As part of three recent events, which saw hundreds working in health policy gather in Accra, Liverpool and London, iDSI sought to delve into important factors that guide the design of Essential Medicines Lists and Health Benefit Packages that can evidentially identify the potential value of different interventions.

The events allowed for an increased understanding of the value of Health Technology Assessment (HTA) and how it underpins strategic purchasing of health services for achieving UHC; and shone a light on ‘demonstration’ countries such as China and Ghana which are making large strides towards ensuring HTA is at the forefront of their policy agenda. Events on this scale are a result of the culmination of many years of engagement; and new partnerships that have enabled iDSI access to new LMIC partners, allowing for regional and global networking and knowledge sharing.

Setting Priorities Fairly: Sustainable Policies for Effective Resource Allocation saw almost 100 policy representatives from across Africa and Europe gathered in Accra, Ghana for a special event in September 2018 that focused on sustainable resource allocation policies for LMICs, co-hosted by iDSI and Health Technology Assessment International (HTAi). The event marks an important milestone in iDSI’s collaboration with Ghana which began in 2008 (via the Global Health and Development Group at Imperial College, formerly NICE International), as well as the nation’s commitment to realising a “Ghana beyond aid” as its booming economy puts it on course to transition from external development aid.

The two-day event, opened by Ghana’s Deputy Minister for Health Mr Kingsley Aboagye-Gyedu, set out to address the difficulties LMICs face with attaining UHC; and how to navigate inconsistent and dwindling healthcare funding. HTA was a key focus, with presentations including global experiences of HTA from eminent researchers, health economists and clinicians from the University of Ghana, Ghana’s National Health Insurance Authority, The Global Fund to Fight AIDS, Tuberculosis and Malaria, World Health Organization, HTAi, iDSI and more.

During his keynote speech Mr Aboagye-Gyedu described how Ghana had incorporated HTA recommendations in its Standard Treatment Guidelines and Essential Medicines List because of its usefulness as tool to assuring value-for-money – from the design and management of benefit packages to the determination of reimbursement list of medicines. This follows a View our iDSI timeline to read more about Ghana’s journey towards UHC to date.

iDSI‘s newly released Health Technology Assessment Toolkit was launched at the event, with each delegate receiving the resource on a USB stick. The HTA Toolkit is a free, accessible resource for technical staff working in health policy keen to build HTA processes in their own countries and was developed in consultation with staff working in health policy around the world.

In October 2018 iDSI co-hosted a satellite session on the opening day of the Fifth Global Symposium on Health Systems Research in Liverpool, with Sida and CHAI, on Health financing towards UHC. Through the collaboration, the session brought together officials from Kenya, Zambia, Indonesia, Malawi – as well Eswatini and Rwanda, with whom iDSI had not previously engaged – representing ministries of health, national health insurers, a Prime Minister’s cabinet and academia. The panellists shared practical experiences from health financing reforms in their countries, with a focus on priority-setting and strategic purchasing. The overarching theme of the symposium was Health Systems for all in the Sustainable Development Goals era and it commemorated anniversaries of two significant global health events – the Alma Ata declaration and the 70 years of the UK National Health Service (NHS).

The same week saw iDSI welcome 22 delegates from China, from both clinical and non-clinical backgrounds, representing various departments within the Chinese Ministry of Health (National Health Commission); the China National Health and Development Research Center (Beijing and Shanghai); local policy makers from three provinces; and academics from Huazong, Beijing and Shanghai universities, to develop their understanding of the UK healthcare system, including health-related legislation and regulatory mechanisms, policy development and health reforms. The momentum behind HTA in China has in part been facilitated by longstanding relationships between the Global Health and Development Group and the enthusiasm of Chinese policy makers following UK study tours to learn about the NHS approach to setting priorities fairly.

The visit preceded the National HTA Congress in Beijing on 25 October 2018 which saw the formal launch of the National Center for Integrated Assessment of Pharmaceuticals and Health Technologies in China, and where iDSI support was noted at the opening event. One of the first major tasks of the national HTA Center will be to update the National Essential Drugs List taking into consideration cost-effectiveness criteria. The HTA Center’s work will be carried out by iDSI core partner the China National Health Development Research Center, a national think-tank set up in 2008 that provides evidence-based technical advice to national and provincial health policy-makers.

iDSI Director Professor Kalipso Chalkidou has said China “can lead the way” with regards to using HTA as a policy tool to contain spending and drive more equitable care. This follows Professor Chalkidou’s attendance to the National HTA Congress, detailed also in an View our iDSI timeline to read more about the evolution of HTA in China.

The annual study tours, which started in 2014 (under NICE International) have involved talks from expert representatives from the Department of Health, the Medicine and the Healthcare Products Regulatory Agency, Public Health England, National Institute for Health and Care Excellence, the UK Health Forum and the London School of Economics.

2017’s study tour was timed so key individuals from the National Health and Family Planning Commission (replaced by the National Health Commission in 2018), CNHDRC and GHD could participate in the 5th UK-China People-to-People Health dialogue, attended by UK Secretary of State Jeremy Hunt; NHFPC Vice Minister Cui Li; and the Parliamentary Under Secretary of State for Public Health and Primary Care Steve Brine and Margaret Chan, former Director-General of the World Health Organization.

We have made slides available from:

Setting Priorities Fairly: Sustainable Policies for Effective Resource Allocation

Health financing towards UHC HSR 2018 satellite session

Chinese delegation visit 2018

What’s In What’s Out contains in-depth case studies of how LMICs have grappled with and guidance on designing Health Benefits Packages for UHC.

The two-day ‘Setting Priorities Fairly: Sustainable Policies for Effective Resource Allocation’ event, opened Ghana’s Deputy Minister for Health Mr Kingsley Aboagye-Gyedu, set out to address the difficulties LMICs face with Universal Health Coverage (UHC) attainment; and how to navigate inconsistent and dwindling healthcare funding.

Health Technology Assessment (HTA) was a key focus, with presentations including global experiences of HTA from eminent researchers, health economists and medical doctors from the University of Ghana, Ghana’s National Health Insurance Authority, The Global Fund to Fight AIDS, Tuberculosis and Malaria, World Health Organization, HTAi, iDSI and more.

During his keynote speech Mr Aboagye-Gyedu described how Ghana had incorporated HTA recommendations in its Standard Treatment Guidelines and Essential Medicines List because of its usefulness as tool to assuring value-for-money – from the design and management of benefit packages to the determination of reimbursement list of medicines.

Ghana’s Deputy Minister for Health Mr Kingsley Aboagye-Gyedu who opened the event

Under the leadership of Ghana’s Ministry of Health, iDSI has been working with a variety of Ghanaian entities for several years now, providing technical assistance and facilitating capacity building for evidence informed priority-setting, to support the tough decisions and trade-offs government is faced with.

Mr Aboagye-Gyedu also acknowledged iDSI’s support on Ghana’s pilot study on cost-effective management of hypertension, describing the project as “gearing the country into a real policy momentum to entrench HTA into the selection and pricing processes.”

Day one of the event consisted of pre-conference workshops aimed at stakeholders with relevant interest in HTA development in sub-Saharan Africa, intended to provide an overview of HTA, covering core technical components and how HTA could be integrated within a broader decision-making process.

The second day aimed to extend global experiences in HTA to the SSA region and increase the understanding of the use of HTA for resource allocation decisions while coordinating policy priorities of SSA nations. A mix of expert speakers provided international perspectives and thought-provoking presentations in plenary and parallel sessions covering a wide array issues pertinent to HTA in SSA.

iDSI‘s newly released Health Technology Assessment Toolkit was launched at the event, with each delegate receiving the resource pre-loaded onto a USB stick. The HTA Toolkit is a free, accessible resource for technical staff working in health policy keen to build HTA processes in their own countries and was developed in consultation with staff working in health policy around the world.

Iñaki Gutierrez Ibarluzea, HTAi Vice President, said: “HTAi was proud to join forces with iDSI as well as HTA colleagues from around the world on this ground-breaking initiative. The healthcare challenges sub-Sahara Africa faces are complex and multi-faceted – by leveraging the collective inputs and suggestions from global leaders we hope the ideas and recommendations stemming from this workshop will further spur development and innovation within the region. The collection of knowledge from the delegates that attended the conference was truly remarkable and we are excited to see what some the brightest HTA minds can achieve as a result of this collaboration.” 

Professor Kalipso Chalkidou, iDSI Director, said: “iDSI was delighted to collaborate with HTAi and Ghana’s Ministry of Health to host the event. Bringing together almost 100 policy representatives from across Africa and Europe, our aim was to support countries’ vision to reach Universal Health Coverage in an equitable and sustainable fashion. It was wonderful to be back in Accra, further strengthening our partnership with the Ministry of Health in Ghana, at this event. I would like to extend my thanks to Mr Aboagye-Gyedu for his endorsement and for formally opening and supporting the event.”

Visit the iDSI Knowlege Gateway to read our round up of the event, including key messages and details of external media coverage.

We have made all presentations from the event available on iDSI’s website.

Press coverage:

Ghana News Agency: Ghana hosts conference on sustainable resource allocation
policies (27 September 2018)
Modern Ghana: Conference On Sustainable Resource Allocation Policies (28 September
2018)
Business Ghana: Ghana hosts conference on sustainable resource allocation policies (1
October 2018)

Chatham House are seeking applications from individuals from West Africa with a background in public health or senior management who wish to enhance their policy-making and leadership skills and effect change. For more information, including potential research topics for 2016, see the link below:

http://www.chathamhouse.org/careers/west-africa-global-health-leaders-fellowship

Applications close Monday 6 June 2016. 

NICE International supported Dr Miqdad Asaria, Research Fellow at the Centre for Health Economics, University of York to travel to Addis Ababa, Ethiopia from 21-27 November 2015.

Dr Asaria conducted a series of meetings with colleagues in Ethiopia, including from the Ethiopian Public Health Institute (EPHI), Overseas Development Institute, the Clinton Health Access Initiative, and other senior academics. In addition, Dr Asaria presented two 90-minute sessions on universal health care and the roles of economic evaluation and health inequality analysis at a workshop hosted by EPHI and the EVIDENT network, which involved policy makers from Ethiopia and the region. The visit was part of a long-term engagement strategy with academics and policy makers in Ethiopia involving NICE International partners and will contribute to on-going work in the country.

NICE International were involved in an initiative to develop ‘learning health systems’ in Sub-Saharan Africa.

At the beginning of August 2015, Kalipso Chalkidou represented NICE International at a 3-day meeting at the Rockefeller Foundation Center in Bellagio, Italy.

The meeting was convened to explore the potential for developing a new initiative, with the aim of and building capacity for pragmatic research and developing more ‘learning health systems’ in Sub Saharan Africa (SSA).

21 participants attended from SSA and across the world, including clinical, academic and policy representatives from Zambia, South Africa, Malawi and Kenya, as well as representatives from the BMJ, the Bill and Melinda Gates Foundation, WHO and other global health partners.

Participants discussed the current needs of SSA countries. The types of initiative and components required to build capacity for high quality, pragmatic research, conducted within clinical settings were explored. The ultimate goal of these initiatives is to improve health outcomes and to support the development of ‘learning health systems’ in Sub Saharan Africa.

A steering group, including NICE International, was formed to move forward with the agreed next steps for such an initiative to get off the ground, including exploring opportunities for funding.

The initiative has since been named Better Outcomes through Learning Data and Engaging in Research (BOLDER) and members of the steering group are currently working on the funding proposal.

The meeting was co-organised by NICE International, Center for Medical Technology and Policy, KEMRI-Welcome, Western University, Ontario and Stellenbosch University, South Africa.

Associate director of NICE International Francoise Cluzeau undertook a scoping visit to Ethiopia in conjunction with the Institute of Tropical Medicine (Antwerp) and EVIDENT, an extensive network of North-South partners that aims to enhance evidence-informed decision-making and policy driven research in both health and nutrition in response to local priority concerns.

The visit included meetings with the State Minister of Health and Ministry of Health Senior Adviser, colleagues from the Ethiopian Public Health Institute (EPHI), Addis Ababa university and the Ethiopian Health Insurance Agency.

Discussions highlighted outlined areas of potential involvement for NICE International/iDSI to help Ethiopia in its efforts on achieving Universal Health Coverage through priority setting activities with a focus on health economics training to help strengthen technical capacity at the Ministry of health and its agencies.

Between 2012 and 2014, the Rockefeller Foundation funded NICE International to support a series of initiatives with the Ministry of Health and associated agencies, including The National Health Insurance Agency (NHIA), The Ghana Health Service (GHS, the largest provider agency) and the Ghana National Drugs Programme. The key objective of this cooperation was to raise awareness among stakeholders in Ghana on the role and value of using evidence-based approaches in healthcare decision making and priority setting, including performance monitoring. See below for further information on this earlier work and

Study visit to the UK