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.

This year I attended because I was representing a collaboration between iDSI and the World Health Organisation (WHO). The first meeting held in July 2016 aimed to develop a guidance document informing countries of methods to set up Health Technology Assessment (HTA) mechanisms for reimbursement purposes. Building on this initial meeting and the consecutive guidance document development, we led a session titled ‘Using HTA to inform country specific reimbursement’ at this year’s conference.

The panel was held on Tuesday afternoon and my fellow panel members included Tessa Tan-Torres Edejer (WHO), Shankar Prinja (Post-Graduate Institute of Medical Education and Research, PGIMER), John Wong (EpiMetrics). Setting the scene, I started by providing a general overview of capacity building needs when looking to establish a HTA mechanism, linked to a paper published by Dr Li of iDSI. Shankar and John provided country examples of capacity building and the development of HTA mechanisms in India and the Philippines respectively. These countries are both in very different stages of the development, however their talks highlighted both the similarities and differences when setting out to develop a HTA mechanism. Tessa spoke about the development and need for the guidance document, which is still in its early development stages though a first draft is due to be published later this year. Watch this space!

The three day conference brought me a huge range of new information and contacts in the Global Health scene which left me with a thirst to explore the field of priority setting even further!  All-in-all, this first experience of a major conference was a memorable one – and not just because of the delicious pasta and gelato in Rome!

Last month Laura Downey, GHD, convened a panel at

The panel was chaired by Kalipso Chalkidou, GHD, and speakers alongside Laura included representatives from the Department of Health Research (DHR), Ministry of Health and Family Welfare, Government of India and the Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

We had some questions for Laura about the panel session and the supporting BMJ paper that was recently published:

What is meant by ‘Institutionalizing HTA’?

Essentially what we mean by this is moving towards a health system where Indian policy makers use evidence generated through HTA to inform their decisions for how health resources are allocated. In order for this to reach the point of “institutionalization”, we would hope that such evidence-informed decision making would be diffused widely. This would be at both the National, or Union, level, as well as at the level of the States, where health is a State-lead subject in India. There’s a long way to go before the country comes close to reaching this point. However, the DHR is taking active measures to bring the HTA message to policymakers across the country in an effort to lay the foundation to effectively bridge the gap between evidence and policy.

How do you build national capacity?

It’s important to define here what we mean by “HTA capacity”, as there are a number of areas for which building up local skills and knowledge is necessary to effectively support the HTA ecosystem.

From the technical perspective, it’s important to build capacity for undertaking economic analyses and developing a robust methodological guide for the conduct of analysis, or what we call a Reference Case. We recently ran a training workshop on economic analyses for HTA in Kerala, which was delivered collectively by experts from Imperial College London, HITAP Thailand, and PGIMER. PGIMER has also developed a series of online modules for studying HTA, which will ensure wider-reach of building skills in this area across the country.

From the wider policy perspective, capacity needs to be built for the policymakers and their health system colleagues to be able to understand and use the HTA results to their advantage. iDSI recently facilitated a study trip for Indian policymakers and academics to Thailand to learn from Thai policymakers on how they have been able to use HTA to achieve UHC.

Capacity-building through education and engagement is also taking place with the stakeholder community. Stakeholders refer to all those with an interest in the analysis, such as the patients themselves who are the ultimate beneficiaries of the policy decisions, as well as civil society organizations, industry bodies, non-government groups, and the clinical and allied health community. Through education stakeholders are empowered to take an active role in how the HTA research questions are shaped, and inform the decisions that are made. iDSI recently co-facilitated a stakeholder consultation event on HTA with the Indian Council of Medical Research and DHR, which brought together academics and policymakers to discuss HTA, its need in India, and the establishment of the MTAB. Further stakeholder engagement meetings are planned to take place in the coming months.

What are the next steps?

There is a long way to go before HTA will be effectively “institutionalised” in India, but the MTAB team at DHR are laying strong foundations for taking the program of work forward. Robust methods and process guidelines are being drafted to guide technically rigorous and uniform analyses. Training to build skills for economic analysis will continue to be delivered; technical exercises to pilot the methods, processes, and technical skills will be undertaken; and the political and stakeholder economy will be addressed along the way through active engagement, advocacy, and education.

iDSI will continue to support this incredible National effort, which represents not only an international collaboration, but a collaboration between complex networks of institutions from all over India.  In a country as large as this, where the population is now said to have surpassed that of China, institutionalising the highly complex process of using HTA evidence to inform policy decisions is a formidable task. However, the herculean efforts already shown by the government of India, led by DHR and the MTAB team, and their technical partners from across the country is nothing short of incredible.

Writing from London on the 1 year anniversary of Brexit where political parlance continues in an unending circular discourse devoid of any discernible path forward, I think we can all learn a lesson from our Indian colleagues.

In the space of less than 1 year, the Government of India have achieved more than most countries would hope to have achieved in 5.

Never more did Ghandi’s words “be the change” ring true, as our colleagues at DHR and the MTAB have shown us. It is a true privilege to be part of this great change in the Indian health system.