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

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

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

  1. 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. 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. 3. Improving health by improving decision-making Governance Health Impact Decisions Appropriate Use Health Technology 3
  4. 4. Evidence for informing decision-making Technological, Ethical, Legislative Conditions Political, Social, Economic Intuitive Conditions 4 Decision-making
  5. 5. Evidence … The process of evidence generation and use may be more important than the evidence itself. 5
  6. 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. 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. 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. 9. Equity oriented, needs based HTA 9 http://www.cgh.uottawa.ca/whocc/projects/ eo_toolkit/index.htm
  10. 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. 11. How should countries develop HTA? 11
  12. 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. 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. 14. National Health Technology Programs for Medical Devices … Interventions Drugs HTA Health Care Medical Device Regulation HTM 14 Drugs … … …
  15. 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. 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. 17. HTA INAHTA Professionals WHO HTA Agencies Country WHO HTA Collaborating Specific HTAi Centers HTA Evidence Informed Policy and Decision Making 17
  18. 18. Ingredients for successful implementation of HTA pilot projects Good Governance Good Successful Collaboration Funding HTA pilots With Partners Adequate Staffing 18
  19. 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 19  Access to financial resources….
  20. 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. 20

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