An exploration of the benefit and challenges of advancing HTA to developing countries.

1. The Advancement of HTA
to Developing Countries:
Concept, Program and
Pilot Project
Technical Advisory Group on Health
Technology and Infrastructure
World Health Organization, Geneva
November, 8, 2009
Reiner Banken M.D. M. Sc.
reinerbanken@gmail.com
Donald Juzwishin MHSA, PhD
donj@ideastoaction.ca

2. Outline
 Why should
developing
countries use HTA?
 How should
countries develop
HTA?
 Actions needed by
WHO for
supporting HTA
Country Projects
 Conclusion
2

3. Improving health by
improving decision-making
Governance
Health Impact
Decisions
Appropriate
Use
Health Technology
3

4. Evidence for informing
decision-making
Technological, Ethical,
Legislative
Conditions
Political, Social,
Economic
Intuitive
Conditions
4 Decision-making

5. Evidence …
The process of evidence
generation and use may be
more important than the
evidence itself.
5

6. Layers of questions & layers of
evidence
How should we do it
Health Technology Assessment
here?
Implementation
Should we do it
here? Appropriateness
Can it work Effectiveness
here?
Efficacy
Regulation
Can it work? Technical
Performance
6

7. CSIH Approach to Health System
Strengthening
Vision: Equity and Accountability
Stewardship and Leadership
“Health in all policies”
Social Determinants of
Health Human Health Financing and
Resource Allocation
Health Framework
Resources
Research for Development
(Evidence-Based planning and
policy-making)
Health Information
Systems
Data for Decision-
Evidence-Based
making
Decision-Making
(Clinical and
Service delivery Community
Community-based)
- treatments interventions
Strong and vibrant and health
and programs Civil Society
promotion
7 Transparent and Accountable Public/Private Sector

8. HTA for long term Health System
Strengthening
Vision: Equity and Accountability
Stewardship and Leadership
“Health in all policies”
Social Determinants of
Health Human Health Financing and
Resource Allocation
Health Framework
Resources
Research for Development
(Evidence-Based planning and
policy-making)
Health Information
Systems
Data for Decision-
HTA for Evidence-Based
making
Decision-Making
(Clinical and
Service delivery Community
Community-based)
- treatments interventions
Strong and vibrant and health
and programs Civil Society
promotion
8 Transparent and Accountable Public/Private Sector

9. Equity oriented,
needs based HTA
9 http://www.cgh.uottawa.ca/whocc/projects/
eo_toolkit/index.htm

10. 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
10

11. How should countries
develop HTA?
11

12. Resolution WHA A60/26
Health Technologies
(+ pharmaceuticals, interventions,
procedures, organizational systems,…)
Medical
Devices
« medical devices as a major subset of health
technologies »
12
http://www.who.int/gb/ebwha/pdf_files/WHA60/A60_26-en.pdf, paragraphe 1

13. 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 ,
13
available at http://bit.ly/47Jlca

14. National Health Technology
Programs for Medical Devices
…
Interventions Drugs
HTA
Health Care
Medical Device
Regulation HTM
14 Drugs … … …

15. Scope of HTA activities
HTA
System
>9 persons
HTA
4-5 persons
Committee
Dedicated
1-2 persons Resources
HTA Knowledge Putting HTA HTA Unit/
Mobilizer into Context Agency
15

16. Country Development of
HTA
 Identification of host country
organization and knowledge
mobilizer
 Orientation
 “Start small, have a
clear audience and  Linkage, uptake and
scope, and address exchange within host country
important questions” and with international
(Lavis et al 2008) community of practice
 Networking within host
country and with international
community of practice
 Execution of a policy relevant
and timely HTA
16

17. HTA
INAHTA
Professionals
WHO HTA Agencies
Country
WHO HTA
Collaborating Specific HTAi
Centers
HTA
Evidence Informed Policy and Decision Making
17

18. Ingredients for successful
implementation of HTA pilot projects
Good
Governance
Good
Successful Collaboration
Funding HTA pilots With Partners
Adequate
Staffing
18

19. 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
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 Access to financial resources….

20. 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.
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