Supporting implementation of HTA in low-and middle-income countries

Article

Updated 13.04.2023

The Norwegian Institute of Public Health (NIPH) is partnering with low-and middle-income countries to support local implementation of health technology assessments (HTA).

All countries face difficult choices deciding which new medical technologies, medicines, preventive measures and practices to introduce into the health system. Based within the Division for Health Services of NIPH, our field of expertise is supporting policy makers in low- and middle-income countries to make better informed decisions, realise universal health coverage (UHC), and Sustainable Development Goal 3: Ensure healthy lives and promote well-being for all ages.

With a focus on evidence synthesis and economic evaluations, our team is specialised in providing evidence for decision support, striving to assist the strengthening of evidence-based, sustainable and equitable choices in healthcare. Our team provides support for building models for scientific and technical cooperation on Health Technology Assessment (HTA). HTA is the primary decision support aid NIPH uses as it enables the most systematic, transparent and evidence-based approach towards comparing alternative interventions based up on pre-defined criteria of interest to decision-makers.

Using adaptive methods to support LMICs developing HTAs

As the world is already facing new challenges while continuing to recover from the COVID-19 pandemic, many LMICs are facing shrinking public spending. Priority setting in health is critical to support the reorientation of health policy to efforts aimed at ensuring the efficient and equitable delivery of essential health services to all citizens. Producing new HTAs requires expertise and significant time investments. Depending on the familiarity of the methods and institutionalization of HTA within the setting, using rapid or adaptive HTA methods that transfer existing HTAs may offer opportunities to find and use relevant evidence to inform decisions. A recent scoping review from our team provides an overview of HTA methods, approaches, or tools to transfer HTAs. These could be further applied in settings with limited HTA capacity. For more information, see a recent publication from our team on Considerations for transferability of HTAs.

Our approach

Our efforts are focused on locally identified and driven activities related to HTA processes, the development of relevant tools and products for producing and using HTA.

Steps of the HTA process

We offer support to partner countries across all steps of the HTA process, as illustrated in the figure.

Aspects of implementation in partnerships with low-and middle-income countries (LMIC)

We share our expertise and support LMICs in conducting and adapting HTA to national contexts and establishing local working processes. In addition, we contribute to templates and tools to serve LMIC and global actors.

Our four phases of work include:

country engagement and skills assessments,
tailored capacity building, including to develop communities of practice and regional collaborations,
technical collaborations,
development and publication of open source tools and resource,
sustainability, institutionalisation and evaluation

Contact point: Katrine Frønsdal

Partners

Countries

Ghana - the Ghana Ministry of Health, the Ghana Health Service, Ghana National Health Insurance Agency and the University of Ghana
Myanmar - the Ministry of Health and Sport, the WHO Myanmar country office, and Thailand's Health Intervention and Technology Assessment Program (HITAP)
Moldova - the Moldovan National Public Health Agency, and the World Bank
Palestine - the National Institute of Public Health, World Health Organization country office in the occupied Palestinian territory

Our networks

World Health Organization (WHO) Headquarters, regional and national offices, including the Decide Health Decision Hub
European partners, mainly as members of the European network for HTA (EUnetHTA), we collaborate with the leading HTA agencies in Europe to improve HTA, develop the methodology and to share knowledge derived from HTAs
Core membership of the International Decision Support Initiative (iDSI)
HTA sister organizations around the world members of the International Network for Agencies for HTA (INAHTA)
Members of the Health Technology Assessment international (HTAi)

The by-monthly newsletter from HTAi covers our collaboration with Moldova in the 2nd edition (pages 4 and 6, https://htai.org/wp-content/uploads/2020/11/Nov-2020-Newsletter.pdf), and our collaboration with Palestine in the 4th edition (pages 2 and 4, https://htai.org/wp-content/uploads/2021/02/January-2021-1.pdf).

Resources

All products that we produce are freely available as global public goods for the pursuit of Universal Health Coverage and will be available here when published.