Addressing the challenges of implementing a Health Technology Assessment Policy Framework in South Africa

Mueller, Debjani

doi:10.1017/s0266462320000562

Cited by 18 publications

(15 citation statements)

References 17 publications

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“…Our findings align with those of research identifying a lack of resources, both financial and human, as challenges to introducing HTA, alongside the absence of government-regulated HTA (21). On the one hand, effective governance, collaboration, and cooperation among key stakeholders of the healthcare system were suggested as possible ways forward for the institutionalization of HTA (22). On the other hand, the perceived usefulness of HTA is an important concept that has not received much coverage.…”

Section: Discussionsupporting

confidence: 82%

Exploring facilitators and barriers to introducing health technology assessment: a systematic review

Suharlim

Kumar

Salim

et al. 2021

Int J Technol Assess Health Care

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Objective This study aims to identify and codify the facilitators and barriers to help implementing partners institutionalize health technology assessment (HTA) successfully and navigate complex systems for health-related policy making. Methods We searched for peer-reviewed and gray literature articles examining HTA programs globally using six databases. Keywords used as a guide for capturing articles included “health technology assessment,” “barrier,” and “facilitator” and their synonyms. Search results were scrutinized for duplicates and screened through a review of titles and abstracts. A full-text review was conducted exploring articles’ coverage of twenty-seven evaluation criteria across four primary areas of interest: barriers/facilitators, motivations, guidelines, and institutional frameworks. Results A total of 18,599 records were identified for duplication check, title, and abstract review. A total of 1,594 articles underwent full-text review, leading to a final synthesis of 262 studies. We found that ninety-seven articles discussed barriers/facilitators, with fifty-three of those discussing local capacity and unavailable human resources. Out of the sixty-six articles discussing motivations, forty-two cited the interest in supporting the decision-making process for, and promoting, appropriate resource allocation. Of the sixty-one articles that discussed guidelines and institutional framework, twenty-one articles described HTA as an independent national unit, and sixteen described their HTA unit as a unit within the Ministry of Health (MOH). Conclusions This systematic review unpacks the dynamic and relevant contexts for understanding the HTA institutionalization process to help policy makers and practitioners achieve tangible progress in confronting the most critical issues facing priority setting and HTA institutionalization.

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Section: Discussionsupporting

confidence: 82%

Exploring facilitators and barriers to introducing health technology assessment: a systematic review

Suharlim

Kumar

Salim

et al. 2021

Int J Technol Assess Health Care

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“…Therefore, a more ambitious objective could be the creation of a HTA committee, as attempted in Tanzania ( 17 ). This could help to limit the uncoordinated approach of adopting measures, and facilitate the collaboration and cooperation between government authorities with related, but differing mandates, for instance departments of ministries of health and ministries of finance, as well as other stakeholders ( 13 ).…”

Section: Discussionmentioning

confidence: 99%

“…Secondly, there is limited and unreliable locally-relevant data to inform country specific HTAs ( 24 – 26 ). Thirdly, more formal local decision-making procedures, such as the use of HTA that simultaneously considers costs and benefits, are often lacking and there is limited understanding by policymakers of its potential value ( 9 , 13 ).…”

Section: Introductionmentioning

confidence: 99%

“…In Africa, South Africa uses formal processes to inform priority setting and decisions on health insurance benefits and essential medicine selection. The country has committed to strengthening HTA capacity and developing its domestic HTA systems ( 8 , 9 ); the imminent objective of introducing a national health insurance program provides an opportunity to formally introduce the use of HTA in decision-making ( 13 ).…”

Section: Introductionmentioning

confidence: 99%

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Assessing the potential of HTA to inform resource allocation decisions in low-income settings: The case of Malawi

Ramponi

Twea²,

Chilima³

et al. 2022

Front. Public Health

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Health technology assessment (HTA) offers a set of analytical tools to support health systems' decisions about resource allocation. Although there is increasing interest in these tools across the world, including in some middle-income countries, they remain rarely used in low-income countries (LICs). In general, the focus of HTA is narrow, mostly limited to assessments of efficacy and cost-effectiveness. However, the principles of HTA can be used to support a broader series of decisions regarding new health technologies. We examine the potential for this broad use of HTA in LICs, with a focus on Malawi. We develop a framework to classify the main decisions on health technologies within health systems. The framework covers decisions on identifying and prioritizing technologies for detailed assessment, deciding whether to adopt an intervention, assessing alternative investments for implementation and scale-up, and undertaking further research activities. We consider the relevance of the framework to policymakers in Malawi and we use two health technologies as examples to investigate the main barriers and enablers to the use of HTA methods. Although the scarcity of local data, expertise, and other resources could risk limiting the operationalisation of HTA in LICs, we argue that even in highly resource constrained health systems, such as in Malawi, the use of HTA to support a broad range of decisions is feasible and desirable.

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“…In this capacity, they have to ensure that safe, effective, and essential technologies are procured and maintained within their respective budgets. Indeed, while the public health sector accounts for about 40% of all expenditure on health, it is under pressure to deliver services to about 80% of the population [16]. Inequalities exist in the distribution of hospitals between provinces and rural settings, with healthcare workers being disproportionately employed in the private sector [13].…”

mentioning

confidence: 99%

Portable continuous wave Doppler ultrasound for primary healthcare in South Africa: can the EUnetHTA Core Model guide evaluation before technology adoption?

Mueller

Pattinson

Hlongwane

et al. 2021

Cost Eff Resour Alloc

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Background This study had a threefold aim: to test the value of stakeholder involvement in HTA to reduce evidence gaps and interpret findings; and to assess a medical device by applying the EUnetHTA Core Model (CM) in South Africa and thus ultimately provide a first overview of evidence for potential widespread adoption of the technology in a primary health care (PHC) setting. Used in primary healthcare setting for obstetric use, the technology under assessment is a low-cost continuous wave Doppler ultrasound (DUS). Methods The scoping of the assessment was defined by involving policy makers in selecting the domains and corresponding questions relevant to the ultrasound and its use. Additionally, hospital managers were invited to respond to dichotomous questions on the criteria for procurement. To substantiate evidence obtained from an initial literature review, different stakeholders were identified and consulted. The evidence generated fromall steps was used to populate the high-ranked assessment elements of the CM. Results The HTA on continuous-wave DUS incorporated the evidence on organizational, ethical, and social value of its use together with effectiveness, safety, and cost-effectiveness of the technology. The domains on “health problem” and “safety” had a higher rank than the rest of the nine domains. Unexplained fetal mortality is the largest single contributor to perinatal deaths in South Africa. Pregnant women in PHC setting were examined using a continuous-wave DUS, after their routine antenatal visit. The healthcare professionals interviewed, indicated the benefit in the use of continuous-wave DUS in the PHC setting and the need for training. Conclusions Collection and generation of evidence based on the HTA CM and the chosen decision criteria provided a generalized but structured guidance on the methodology. Several questions were not applicable for the technology and the context of its use and elimination of those that are inappropriate for the African context, resulted in a pragmatic solution. Engaging and consulting local stakeholders was imperative to understand the context, reduce evidence gaps, and address the uncertainties in the evidence, ultimately paving the way for technology adoption. Given the ongoing studies and the evolving evidence base, the potential of this technology should be reassessed.

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Addressing the challenges of implementing a Health Technology Assessment Policy Framework in South Africa

Cited by 18 publications

References 17 publications

Exploring facilitators and barriers to introducing health technology assessment: a systematic review

Exploring facilitators and barriers to introducing health technology assessment: a systematic review

Assessing the potential of HTA to inform resource allocation decisions in low-income settings: The case of Malawi

Portable continuous wave Doppler ultrasound for primary healthcare in South Africa: can the EUnetHTA Core Model guide evaluation before technology adoption?

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