Yesterday, Ghana launched its first Strategy for Health Technology Assessment (HTA).

This strategy sends out a clear message of Ghana’s ambitious commitment to evidence informed priority setting. It recognizes that building an HTA function demands action on several areas, including capacity development, topic selection, and bespoke methods guidelines, all linked by a strong governance framework.

In Sub-Saharan Africa, the use of HTA is still very limited, and the Ghanaian progress in this area represents a regional achievement that others can learn from. The strategy builds on iDSI supported work on hypertension, which involved the creation of a Technical Working Group (TWG), a concept that is now part of the architecture of HTA.

Mr Agyeman-Manu, Ghana’s Health Minister, said that so far work in HTA had begun to demonstrate value addition in areas including assessing value in changing from amoxicillin suspension to dispersible tablets, assessment of the cost components of Ghana’s COVID-19 Vaccination Plan as well as the cost-effectiveness of treatment for newly diagnosed hypertension cases.

The launch and new strategy is also key opportunity for regional and continental leadership and shared learning – there has been interest in Ghana’s journey from officials in Tanzania, and participants at the launch event included representative from the Ethiopian Public Health Institute and RSSB Rwanda.

iDSI has been building strong partnerships in Ghana for over 10 years. As the first Sub-Saharan African nation to introduce a tax-funded National Health Insurance Scheme (NHIS) in 2003, Ghana is committed to achieving universal health coverage (UHC) by 2030. To enable this vision, iDSI has continued collaborations with governmental, clinical and academic partners in-country to strengthen evidence-based decision making in healthcare for Ghana’s population of 30 million.

Progress on HTA has been led by a committed team in Ghana that includes Martha Gyansa-Lutterodt, (MoH Ghana), Brian Asare (HTA secretariat, MoH Ghana) and Justice Nonvignon (University of Ghana & co-Chair of the TWG). Martha Gyansa-Lutterodt in particular had a key role in driving HTA development through her leadership as Director of Pharmaceutical Services at the MoH, and now as Director of Technical Coordination within that ministry.

CGD and our iDSI partners (LSHTM, NIPH and the University of Ghana) will continue to support the strengthening of the nascent HTA structures, with an emphasis on institutional coordination and “end to end” HTA thinking – from topic selection to strategies for implementing HTA findings and assessing impact. 

If you are a policy-maker working on the COVID-19 response in your country, we would love to hear about your experience and intention to work with those models, as well as your assessment of the perceived gaps. In addition, we would like to learn from you how models can be best communicated, including what they should report.

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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.

The 2019 study tour represented another successful collaboration between core iDSI partners to support knowledge strengthening among key policy makers in China through interaction with representatives from UK government agencies, NHS, academic and private sector colleagues involved in healthcare.

The Chinese participants included seven representatives from the National Health Commission, including representation from the Department of Drug Policy and Essential Medicines Systems, and the Department of Healthcare Reform; a representative from the Department of Social Security, Ministry of Finance; and representatives from provincial health authorities, including the health commissions of Liaoning, Jiangsu and Henan. Researchers and policy advisers from CNHDRC and the Shanghai Health and Development Research Center also joined, in addition to colleagues from the academic sector in China, the latter including representation from Peking University, the Beijing Normal University, and the China Pharmaceutical University. Full details of all the participants can be found listed in the agenda.

As in previous years, all 27 delegates received a detailed introduction into the structure and financing of the NHS, including the role of HTA in supporting resource allocation decisions in the UK. In addition, there was a special focus on primary care, led by the Imperial College WHO Collaborating Centre for Public Health Education and Training, and an afternoon workshop hosted by the Centre for Health Economics at the University of York, which explored specific issues relating to the application of economic techniques to inform discussions on evaluating health system performance and efficiency.

For this year’s tour, we also placed a special emphasis on the UK’s approach to cancer care, specifically in relation to the process adopted by the National Institute for Health and Care Excellence (NICE) when evaluating new oncology products. We also explored the importance of considering the value that new innovations could bring within the context of delivering appropriate and timely pathways of care, including radiology, pathology, surgery, and radiotherapy. The UK’s experience in these issues can potentially provide useful insights for the Chinese setting, given that cancer has become a leading cause of mortality in the country. This is being driven by an ageing population and the prevalence of lifestyle factors such as smoking, with lung, stomach and breast being among the most common cancers. Policy makers in China have recognised the need to strengthen systems for assessing the clinical benefit of new cancer medicines, and this will be the focus of planned further collaboration between the Global Health and Development Group at Imperial and CNHDRC.

We would like to thank everyone who attended and contributed to the two-week study tour, with a special thanks to the British Embassy in Beijing, and Professor Kun Zhao and her team at the CNHDRC.

Saw Swee Hock School of Public Health, National University of Singapore, 24-28 June 2019. By invitation only

Universal health coverage (UHC) is not only to be made available but also sustainable and every country is now thinking about how to make both happen. Health technology assessment (HTA) is one of the helping tools, which is increasingly used in both resource-rich and poor settings.

NIHA LDP 2019 is designed for senior policymakers and HTA researchers who would like to know more how to make HTA work better to enhance UHC in their countries. The policymakers and the researchers will be paired to work together not only during the programme period, but also long-term post-programme.

The programme is co-hosted by iDSI and the Access and Delivery Partnership, and will feature iDSI expert speakers including from the
HITAP, Center for Global Development, Imperial College London, and China National Health Development Research Center.

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 22 delegates, from both clinical and non-clinical backgrounds, visited London and Cambridge to develop their understanding of the UK healthcare system, including health-related legislation and regulatory mechanisms, policy development and health reforms.

Along with visits to St Thomas’ Hospital, Boots Pharmacy’s corporate office and AstraZeneca, the group received talks on the role and function of National Institute for Health and Care Excellence and the Medicines and Healthcare Products Regulatory Agency in protecting and improving public health; the pricing of branded and generic pharmaceuticals in the UK; vaccine evaluation; the development of evidence-based clinical pathways and integrated care pathways; and how to best to make use of electronic health record systems.

Members of the delegation from China with iDSI staff in Queen’s Gate

Yu Ou’yang from the Division of Medical Administration within the Hunan Provincial Health Commission in China said: “Over the last two weeks we have had presentations from almost 30 experts, even though the context of the UK and China is very different there has been so much for us to learn here. During the study tour I have realised healthcare management and delivery in the UK is very detailed and precise to ensure all goes as smoothly as possible, the UK also takes into account the balance between cost and effectiveness in healthcare which is extremely important. It has been great to learn more about standardised operations such as Clinical Commissioning Groups and NICE and their responsibilities. I would like to extend my thanks to all the presenters and those that facilitated our practical days.”

Ying Peng, who is based in Beijing but also carrying out a PhD in Health Economics at the University of Sheffield, said: “The range of presentations we received will really help my own PhD studies, I’ve definitely developed my understanding of how new interventions are appraised in the UK and how evidence is the pinnacle of decision-making. It was really important for me to learn more about the UK health system, which organisations underpin it and how this could be adapted for China.”

The group was made up of officials from iDSI core partner the China National Health and Development Research Center (CNHDRC) and the Chinese Ministry of Health (National Health Commission); along with policy makers and academics from Huazong, Beijing and Shanghai universities.

Liu Jianan, from the Division of the Essential Medicines List, within China’s National Health Commission, said: “Our delegation is diverse but between us all we have rich experience and knowledge. Our learning over the last two weeks has been delivered in such a systematic way; there is still much more we can learn from the UK healthcare system however for now I am pleased we will all be able to bring back our experiences from this trip, especially for matters such as pricing for medicines, which is of broad and current interest in China.”

Chen Bo, a PhD student from Peking University’s School of Public Health, said: “I feel very lucky to be here. The talks have inspired me a lot, particularly as my current area of study is public hospital reform at county-level in China. For me the most valuable part of the study tour has been expanding my knowledge of the ways in which hospital reforms could be made more efficient; and learning so much about Cost Effective Analysis exercises and ways we could push forward with this in China.”

Francis Ruiz, iDSI Senior Advisor, said: “The Global Health & Development Team at Imperial and iDSI have been delighted to organise study tours to the UK for senior Chinese officials since 2014. The talks from various presenters, including representatives from The Nuffield Trust, NHS England, NHS Benchmarking and feedback on their own workstreams from the delegates themselves has been a fantastic complement to off-site days where the group observed the delivery of health care first-hand and attended a workshop focused on primary care. We hope the visit was valuable and will have positive impact on them as individuals; and help develop the UK-China partnership in Health Technology Assessment.”

The workshop was the first in a series that are designed to help build capacity for undertaking HTA in India; and come as the Global Health and Development team at Imperial College London have signed a Letter of Understanding with the Department of Health Research (DHR) within the Government of India, who are leading on an exciting initiative to institutionalise HTA.

Over 30 attendees gathered in Delhi for the workshop which focused on introducing participants to the key concepts of evidence-based priority setting and HTA, how to frame an economic evaluation, and how to identify key stakeholders for consultation throughout the HTA process.

Senior Scientist Dr Kavitha Rajsekar discussed the importance of HTA for India and gave an update on the latest developments on HTA in India. Ensuring that an evidence-based, inclusive, and transparent system is put in place via the HTAIN will aid health resource allocation decisions across the country.

Associate Prof Shankar Prinja presented the results of the cost effectiveness of auto disposable syringes, one of the first studies to be approved by the HTAIN Technical Appraisal Committee which has resulted in the government of Andra Pradesh using results to inform their decision to invest in autodisposible syringes to reduce rates of infection due to needle re-use in the state.

Alex Winch discussed what UHC means for India and how establishing fully functioning HTAIN centers will provide a sound basis upon which health resource allocation decisions can be made in India, to ensure that every rupee spent buys the maximum health possible.

Dr Laura Downey and Dr Pankaj Bhaguna outlined what evidence is required to undertake HTA analyses, drawing from their own experience of conducting HTA in India; and their recent publication on identifying publicly available data sources for HTA in India.

Dr Oshima Sachin presented on how evidence for health costs is being collected by the HTAIN and a network of partners from across India to form a common costing database, which iDSI is providing technical advice and assistance with.
Dr Aamir Sohail introduced the concept of equity and ethics in informing HTA in India; and shared his experience of conducting a literature review on equity to inform the intraocular lens HTA undertaken by the HTAIN secretariat at DHR.

Juliet Eames and Saudamini Dabak of HITAP Thailand introduced the concept burden of disease and measuring quality of life to estimate Quality Adjusted Life Years (QALYs), as well as Disability Adjusted Life years (DALYs).
The presentations stimulated lengthy discussions amongst participants as to the challenges of conducing HTA in India, when such evidence is often not available and not routinely collected.

A follow up workshop will be held in three months’ time and iDSI is pleased to report feedback received from participants to this workshop was overwhelmingly positive, with 75% of participants reporting they plan to use the skills and knowledge that they had learned during the course towards undertaking a policy-relevant HTA study.

This comes as the government of India has committed to achieving the Sustainable Development Goals and Universal Health Coverage by 2030.

Setting the right priorities to maximise value of health spending in India towards achievement of UHC will require a robust mechanism to comparatively assess available evidence according to a well-governed, inclusive, transparent and fair process. In almost all high income and most middle-income countries, Health Technology Assessment (HTA) is the gold standard of such evidence-informed priority setting.

The government of India has committed to institutionalising HTA as a core component of decision making in health, in line with a growing momentum for countries to adopt HTA as an integral component of health priority-setting. The Department of Health Research (DHR), under the Ministry of Health and family welfare, has recently established HTAIn – a team charged with the responsibility of conducting HTA to produce evidence regarding the cost-effectiveness of health interventions to inform resource allocation decisions across the Indian health system.

Union Minister for Science and Technology Harsh Vardhan: said: “It is essential to assess, through an evidence-based approach, whether a particular technology can impact disease management, prevention strategies and policy decisions. This is possible through health technology assessment studies”

Under the auspices of HTAIN, the DHR has established a network of HTA Regional Resource Hubs in collaboration with various State Government-affiliated Institutes. These hubs will provide technical support towards the National HTA effort, as well as to local State government requirements. As HTA is nascent to India, staff of these HTA resource hubs will need to undertake significant training in health economics and cost effectiveness analysis in order to conduct HTA for the HTAIn. This requirement for capacity building was recognised by Mr Vardhan who said: “There should be collaborative teaching programmes with faculty from both medical and engineering institutions for manpower generation and skill development in health care technology assessment.”

iDSI have partnered with the DHR under an agreement to provide technical capacity building support for HTA Resource Hubs across India in order to bridge this capacity gap and build a cadre of skilled health economists equipped with the knowledge and skills to undertake HTA. A number of HTA skill building workshops have been held to date in Delhi, Kerala, and Chandigarh.

The next workshop will be held in Delhi from 4-6 July, where facilitators from iDSI, the HTAIN and PGIMER. Chandigarh will hold the first of four skill building workshops for the recently established HTAIN Technical Resource Hubs.
iDSI will continue to support this exciting National effort led by the DHR and the HTAIN, which represents not only an international collaboration, but a collaboration between complex networks of institutions from all over India.