Time for Health Technology Assessment

A health technology is defined as an intervention that may be used to promote health, to prevent, diagnose or treat acute or chronic disease, or for rehabilitation and include pharmaceuticals, devices, procedures and organizational systems used in health care (International HTA glossary). Health technologies (HT) such as medical devices are crucial in the prevention, diagnosis, and treatment of illness and disease, as well as patient rehabilitation (WHO, 2011), and as such, are essential for a functioning health system including universal health coverage (UHC) (WHA, 2007, WHA 2014 ).Health Technology Assessment (HTA) is the systematic evaluation of the properties and effects of a health technology, addressing the direct and intended effects of this technology as well as its indirect and unintended consequences, and aimed mainly at informing decision making regarding health technologies (International HTA glossary). The HTA is usually divided into a ‘micro’ HTA focusing on drugs, devices and the likes, and a ‘macro’ HTA focusing on different elements of the health system itself (Towse et al., 2011). It usually involves evaluation of the social, economic, organizational and ethical aspects of the technology by a multidisciplinary team.

As countries such as Bangladesh strive to achieve UHC, the decision-making with respect to choosing the appropriate and cost-effective technologies for optimum health outcomes is becoming increasingly important (Mori and Robberstad, 2012, Ogembo, 1998, Quaye, 1996). Recently, interest in HTA in LMICs is growing for making regulatory, coverage/formulary and reimbursement decisions (Oortwijn et al., 2010, Tantivess et al., 2009, Rajan et al., 2011, Attieh, 2012). However, while resorting to HTA for decision-making,  LMICs face difficulties from lack of data, technical expertise, and institutions with capacity to conduct HTA (Chalkidou K et al., 2010), and as such formal, independent HTA structure is mostly non-existent (Sivalal 2009, Babigumira et al. 2016). Bangladesh is no exception in this regard (Sivalal, 2009). It has some guidelines such as the National guideline on medical biotechnology (DHGS, 2010) and a registration guideline for drugs and devices (DGDA, 2015), but has neither any specific policy on HTA nor a HTA management unit or HTA organization (WHO, 2014, WHO 2015). This capacity for HTA, especially in the public sector, has become essential given the political commitment of the hierarchy for advancing UHC in the era of the SDGs. (WHA, 2011).

The Health Economics Unit (HEU) was established in 1994 under the Ministry of Health and Family Welfare (MoHFW) with the objectives of developing health economics analytical capacity in Bangladesh and contributes to policy agenda setting, formulation, implementation and monitoring and evaluation. During the third sector programme on health HPNSDP 2011 – 16(MoHFW, 2011), HEU developed the first ever Health Care Financing Strategy (2012-2031) (HEU, 2012) charting a financial roadmap for achieving UHC by 2032 and currently piloting a health protection scheme for people below poverty line (Shastha Suraksha Karmasuchi, SSK).  In the next health sector plan (HPNSIP 2016 – ’21), The Health Economics and Financing (HEF) Operational Plan (OP) of HEU have five major components of which three are relevant to this proposal: Health economics and financing options including UHC and capacity building and and involve examining efficient and effective usage of available resources towards universal health coverage (Component 1), improvement of Quality of Health care services (component 3), and tracking health expenditure (component 4). To implement these OP-related activities, HEU has prioritized the need of capacity building in these different fields with the ultimate objective of advancing the UHC agenda of the government. In this, institutional capacity development on HTA has been identified as one of prime area to enhance the HEU’s capacity (HEU, HEF OP 2017).

{Excerpts from a proposal}

References

Attieh, R. andGagnon, MP. 2012. Implementation of local/hospital-based health technology assessment initiatives in low- and middle-income countries. Int J Technol Assess Health Care, 28, pp.445–451.

Babigumira, JB., Alisa, M., Bartlein, JR., Stergachis, A., Louis, P. and Garrison, Jr. 2016. Health technology assessment in low- and middle-income countries: a landscape assessment. Journal of Pharmaceutical Health Services Research.DOI: 10.1111/jphs.12120

Chalkidou, K. Levine, R. and Dillon, A. 2010. Helping poorer countries make locally informed health decisions. BMJ.16, pp.341.

Directorate General of Health Services (DGHS).2010.National guideline on medical biotechnology.Ministry of Health and Family Welfare, Government of the People’s Republic of Bangladesh.

Directorate General of Drug Administration (DGDA). 2015. Medical device registration guideline Bangladesh 2015.  Ministry of Health and Family Welfare, Government of the People’s Republic of Bangladesh.

Health Economics Unit (HEU). 2012. Health Care Financing Strategy 2012-2032.Ministry of Health and Family Welfare, Government of the People’s Republic of Bangladesh.

Health Economics Unit (HEU).2017.Health Economics and Financing Operational Plan.Ministry of Health and Family Welfare, Government of the People’s Republic of Bangladesh.

Ministry of Health and Family Welfare (MoHFW, 2011).Health Population and Nutrition Sector Development Program (HPNSDP) 2011-16. Government of the People’s Republic of Bangladesh.

Mori, AT. And Robberstad, B. 2012. Pharmacoeconomics and its implication on priority-setting for essential medicines in Tanzania: a systematic review. BMC Med Inform DecisMak ,12, pp.110..

Ogembo-Kachieng'a, M.1998.Health care technology in public health institutions in Kenya.East Afr Med J,75, pp.632–636

· 

· 

· 

· 

· 

·Find articles by 'David Banta'

·Filter current search by 'David Banta'

Oortwijn, W., Mathijssen, J. and Banta, D. 2010. The role of health technology assessment on  pharmaceutical reimbursement in selected middle-income countries. Amsterdam: Health Policy ,95,pp. 174–184.

Quaye, R. 1996. Assessment of medical technology and the challenge for health reform in Africa. Int J Health Care QualAssur, 9, pp. 38–43.

Rajan, A.Gutierrez-Ibarluzea, I.and  Moharra, M.2011.  Addressing issues in health technology assessment promotion: motives, enablers, and barriers.Int J Technol Assess Health Care, 27, pp.55–63.

Sivalal, S. 2009. Health technology assessment in the Asia Pacific region.International Journal of Technology Assessment in Health Care, 25( 1 ), pp.196–201. Doi:10.1017/S0266462309090631

Tantivess, S., Teerawattananon, Y. andMills,  A. 2009. Strengthening cost-effectiveness analysis in Thailand through the establishment of the health intervention and technology assessment program. Pharmacoeconomics ,27,pp.931–945.

Towse, A., Devlin, N., Hawe, E. and Garrison, L.2011. The evolution of HTA in emerging markets health care systems: analysis to support a policy response. Consulting Report. Available at: https://www.ohe.org/publications/evolution-hta-emerging-markets-health-caresystems-analysis-support-policy-response (accessed 30 October 2014).

World Health Organization (WHO). 2014. Global Atlas of medical devices. Country report- Bangladesh. WHO SEAR. Available at: http://www.who.int/medical_devices/countries/bgd.pdf?ua=1

World Health Organization (WHO). 2011. Health Technology Assessment of Medical Devices. WHO Medical Device Technical Series. Available at:http://apps.who.int/medicinedocs/en/d/Js21560en/

World Health Organization (WHO). 2015. Global Survey on Health Technology Assessment by National Authorities. Available at: http://www.who.int/health-technology-assessment/MD_HTA_oct2015_final_web2.pdf.

World Health Assembly (WHA). 2007. Resolution WHA60.29 i. Available at: http://www.who.int/healthsystems/WHA60_29.pdf?ua=1

World Health Assembly (WHA). 2014. Resolution WHA67.23.Available at: http://apps.who.int/gb/ebwha/pdf_files/WHA67/A67_R23-en.pdf?ua=1

World Health Assembly (WHA).2011.Her Excellency Sheikh Hasina, Prime Minister of Bangladesh Speech to the Sixty-fourth World Health Assembly. Media Centre: World Health Organization