iDSI contributed extensively to the 5^th Biennial African Health Economics and Policy Association (AfHEA) conference 2019, including organising 10 sessions and bringing over 30 researchers and experts to the conference, strengthening our collaborations with African partners. The conference occurred as iDSI turns its focus increasingly towards Africa, working to support decision-making and health priority-setting across the continent.

iDSI kicked off the week with a pre-conference session on applying health economics for immunisation, delivered with Teaching Vaccine Economics Everywhere. Through the conference we ran 10 sessions covering a range of topics on how African countries can use clear decision-making processes as they strive towards UHC. These sessions brought practitioners and policymakers together to identify cost-effective pathways towards achieving UHC and primary healthcare (PHC) for all, the theme of the conference.

As importantly, and true to iDSI’s collaborative nature, the conference was a great opportunity for our network to come together. From Australia to Zambia, it was a great chance for us to bring the iDSI family together so that network partners could continue to share knowledge and provide support to policymakers and researchers across the globe.

Key takeaways

• There is a huge momentum towards UHC and PHC for all in Africa. With limited resources and growing pressures on healthcare systems, sound decision-making and effective prioritisation will be crucial.
• Supporting country-owned decision-making in Africa requires understand the priorities and values of decision-makers. iDSI should work to support systems that reflect these local principles. Ethical analysis and explicit consideration of equity concerns can guide such work.
• At present, health technology assessment and appraisal across Africa is fragmented. Often small teams, based in health ministries and without explicit remit, are conducting HTA in an ad hoc way. There is much value in bringing these users and producers of HTA evidence together; and iDSI is keen to collaborate with AfHEA to develop a community of practice to do just that.

More detail on the key messages can be found in this document.

Preconference workshop – Applied Health Economics in Africa Using Examples from Immunization

iDSI’s AfHEA involvement kicked off with a full house at our pre-conference session, delivered together with Teaching Vaccine Economics Everywhere, on applying health economics to vaccines. This session brought together academics, policymakers in health ministries, officials from multilateral organisations, students and others. Opening the session, David Bishai (Johns Hopkins University) spoke passionately about the need to prioritise within available health budgets, emphasising that “saving money is saving lives”.

The session increased understanding of how health economics tools can be used in resource allocation decisions for health technologies including national essential medicines lists and health benefits packages. iDSI’s interactive components brought the session to life and enabled participants to enhance their learning.

• David Bishai: Introduction to Vaccine Economics
• Tommy Wilkinson: Introduction to Priority Setting in Health
• Tommy Wilkinson: Introduction to Economic Evaluation – Using HTA
• Justice Nonvignon: Measuring Costs of Health Interventions
• Ijeoma Edoka: Measuring and Valuing Health Outcomes
• Ijeoma Edoka: Application of Economic Evaluation – Decision Modelling
• David Bishai: TVEE: Creating the Architecture for Sustainable Vaccine Financing

Organised sessions

The iDSI-organised sessions brought together health economics, policy and ethics experts from across the iDSI global network.

• Organised session 1: Sound Decisions Making for UHC
• Organised session 2: Teaching Health Economics – a Low and Middle Income Country Focus
• Organised session 3: Agent Based Modelling
• Organised session 4: Addressing Ethics Considerations
• Organised session 5: Approaches for Achieving UHC – Perspectives from Africa and Asia

Oral sessions

As part of the main conference break-out session, iDSI members presented their work alongside other leading health economists from across Africa.

• Tommy Wilkinson: Approaches for achieving Universal Health Care: Policy Perspectives from Africa and Asia
• Gavin Surgey: Revision of STG and NEMLIT in Tanzania: a mechanism for introducing HTA?
• Maio Buluwayo: The Potential Impact of a 25% Tax on Sugar Sweetened Beverages in Zambia
• Sam Hollingsworth: Health technology assessment capacity at national level in sub-Saharan Africa: a survey of stakeholders
• Kim MacQuilkan: How can HTA improve equity, access and quality of healthcare services?
• Kim MacQuilkan: Strengthening Health Technology Assessment Systems in the Global South

Francis Ruiz of GHD, along with Professor Stephen Campbell of the University of Manchester, and Professor Daniel Keenan (Chair, NICE Indicator Advisory Committee), participated in a panel session focused on “Developing Evidence Based Indicators to Drive Quality in Healthcare”. Professors Campbell and Keenan discussed quality improvement initiatives within the UK NHS including the role of NICE and the impact of the Quality and Outcomes Framework in primary care. Francis Ruiz ended the panel session by describing the recent Banco Interamericano de Desarrollo (BID)-funded project, led by GDD, to support national quality indicator development in Mexico. The focus of this project was on developing a sustainable and robust methodology for indicator development, which will ultimately be led by the General Directorate of Quality and Health Education of the Secretaría de Salud, in collaboration with relevant government and public bodies. It began with a situational analysis of the existing system, including an assessment of the current availability of data to support the development of contextually relevant and viable quality indicators. The project culminated with the production of a manual for the development of a core set of national level quality indicators, setting out the processes and methods to be followed and the responsibilities of different institutions in supporting the creation of evidence-based indicators. Francis Ruiz concluded his presentation by noting that the capacity for robust quality improvement initiatives in Mexico already exists; the bigger challenge relates to overcoming system fragmentation and the associated tendency to duplicative and inefficient activities. The government of Mexico is committed to strengthening their existing quality indicator and monitoring system; it is hoped that this work and the manual produced by the GHD team for the Secretaría de Salud will support its ambition to create evidence-informed indicators within the context of a transparent and deliberative decision-making process.

The presentation delivered by Francis Ruiz is available here.

More and more, private health care is promoting health checkups. The more tests the consumer takes the higher the costs are incurred. Nevertheless, expensive tests cannot guarantee better health outcomes. Evidence even suggests that some tests such as prosthetic-specific antigen tests have definite harms that outweigh the benefits due to over diagnosis and over treatment.

Meanwhile, some countries allocate public resources towards population health screening to ensure that everybody who is eligible receives the tests regardless of their ability to pay.  This is because the government has a big assumption that screening followed by early treatment will yield better health gains or save cost from late treatment.

To academics and technical advisers, what are you going to do if the government asks what should be included in the benefit package for population based screening in your own setting. This question poses a big challenge given a hundred or if not thousands of tests available in the market for every disease.

The Health intervention and technology assessment program (HITAP), a member of the International Decision Support Initiative (iDSI), proposed one solution that combines policy process and technical evidence to address this question. They start with narrowing down the scope by ranking and prioritizing the top twelve health problems using stakeholder consultations. Clinical experts and industries play a major role in identifying possible screening interventions and early treatment for each prioritized health problem followed by health technology assessment in order to assess clinical benefit, value-for-money, feasibility and ethical implications.

The study resulted with a set of eleven population based health screening for the Thai population based on age, sex and frequency of screening. The recommendation has been adopted by the Thai government and the implementation started in October 2015.

The results of the study may not be transferable in other settings. However the approach is likely to be applicable to others. This case study affirms iDSI key principle in applying technical work in the policy process to address specific problems faced by national authorities. As a result, capacity building of the local stakeholders including decision makers and technical advisors grew at the heart of iDSI work.

For more details on the study please visit the following journal publication:

http://onlinelibrary.wiley.com/doi/10.1002/hec.3301/full

Controlling antimicrobial resistance requires a determined action and effort, and the objective of this partnership is to create an evidence-informed methodology and a governed working process to develop and implement policies and guidelines. NICE International’s role is to advise on the development and implementation of quality standards and indicators for AMR, based on previous collaboration with Vietnamese policymakers and clinicians on developing quality standards for acute stroke.

The first workshop [report in Vietnamese] in September 2015, hosted by the Ministry of Health, was attended by delegates from different ministries, national and international agencies, and external AMR experts. Its purpose was to share operational experience, coordination and cooperation to prevent drug resistance in Vietnam, caused in part by overuse of antibiotics. Dr. Nguyen Thi Xuyen, Deputy Minister of Health, highlighted the need to implement the National Action Plan on prevention of drug resistance to combat this issue. A second workshop in Hanoi is planned for 10-11 December 2015, and will cover the development and implementation of quality standards and indicators for AMR.

This work will be one component of iDSI’s ongoing practical support for Vietnam, alongside further health technology assessment capacity building and strategic roadmap development to inform the health benefits plan.

In December 2015, Francoise travelled to Hanoi for a workshop to develop QS in AMR, which you can read more about here