The Advancement Of Hta To Developing Countries Concept, Program And Pilot Project
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Transcript of 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
3
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
8
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
9
Equity oriented, needs based HTA
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
11
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 »
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 ,
available at http://bit.ly/47Jlca
14
National Health Technology Programs for Medical Devices
Regulation
HTA
HTM
Medical Device
Health Care
Drugs
Interventions Drugs
……
…
…
15
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
16
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)
17
Country Specific
HTA
WHO HTA Collaborating
Centers
INAHTAHTA
Professionals
HTA Agencies
HTAi
Evidence Informed Policy and Decision Making
WHO
18
Ingredients for successful implementation of HTA pilot projects
Successful HTA pilots
Good Governance
Adequate Staffing
FundingGood
Collaboration
With Partners
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
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.