The HTAi Workshop in Accra, Ghana included a program featuring two plenary sessions.
Plenary One: Historical development and current practice of HTA in Africa: successes, failures and opportunities. What are the next steps?
Although there have been numerous attempts to introduce HTA in SSA, HTA institutionalization is yet to be established in the region (with the exception of South Africa). One factor in this slow development of HTA functions in SSA, relates to the technical and process challenges commonly associated with HTA institutionalization. A cursory examination of best practice internationally highlights the importance of using robust methods with good quality local health data and appropriate governance arrangements to support multi-stakeholder engagement. It is, however, important to recognize that there is no “one size fits all” structure for HTA institutionalization, and historical evidence seems to suggest that key inputs into the HTA process (such as local health data on resource use and activity) can evolve and improve in parallel to an operational HTA function.
Taking this insight as the basis for this session, we will hear how HTA is positioned within a health system, its specific role within it and the health priorities it could address. We plan to identify the links between an HTA function that would evolve over time and national policy priorities to enhance health systems in SSA. These dimensions can also be important in identifying capacity needs so that a focused and tailored strategy for capacity building for HTA can be developed, recognizing the multi-stakeholder components associated with its successful implementation.
The session provides an opportunity to discuss different HTA positioning approaches during in-country early development phases and as it matures over time, using international case examples where available, and highlighting HTA’s potential benefits. It also aims to map progress to date in HTA within the region in Africa following the passing of the WHO resolution WHA67.23 “Health intervention and technology assessment in support of universal health coverage” in 2014. Highlighting successes, challenges and opportunities in HTA development, drawing on examples from sub Saharan African countries where possible.
Michael Borowitz, Chief Economist, Global Fund to Fight Aids, TB and Malaria
Kalipso Chalkidou, Director, International Decision Support Initiative (iDSI)
Iñaki Gutiérrez-Ibarluzea, Incoming President, Health Technology Assessment International (HTAi)
Sarah Garner, Coordinator, Innovation Access and Use, World Health Organisation (WHO, HQ)
Martha Gyansa-Lutterodt, Director of Pharmaceutical Services and Chief Economist, Ministry of Health Ghana
Plenary Two: Sustainable Transition from Aid – towards value for money for equitable outcomes and moving beyond ‘disease silos’
In SSA, a number of countries are heavily reliant on external resources for health financing. However, the global landscape of donor aid for health is rapidly changing; international aid has plateaued and middle income countries are ‘transitioning from aid’. Furthermore, international donor agencies such as the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFTAM) are working towards funding models that reflect greater emphasis on value for money. These developments were reinforced by the global movement to strengthen health systems for universal health coverage (UHC) under the name ‘UHC2030’.
It is therefore imperative to plan for a sustainable ‘transitioning’ process for aid – receiving countries in Africa, especially in anticipation for countries with heavy dependence on external resources for healthcare financing. It will also be important to assess the structural and technical consequences of donor-led vertical disease programs within these healthcare systems, to move beyond silos and integrate disease programs within national health system platforms and infrastructures.
This session will explore the challenges and opportunities that lie ahead of African countries that are set to transition from external aid in the near future. Moreover, we will assess how donors and African countries can collaboratively engage in planning for sustainable transitioning from aid all the way from the beginning of the process itself, and to identify how capacity building for HTA can play a role in supporting plans for sustainable transition.
The session goes further to highlight recent progress in value for money considerations as highlighted by ‘Performance agreement between Department for International Development (DFID) and the GFTAM’, and how can this approach can help as we move beyond the ‘silo effect’ of vertical disease programs. We will also
draw on insights from proceedings and mapping exercise done by UHC2030 Technical Working Group on ‘Sustainability Transition from External Financing and Health System Strengthening’.
Koku Awoonor, Director, Policy Planning Monitoring and Evaluation, Ghana Health Service (GHS)
Michael Castro, Programme manager Budget transparency and accountability, the Collaborative Africa Budget Reform Initiative (CABRI)
Solomon Memirie, Senior Researcher, Centre for Medical ethics and Priority setting (CEPS), Addis Ababa University
Lydia Dsane-Selby, Deputy Chief Executive, Operations, National Health Insurance Authority Ghana (NHIA)
David Njuguna, Senior Health Economist, Ministry of Health Kenya