Ghana has been a pioneer in embracing UHC initiatives. Starting with the “Health for All” movement in the 1970s, going through the early 1980s when the Ghana Primary Healthcare Strategy was adopted, and the 1990s when the district health systems were established. In the early 2000s, these efforts were consolidated and Ghana became the first sub-Saharan African country to establish a National Health Insurance Scheme (NHIS), following adoption of the NHIS act in August 2003, amended in 2012[2].

Sustainable UHC requires developing frameworks for priority setting and making difficult choices. In October 2019, Ghana showed leadership in this area when the Minister of Health announced plans to formally introduce Health Technology Assessment (HTA) to support UHC in Ghana (See our iDSI blog concerning this here)[3]. Taking forward this initiative are two recently established committees: one to provide strategic and political oversight (the Steering committee), and another focused on the technical aspects of producing and interpreting HTA relevant evidence (the Technical committee, also referred to as the  Technical Working Group (TWG)). Ghanaian policy makers see HTA as critical to enhancing healthcare efficiency and maximising the value of every Cedi spent.

Our team has just returned from a week-long visit to Ghana, where we attended the ministry’s Development partners engagement meeting and helped deliver an HTA Policy Seminar to facilitate timely discussions among national and international stakeholders involved, specifically on the practical implications of this initiative to institutionalise HTA in Ghana. During these proceedings, we asked some key questions, such as: “what is Ghana’s vision for HTA institutionalisation?”, “What is the national strategy to deliver this vision?” and “How can local and international stakeholders get behind a country-led agenda and collaborate effectively to successfully realise this vision?”

The meetings highlighted the importance of tapping into existing capacities in the country, and the need to devise a bespoke multi-levelled capacity building plan for individuals, institutions, and the wider environment. We have identified an indisputable need for strengthening cooperation and communication among the various stakeholders working in the HTA space in Ghana. These include, within Ghana, the Ministry of Health, Ministry of Finance, National Health Insurance Authority (NHIA), Ghana Health Service (GHS), academic institutions, and civil society. To support key country stakeholders on their HTA journey, there is also a growing interest among international development partners in the importance of developing country-owned priority setting mecahnaisms, supported by cost-effectiveness evidence.

In this context, coordination between international partners in Ghana will be critical, and ongoing initiatives to bring together multilateral bodies in support of development are welcome. These include the “Global Action Plan for Healthy Lives and Well-being for All”  with Gavi, the Global Financing Facility (GFF), the Global Fund, World Bank and WHO all actively involved in an an accelerator on sustainable financing that recognises the need for strengthening “country led, demand driven and evidence-informed” systems, to increase the efficiency and effectiveness of health spending.

It is also worth noting that Ghana was among nine countries joining the GFF in 2019. The GFF partnership seeks to support countries build investment cases for prioritising reforms relating to reproductive, maternal, newborn, child and adolescent health and nutrition. An important part of this support concerns strengthening country-led platforms for priority setting, mobilising evidence and input from key stakeholders.

Further both the Joint Learning Network and the SDG Accelerator funded by USAID and BMGF (Results for Development), are active in Ghana and their presence offers opportunities for engagement and investment in South-South learning and also in institutional strengthening.

These international initiatives also recognise the importance of strengthening informational and payment system infrastructures to support priority setting and wider health system strengthening. In that context, it is worth noting the work of PharmAccess in supporting NHIA develop systems that generate accurate real time data for analysis and access to financing.

The iDSI network has supported Ghanaian collaborators since 2009, and we are currently engaging with country partners to help realise a fully formalised HTA function following the announcement in October 2019. (More details on our work in Ghana available on our page.) A key measure of success for HTA institutionalisation in Ghana relates to developing effective partnerships and facilitating cooperation between the stakeholder groups. Such partnership working is an  important feature of the iDSI network’s  theory of Change[4] (see our recent publication about building relationships that focus on people, policy, and process for implementing HTA)[5].

In light of these recent developments, Ghana can be regarded as a regional leader in the area of priority setting for UHC. Such leadership can align with and feed into, ECOWAS regional plans for macro-economic policy convergence[6]. Ghana’s successes in the past and its ambitions in the future have the potential to positively influence other countries on the continent, offering a confident message of what can be achieved as we work towards reaching UHC.

Interested to find out more about national HTA agenda and UHC progress, listen to our podcast with Martha Gyansa-Lutterodt here.

Do you have a query on our iDSI work in Ghana?

Visit our iDSI Ghana country page, here. Or get in contact with author of this blog at m.gad@imperial.ac.uk .

[1] World Health Organisation (WHO), definition of UHC, available at: https://www.who.int/health_financing/universal_coverage_definition/en/

[2] Grace Antwi-Atsu, Universal Health Coverage in Ghana, can we really make a progress? Available at: https://www.sightsavers.org/blogs/2019/08/universal-health-coverage-ghana-how-can-we-really-make-progress/

[3] Ghana’s Minister of Health launches the National HTA steering committee and calls for HTA institutionalisation in the country, available at: https://idsihealth.org/blog/ghanas-minister-of-health-launches-the-national-hta-steering-committee-and-calls-for-hta-institutionalisation-in-the-country/

[4] International Decision Support initiative (iDSI) Theory of Change, available at: https://f1000research.com/documents/7-1659

[5] Implementing health technology assessment in Ghana to support universal health coverage: building relationships that focus on people, policy, and process, available at: https://www.cambridge.org/core/journals/international-journal-of-technology-assessment-in-health-care/article/implementing-health-technology-assessment-in-ghana-to-support-universal-health-coverage-building-relationships-that-focus-on-people-policy-and-process/1C9B9F3ABB79CD782DD06D1FC4225411

[6] What’s Africa’s Eco: What difference would a single currency make? Available at: https://www.bbc.co.uk/news/world-africa-48882030

On Friday 4th October 2019, members of the International Decision Support initiative (iDSI) were invited to the Ministerial Inauguration meeting of Ghana’s first National Health Technology Assessment (HTA) steering and technical committees for HTA. The invitation acknowledged iDSI’s 11 years of active involvement in the country advocating for prioritising evidence-informed decision making in Ghana

The honourable Kwaku Agemang-Manu, Minister of Health in Ghana started the event with an announcement of the launch of a steering and technical committee to institutionalise HTA in Ghana.

This new National Steering Committee, with representatives from the public and private sectors, as well as development partners, aims to set the HTA agenda. The National Steering Committee will also oversee HTA activities in the country, and provide advice on governance and structuring process and methods for assessments and decision making to ensure the nationwide HTA function is sustainable.

This step comes as the Ministry of Health reinforces its commitment to attaining Universal Health Coverage (UHC) through effective resources allocation within the Ghanaian healthcare system. According to the Ministry of Health, the technical committee will play a technical supporting role for evidence generation and supporting the steering committee in preparation of the tools needed to support and operationalise HTA activities as envisioned by the main stakeholders in the country. Both committees are expected to be coordinated and run by a Ministerial Secretariat, which was assembled and trained since 2016, and continues to receive extensive support from the iDSI network

Leading directors from the Ministry of Health, including Ms Martha Gyansa-Lutterodt, Director–Technical Coordination Unit and iDSI advisory board member, Ms Joycelyn Azeez, Director–Pharmacy Unit and Mr Hamidu Adakurugu, Director of Administration attended the meeting. In addition, other national executives, such as Lydia Dsane- Selby, Chief Executive Officer–National Health Insurance Authority, attended the event. They have been working closely with our network on technical assistance projects, most recent of which was an HTA study on hypertension in Ghana, which informed price negotiations and the 2017 update on standard treatment for hypertension.

As a global network of health, policy and economic experts, supporting countries to achieve UHC and Sustainable Development Goal 3 (SDG 3), iDSI has been fully committed to supporting the development of tailored institutional capacity for HTA in Ghana across all government, academia, and private entities. We have been working to foster collaboration nationally and internationally, emphasising country ownership and local mandate, so countries can lead their own progress towards UHC with support from international partners.

Ghana has achieved critical milestones for developing HTA capacity through recent achievements with iDSI support and ministerial leadership, such as:

• Ghana’s first national economic evaluation on hypertension management. This work informed price negotiation, procurement, and changes to the standard treatment guidelines.
• Practical learning and knowledge mobilisation, using the hypertension project as a case study to raise awareness and build practical experiences around conduction economic evaluations for HTA in Ghana.
• Ghanaian stakeholders attending bespoke iDSI trainings that address differential needs across various Ghanaian stakeholders aimed to develop the necessary capacities in-country.
• Developing a country strategy for HTA institutionalisation and laying foundations for assembling HTA committees by sharing global experiences of process and methods deployed for similar activities internationally.

To formalise our relationship and commitment, iDSI are in the process of signing a Memorandum of Understanding (MOU) between the Ministry of Health, the University of Ghana and Kwame Nkrumah University of Science and Technology (KNUST). This will be instrumental in harmonizing all national and international efforts.

We are eager to continue our longstanding collaboration in Ghana to help the county realise its vision for HTA institutionalisation. Our cross-country team, made up of members of the Ministry of Health secretariat, are expected to fully carry out the operations of the announced committee, will be meeting this week in Oslo, Norway to discuss the outcomes of this inauguration meeting and organise a plan of action for iDSI activities going forward.

Within the next few years, Ghana can be an African leader in HTA institutionalisation, which will in turn help expand activities beyond Ghana, situating the country as a regional hub to mobilise knowledge and capacities in other African countries. Ghana is already a leading member state in the West African Health Organisation (WAHO) and can play a leading role to strengthen south-south collaboration, drawing on its rich experience in the field of HTA. A great example to follow is the achievement of Health Intervention and Technology Assessment Program (HITAP) in Thailand, which emerged as a major regional hub extending support to Asian and African countries’ efforts, to achieve HTA institutionalisation.

As the Minister of Health accurately described, Ghana has positioned itself to institutionalise HTA. However, the main bulk of work is still yet to come, and as we look forward to our next phase of work in Ghana, we call on all involved parties to engage with each other and keep effective communication strategy. We also invite the Ghanaian government to continue leading the way by mobilising essential domestic resources to self-sustain and steer future developments in this new dynamic age of healthcare in Ghana.

Congratulations to all involved in this important development.

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

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)

The ‘setting priorities fairly’ event is the first of its kind for Sub Saharan Africa (SSA), with the main event opened by Ghana’s Minister for Health, Kwaku Agyemang-Manu. How important is it for representatives from SSA to share knowledge to optimise the impact of health spending?

The prospect of HTA in SSA is promising, with an increasing number of countries planning to use HTA as a priority-setting tool to promote Universal Health Coverage (UHC). In the light of this, it is crucial that SSA countries share experiences (however little) to learn from each other.

What can attendees to your workshop session on case studies of how Health Technology Assessment can inform decisions on cost-effectiveness expect?

Attendees can expect to learn what has been done already, especially in the case of Ghana and how that applies to their specific country context.

Ghana was the first Sub Saharan African country to introduce a National Health Insurance Scheme (NHIS) and has long standing commitment towards achieving UHC, of course, there is no “one-size-fits-all” approach to UHC, but what is on Ghana’s agenda?

Ghana’s road to UHC through the NHIS has been brave and bumpy, with key challenges relating to financial sustainability. However, given the political support – from all sides of the political divide – the future of the NHIS is bright. A key approach is expanding enrolment through innovative strategies including group enrolment, enrolment of prison inmates etc. In addition, there are efforts to boost the financial status of the NHIS while removing other bottlenecks to promote UHC. A key way forward is re-visiting the Primary Health Care agenda to strengthen close-to-client services and implement provider payment mechanisms that reduce overall service costs and enhance sustainability of the scheme. The overall improvements in the economy could boost fiscal space for health and fast-track attainment of UHC.

You have led on a number of research projects on health economics and policy in Ghana, Botwsana, Kenya, Malawi and Nigeria – what has been your biggest achievement?

My joyous moments (which I see as achievements) are when I see that recommendations from a previous study I was involved in are evaluated and implemented. A typical example was when the Ministry of Health and World Health Organization in Botswana accepted the findings and recommendations of our study on efficiency and begun planning to implement.

What do you enjoy most about your role?

I enjoy seeing my former students in decision-making roles, applying some of the things they learnt. I also enjoy being involved in discussions and networking (with networks such as the platform that iDSI provides) that are directly relevant for evidence-informed policy making in low- and middle-income countries, particularly efforts that benefit Ministries of Health.

If you weren’t a health economist, what would you be doing instead?

I would have been a geomorphologist, studying earth formations.

Registered delegates can attend the workshop Justice will feature in, ‘Introduction to Health Technology Assessment’, from 1pm on 26 September 2018, as part of Setting priorities fairly: sustainable policies for effective resource allocation in Africa.

The recent report by the International Decision Support Initiative (iDSI) goes some way towards making the case for Health Technology Assessment (HTA) mechanisms in SSA to support more effective resource allocation when tackling this double burden. Hypertension was chosen as the case study, given its relatively high and growing prevalence in Ghana reaching up to 48% . An economic evaluation was undertaken based on an adaptation of a model developed for the 2006 update of the NICE guideline on hypertension management.

Seven key messages arise from this analysis, which made use of local Ghanaian data and policy-maker engagement:

1. Within the Ghanaian National Health Insurance remit, prescribing diuretics is estimated to cost an additional GH¢642 per DALY averted compared to no intervention.
2. Incremental cost per DALY avoided for Calcium Channel Blockers compared with diuretics is GH¢32,482.

Over the next 5 years Ghanaian authorities can

3. Save up to GH¢ 25,000,000, if they negotiate only a 10% reduction in average drug prices.
4. Save up to GH¢ 18,000,000 by encouraging only a 10% prescription shift from Calcium Channel Blockers to Diuretics, where clinically appropriate.
5. Save up to GH¢ 5,000,000 by encouraging a 10% shift from other drug classes to diuretics, where clinically appropriate.
6. Provide diuretic treatment to all patients with diagnosed but untreated hypertension using only a fraction of savings above (GH¢ 5,900,000) and can generate a net gain of 46,000 extra DALYs averted

Last but not least…

7. This report is an example of the value of being able to share HTA knowledge more freely, specifically executable economic models that can be adapted to local contexts. It demonstrates the positive impact of having open access sources for HTA knowledge dissemination on major health policy challenges worldwide.

To view the details of iDSI Ghana work including analytics, assumptions, and the data behind these key messages, download the report or view it here.

At the end of March 2017, Professor Jo Lord, Director of the Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, and Dr Kalipso Chalkidou travelled to Accra, Ghana to meet with colleagues and follow up on latest developments. iDSI is co-producing with our Ghanaian partners a full report on the technical and data aspects of the model, discussing the likely characteristics of a Ghana-specific Reference Case for economic evaluation and setting out specific policy angles of interest to Ghanaian policy makers, including the potential linkage between HTA and reimbursement. We aim to set out a vision for joint working over the next 2-3 years, based on the country’s priorities and commitment to building the needed capacities for effectively using economic and clinical evidence of comparative effectiveness to inform spending decisions. The report will offer robust estimates of savings from shifts in current practice, from changes in prescribing behaviour to reductions in prices and population level prevention and screening initiatives, to inform Ghanaian policy makers about resources that can be released to expand the breadth and depth of coverage, without harming quality. We hope to do more such analyses on NCDs, including diabetes and end stage kidney disease as well as mental health, as we continue our joint efforts.

At a time where Ghana is transitioning away from aid whilst striving to expand and ensure the financial sustainability of its health insurance scheme, transparency and accountability when it comes to important investment decisions, become even more important. Building on strong institutional structures for multi-stakeholder engagement and evidence informed policy such as the Essential Medicines List and the Standard Treatment Guidelines and the recently formed HTA Working Group, and on existing academic groups with a track record in the field of HTA at Kumasi (KNUST) and Accra (School of Public Health) this is an opportunity to help build a Ghanaian HTA system better to control escalating costs and inform future investment and disinvestment decisions.

A case for further investment in health cannot be made unless systems are in place to ensure good value for money for every Cedi spent. Identifying, in an evidence informed way, opportunities for releasing resources for reinvestment to expand coverage whilst ensuring health outcomes remain the same or improve, is a powerful argument for more and better spending in health. Our report will go some way towards making the case for an HTA mechanism for strengthening the handle of the Ghanaian authorities over its own budget through tackling a specific cased of high spending and high burden, namely hypertension management. Using Ghanaian data and making all assumptions explicit, the analysis will point to areas for improved spending, quantifies potential savings and health gains from reallocation and make a case for an institutionalised approach to HTA in Ghana, as an important tool for transitioning away from aid and towards sustainable and affordable Universal Healthcare Coverage.

Health Technology Assessment offers a framework for decision making though multi-stakeholder processes and a multidisciplinary approach which aims to incorporate evidence and values, locally relevant, to drive better decisions. But it relies heavily on implementation levers such as provider payment, contracting, patient and professional education and strong regulation to make a difference.

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