu

et al. 2020

BMC Health Serv Res

124

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Background: Since the advent of democracy, the South African government has been putting charters, policies, strategies and plans in place in an effort to strengthen public health system performance and enhance service delivery. However, public health programme performance and outcomes remained poor while the burden of disease increased. This was also the case in the Free State Province, where major public health system challenges occurred around 2012. Assessment was necessary in order to inform health system strengthening. Methods: The study entailed a multi-method situation appraisal utilising information collated in 44 reports generated in 2013 through presentations by unit managers, subdistrict assessments by district clinical specialist teams, and group discussions with district managers, clinic supervisors, primary health care managers and chief executive and clinical officers of hospitals. These data were validated through community and provincial health indabas including non-governmental organisations, councils and academics, as well as unannounced facility visits involving discussions with a wide range of functionaries and patients. The reports were reviewed using the World Health Organization health system building blocks as a priori themes with subsequent identification of emerging subthemes. Data from the different methods employed were triangulated in a causal loop diagram showing the complex interactions between the components of an (in) effective health system. Results: The major subthemes or challenges that emerged under each a priori theme included: firstly, under the 'service delivery' a priori theme, 'fragmentation of health services' (42 reports); secondly, under the 'health workforce' a priori theme, 'staff shortages' (39 reports); thirdly, under the 'health financing' a priori theme, 'financial/cash-flow problems' (39 reports); fourthly, under the 'leadership and governance' a priori theme, 'risk to patient care' (38 reports); fifthly, under the 'medical products/technologies' a priori theme, 'dysfunctional communication technology' (27 reports); and, sixthly, under the 'information' a priori theme, 'poor information management' (26 reports). Conclusion: The major overall public health system challenges reported by stakeholders involved fragmentation of services, staff shortages and financial/cash-flow problems. In order to effect health systems strengthening there was particularly a need to improve integration and address human and financial deficiencies in this setting.

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“…For example, in the overwhelming majority of countries in SSA, value sets are simply not available for the most commonly, and widely understood, generic HRQoL tool, the EQ-5D (five dimensions). The adoption of QALYs is feasible in SSA [65], and awareness raising together with action and support for research efforts at developing value sets for Ghana through peer or South-South channels may be an important means of methods development [7]. This highlights the importance of having a reference case [22] that signals preference (and creates a demand) for certain types of data [78].…”

Section: Implications For Policy and Practicementioning

confidence: 99%

“…Health technology assessment (HTA) represents a commonly used approach to synthesising evidence on the effectiveness and costs of an intervention, which also aims to consider social value judgements as part of a process to inform efficient and equitable resource allocation [1,2]. While the specific methods and processes vary according to context, HTA informs health spending decisions in almost all high-income countries [3], and increasingly in middle-income countries such as Thailand [4,5] and South Africa [6,7], and regions including the Middle East and North Africa [8,9]. The World Health Assembly Resolution of 2014 on Health Intervention and Technology Assessment recognizes the importance of this approach as a key element of any strategy for achieving universal health coverage (UHC) [2,10].…”

Section: Introductionmentioning

confidence: 99%

What do we need to know? Data sources to support evidence-based decisions using health technology assessment in Ghana

Hollingworth

Downey

Ruiz

et al. 2020

Health Res Policy Sys

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Introduction Health technology assessment (HTA) is an effective tool to support priority setting and generate evidence for decision making especially en route to achieving universal health coverage (UHC). We assessed the capacity needs, policy areas of demand, and perspectives of key stakeholders for evidence-informed decision making in Nigeria where HTA is still new. Methods We surveyed 31 participants including decision makers, policy makers, academic researchers, civil society organizations, community-based organizations, development partners, health professional organizations. We revised an existing survey to qualitatively examine the need, policy areas of demand, and perspectives of stakeholders on HTA. We then analyzed responses and explored key themes. Results Most respondents were associated with organizations that generated or facilitated health services research. Research institutes highlighted their ability to provide expertise and skills for HTA research but some respondents noted a lack of human capacity for HTA. HTA was considered an important and valuable priority-setting tool with a key role in the design of health bene ts packages, clinical guideline development, and service improvement. Public health programs, medicines and vaccines were the three main technology types that would especially bene t from the application of HTA. The perceived availability and accessibility of suitable local data to support HTA varied widely but was mostly considered inadequate and limited. Respondents needed evidence on health system nancing, health service provision, burden of disease and noted a need for training support in research methodology, HTA and data management Conclusion The use of HTA by policymakers and communities in Nigeria is very limited mainly due to inadequate and insu cient capacity to produce and use HTA. Developing sustainable and institutionalized HTA systems requires in-country expertise and active participation from a range of stakeholders. Stakeholder participation in identifying HTA topics and conducting relevant research will enhance the use of HTA evidence produced for decision making. Therefore, the identi ed training needs for HTA and possible research topics should be considered a priority in establishing HTA for evidenceinformed policy making for achieving UHC particularly among the most vulnerable people in Nigeria.

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Strengthening health technology assessment systems in the global south: a comparative analysis of the HTA journeys of China, India and South Africa

Cited by 61 publications

References 45 publications

Health technology assessment capacity at national level in sub-Saharan Africa: an initial survey of stakeholders

Health technology assessment capacity at national level in sub-Saharan Africa: an initial survey of stakeholders

Public health system challenges in the Free State, South Africa: a situation appraisal to inform health system strengthening

What do we need to know? Data sources to support evidence-based decisions using health technology assessment in Ghana

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