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HTA - CHALLENGES FOR EMERGING COUNTRIES

Sivalal Sadasivan, Monash University, Sunway Campus,

Malaysia

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INTRODUCTION

• emerging economies - challenges of – scarce resources – limitless health care needs

• need to ensure scarce resources used optimally - maximal benefits to community

• solution - use HTA in policy making & decision making - national & institutional levels

• many emerging economies - no HTA

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LACK OF RESOURCES

• insufficient expenditure on health care –grappling with setting up basic infrastructure

• inequitable distribution of resources e.g. emphasis on curative services

• high disease burden especially communicable diseases

• “reactive” management of health care• inadequate manpower

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LACK OF AWARENESS

• economies unaware of benefits of HTA• lack of evidence-based culture• demands for latest technologies from

healthcare providers & community• lack of awareness on potential dangers,

lack of efficacy, poor economic value - strong marketing strategies by manufacturers/ distributors

• lack of awareness on effective technologies in public sector

• mushrooming private sector competing through technologies

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LACK OF REGULATION

• many economies – no legislation to control technologies especially medical devices, medical & surgical procedures

• private hospitals/clinics not regulated• lack of regulation on numbers/location

of expensive/sophisticated technologies

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POLITICAL FRAMEWORK

• economies – HTA efforts initiated – change of government/leader/personnel → change of policy

• lack of political will• political system/healthcare system not

conducive e.g. predominant fee-for-service private sector

• financing mechanisms – lack of health insurance system

• centralised/decentralised systems

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LACK OF ACCEPTANCE OF HTA

• top policy makers/decision makers not convinced on need/benefits of HTA – insufficient/ineffective “marketing” of HTA

• policy makers not accepting HTA conclusions/ recommendations

• lack of acceptance by clinicians• experience based approach - no faith in

EBM• lack of local/regional “success stories”

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LACK OF IMPLEMENTATION OF HTA

• lack of effective implementation plan• no effective dissemination strategy• lack of commitment by policy

makers/decision makers• controversial issues – local cultural issues• lack of resources – involves introduction of

expensive technologies e.g. immunisation, inhalers for bronchial asthma

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LACK OF TRAINING

• lack of trained manpower/insufficient core group of trained personnel

• no follow up training• lack of mentoring programmes• insufficient/poor quality/inappropriate

training e.g. different training required for users of HTA vs. doers of HTA

• insufficient personnel trained in specialized areas e.g. health economics, literature search

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LACK OF SUSTAINED EFFORTS

• tendency to “drop off” – determination to persevere against odds

• strong commitment lacking• lack of support – resources, personnel• inadequate networking• failure to carry out modifications to

suite local requirements/constraints

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SOME SUGGESTED STRATEGIES

• adopt/adapt HTA reports from other countries/agencies

• seek mentorship/job attachments/on-the-job training opportunities

• local workshops using local examples/ situations

• careful selection of appropriate personnel

• obtain support from top management – “marketing” by external agencies – HTAi, INAHTA, WHO

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SOME SUGGESTED STRATEGIES

• joint assessments with established HTA agencies

• careful selection of initial HTA topics to facilitate acceptability

• “marketing” of benefits brought about by HTA recommendations e.g. cost savings, withdrawing/not allowing unsafe/ineffective technologies

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SOME SUGGESTED STRATEGIES

• involvement of top policy makers/decision makers

• use of “ambassadors”

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CONCLUSION

• HTA communities - make efforts to introduce HTA in countries lacking HTA

• HTA communities - provide support to HTA agencies in early stages

• Need to sustain/protect global resources & protect communities