Health Technology Assessment in Low and Middle Income Countries: Emerging Technical Area of Interest for Joint Learning

Universal Health Coverage is mandated by many low and middle countries. Countries in Asia and Africa are launching publicly sponsored health insurance program for covering populations. These countries continue to face challenges in providing adequate benefit coverage due to limited resources which may be due to shrinking fiscal space or global financial crisis. Priority setting for the health sector becomes all the more important for the developing countries to address the impending disease burden and to reduce morbidity and mortality.

The Joint Learning Network for Universal Health Coverage recently hosted the Network Wide Meeting in Malaysia in July 2016. Health Technology Assessment was one of the core technical sessions that participating countries were interested in jointly learning from.

Using evidence for decision making is a rational approach. Health Technology Assessment is an effective tool used for decision making for covering technologies and drug under health insurance plan. Health Technology Assessment is an established tool for systematic and evidence based decision making.

The goal of Health Technology Assessment program is to apply a formalized and systematic process to adopt a new medical technology. The Health Technology Assessment process enables an evidence based decision making process. Health Technology Assessment follows modern principles of Evidence Based Medicine, cost effectiveness, and provision of patient centered services.

Health Technology Assessment helps ease patient access to cost effective health technologies that improve health outcomes. Health Technology Assessment programs minimize the use of technologies that are ineffective and harmful. Health Technology Assessment programs contribute to value for money investments in health technology.

Dr. Sivalal Sadasivan, Associate Professor from Monash University, Malaysia, presented an overview on concepts of Health Technology Assessment. He shared his experience from setting up Health Technology Assessment unit at the Malaysian Ministry of Health.

Some of the Joint Learning Network member countries are keen to start Health Technology Assessments in their respective countries such as the Philippines, Kenya, India, Vietnam, and Malaysia. The member countries expressed interest in being part of a collaborative learning environment on the subject were they get to understand and learn from the experiences of other countries on Health Technology Assessments. The participants mentioned that they face challenges in setting up due to limited capacity and skills set available to undertake Health Technology Assessment studies. The political and regulation environment is currently not conducive, since the decisions made are the personal opinions of experts and advisors of the Ministries.

Participants raised that there are number of resources available on the web, but would need some support in prioritization and identification of suitable or appropriate resources for their country setting. The participants emphasized that the joint learning will help the member countries in learning from some good practices in Health Technology Assessment. These member countries are at different stage of establishing the systems.

Some of the member countries shared their intension to start Health Technology Assessments and some shared what they are already doing on Health Technology Assessments in their countries.

The Government of Kenya has declared health as a basic right. Health has become one of the political subjects in Kenya. The politicians have promise too much to the people but the resources are limited. Kenya is keen to start evidence based decision making using Health Technology Assessment. The health economics unit has convened a team to understand what it requires to do Health Technology Assessments and thereafter conducting Health Technology Assessments, Kenya has reached out to the Joint Learning Network to seek technical guidance and input.

Philippines Health Insurance Corporation has an initiative to design their own Health Technology Assessment program. The European Union is providing technical support to this initiative. PhilHealth will develop program, policy, and implementation plan to take off the Health Technology Assessment program. The program has a capacity building approach phased in the program. The work will involve:

Orientation of identified stakeholders

Advocacy and consensus building

Undertaking situational analysis

Propose a governance structure

Develop an implementation plan with budget

Prepare a policy instrument to institutionalize and operationalize the program

In addition, the State Government of Kerala in India has expressed interest in setting up the Health Technology Assessment unit in the Department of Health. The State government is undertaking Universal Health Coverage projects in the state and Health Technology Assessment as one of the key priorities. The leadership in the state is keen to establish an evidence based decision making process while considering their benefit package and would like to look at other country experiences in setting up Health Technology Assessment in a resource limited setting.

The participants were also informed about the International Decision Support Initiative as an available resource on Health Technology Assessments. The International Decision Support Initiative provides technical support to establish Health Technology Assessment in low and middle income countries. The International Decision Support Initiative is a global partnership of leading government institutes, universities, and think tanks to support policymakers in priority setting for universal health coverage. The International Decision Support Initiative provides demand driven practical support and knowledge products to policymakers and funders to make better decisions for better health. More information and knowledge products are available at

Different countries have different trigger points or reasons for initiating Health Technology Assessments. In Malaysia, pressure from private sector institutions to cover for an expensive technology in cardiac led to institutionalization of Health Technology Assessment in the country.

The Institutional structure built for Health Technology Assessment will determine their success. In Korea, a special agency was created to undertake Health Technology Assessments. The National Evidence based Healthcare Collaborating Agency was created to assess the safety and effectiveness of the technology, or procedure. Health Insurance Review and Assessment Services undertakes the economic evaluation of the respective technologies.

Politicization of Health Technology Assessment is one of the most critical issues. Working with academics, private institutions, and community organization is important in the decision making process. Creating a formal network at country level is important in the decision making process.

Advocacy of Health Technology Assessment among policy makers will help in implementing at the country level. Linkage of the Health technology assessment program to the legal framework in the country is important. Some of the drugs or technologies may be safe and cost effective, but the evaluation of the legal structure needs to be undertaken.

Health Technology Assessment requires skills in economic and medical evaluation. Adequate capacity is essential for the Health Technology Assessment program. Capacity building and training of personnel is key to quality results from the assessments.

Countries do not need to undertake Health Technology Assessment from scratch but can rely on the assessment carried out in other countries and settings. Health Technology International Assessment International and International Association for Health Technology Assessment are two main sources for Health Technology Assessment data available globally. One of the challenges for the countries is to identify and rank available resources.

The Joint Learning Network will conduct a situation analysis and detailed needs assessment of Health Technology Assessment within the member countries. This will help in identifying where the countries are at with establishing and implementing Health Technology Assessments for decision making and common challenge areas for joint learning. The needs assessment will capture the status of governance and institutional structures, engagement, capacity building, training, and understand the demand and use of Health Technology Assessment results.