As countries move towards Universal Health Care coverage and transition from development assistance for health, there is an even more acute need to establish robust processes for assessing and integrating new cost-effective health technologies: a key pillar of financially sustainable, and transparent health systems.

A key strategy to support enhancing VfM is through the incorporation of context specific and economically informed evidence into all levels of health decision-making.

Last month iDSI was in Geneva running an introductory course for Unitaid and the Global Fund on economic approaches used in public health, with specific reference to HIV, TB and Malaria. The two day course covered:

1. Existing approaches to VfM at the Global Fund and Unitaid
2. The theory behind why priority setting in health is important, methods behind conducting economic analysis and practical applications of priority setting in countries
3. How countries are introducing and developing Health Technology Assessment (HTA) processes on the path to Universal Health Coverage

The course was facilitated by Francis Ruiz and Alex Winch (Imperial College London) along with Professor Alec Morton (University of Strathclyde). The training was organised by Ross Leach from Unitaid and Shufang Zhang from the Global Fund.
Attendees from the Unitaid strategy, results and finance teams joined staff from the Global Fund’s Technical Advice & Partnerships, Health Product Management and Grant Management divisions.

Ongoing iDSI projects in the Philippines and Kenya were referenced, along with practical examples of integrating the STAR (Socio-Technical Allocation of Resources) tool in countries; and a deep dive on how VfM is considered in published literature around Malaria, HIV and Hepatitis C.

At the national level, countries are increasingly developing formalised HTA processes to support evidence-based trade-offs in health, across a range of diseases and for the adoption of innovative health technologies.

At the international level, countries are looking to the development community more and more for guidance and support on incorporating HTA, as expressed in World Health Assembly resolution 67.23 on HTA. iDSI hopes to harness more opportunities to further engage with multi-lateral financing organisations such as the Global Fund, Unitaid and normative technical agencies such as the World Health Organization on the robust use of economic evidence in resource allocation and decision making.

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.