The Advancement Of Hta To Developing Countries Concept, Program And Pilot Project

Reiner Banken M.D. M. [email protected]

Donald Juzwishin MHSA, [email protected]

The Advancement of HTAto Developing Countries:

Concept, Program and Pilot Project

Technical Advisory Group on Health

Technology and InfrastructureWorld Health Organization, Geneva

November, 8, 2009

2

Outline

Why should developing countries use HTA?

How should countries develop HTA?

Actions needed by WHO for supporting HTA Country Projects

Conclusion

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Improving health by improving decision-making

Health Technology

Appropriate

Use

Health Impact

Decisions

Governance

4

Evidence for informing decision-making

IntuitiveDecision-making

Political, Social,

Economic

Conditions

Technological, Ethical,

Legislative

Conditions

5

Evidence …

The process of evidence

generation and use may be

more important than the

evidence itself.

6

Layers of questions & layers of evidence

Technical

Performance

Implementation

Re

gu

lation H

ea

lth T

ech

nolo

gy A

sse

ssm

ent

EffectivenessCan it work here?

Efficacy

Can it work?

AppropriatenessShould we do it

here?

How should we do it here?

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CSIH Approach to Health System Strengthening

Health Information

SystemsData for Decision-

making

Research for Development(Evidence-Based planning and

policy-making)

Evidence-Based Decision-Making

(Clinical and Community-based)

Health Human Resources

Health Financing and Resource Allocation

Service delivery - treatments

and programs

Community interventions

and health promotion

Stewardship and Leadership

Transparent and Accountable Public/Private Sector

So

cia

l Dete

rm

inan

ts o

f H

ealth

Fram

ew

ork

“H

ealth

in a

ll po

licie

s”

Vision: Equity and Accountability

Strong and vibrant Civil Society

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HTA for long term Health System Strengthening

Health Information

SystemsData for Decision-

making

Research for Development(Evidence-Based planning and

policy-making)

HTA for Evidence-Based Decision-Making

(Clinical and Community-based)

Health Human Resources

Health Financing and Resource Allocation

Service delivery - treatments

and programs

Community interventions

and health promotion

Stewardship and Leadership

Transparent and Accountable Public/Private Sector

So

cia

l Dete

rm

inan

ts o

f H

ealth

Fram

ew

ork

“H

ealth

in a

ll po

licie

s”

Vision: Equity and Accountability

Strong and vibrant Civil Society

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Equity oriented, needs based HTA

http://www.cgh.uottawa.ca/whocc/projects/eo_toolkit/index.htm

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Why should developing countries use HTA?

HTA contributes to get good health technologies to poor people in poor countries

HTA is a pragmatic, highly adaptable tool to improve decision-making

HTA processes can create consensus among stakeholders on priorities and on needed actions

HTA guides and supports implementation

HTA improves Governance and strengthens Health Systems

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How should countries develop HTA?

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Resolution WHA A60/26

Medical

Devices

Health Technologies

(+ pharmaceuticals, interventions,

procedures, organizational systems,…)

http://www.who.int/gb/ebwha/pdf_files/WHA60/A60_26-en.pdf, paragraphe 1

« medical devices as a major subset of health

technologies »

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Challenges for HTA in developing countries

HTA offers critical information on technology solutions but…• To date most HTA applications have been

developed for high income countries with relatively well-established planning and regulatory systems in place

To be useful for developing countries, there is a need to …

• Find ways to lower the cost of establishing and maintaining HTA functions and capacities

• Better link HTA with governance and organizational reforms in the developing countries to generate appropriate demand

Akiko Maeda, World Bank, HTAi Conference, 2009 ,

available at http://bit.ly/47Jlca

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National Health Technology Programs for Medical Devices

Regulation

HTA

HTM

Medical Device

Health Care

Drugs

Interventions Drugs

……

…

…

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Scope of HTA activities

HTA Knowledge Mobilizer

1-2 persons

Putting HTA into Context

HTA Unit/ Agency

4-5 persons

>9 persons

DedicatedResources

HTA Committee

HTA System

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Country Development of HTA

Identification of host country organization and knowledge mobilizer

Orientation

Linkage, uptake and exchange within host country and with international community of practice

Networking within host country and with international community of practice

Execution of a policy relevant and timely HTA

“Start small, have a clear audience and scope, and address

important questions” (Lavis et al 2008)

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Country Specific

HTA

WHO HTA Collaborating

Centers

INAHTAHTA

Professionals

HTA Agencies

HTAi

Evidence Informed Policy and Decision Making

WHO

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Ingredients for successful implementation of HTA pilot projects

Successful HTA pilots

Good Governance

Adequate Staffing

FundingGood

Collaboration

With Partners

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Actions needed from WHO for developing HTA

Facilitate links between country HTA focal points and international knowledge resources

Support a Community of Practice of Country HTA Focal points

Advocate HTA as part of Good Health Governance and Health Systems Strengthening

Establish linkages at WHO between HTM, HTA, National Health Research and Evidence informed decision-making

Increase the number of staff with the relevant skills and understandings of HTA

Support the evaluation of the pilot projects

Access to financial resources….

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Conclusion

A gradual introduction of HTA in developing countries with support from WHO and other international organisations, accompanied by

an appropriate evaluation, will help to

get good health technologies to poor people in poor countries,

improve governance and

strengthen health systems.