Health technology assessment in sub-Saharan Africa: an initial survey of stakeholders

Jun. 12, 2020

Report authors: Sam Hollingsworth, Kalipso Chalkidou and Francis Ruiz

In this blog, Samantha Hollingworth, Francis Ruiz and Kalipso Chalkidou from the International Decision Support Initiative (iDSI), discuss the findings of their recently published Brief Report, which aims to rapidly assess current health system priorities and policy areas of demand for health technology assessment (HTA) in Sub-Saharan Africa, and identify key gaps in data and skills to inform targeted capacity building.

Most countries have committed to universal health coverage (UHC) in the context of the sustainable development goals for affordable access to essential medicines and other health technologies. Many countries in sub-Saharan Africa (Africa) have established national health insurance systems (or are planning to) but they require governments to set health priorities within a limited health budget.

Supporting countries to make informed decisions

Health Technology Assessment (HTA) provides a structured way to bring together evidence of clinical and cost effectiveness to inform priority-setting activities. In establishing HTA systems, you need to involve many stakeholders including (government) decision makers, clinicians, academics, consumers, development partners, and HTA knowledge brokers. The International Decision Support Initiative (iDSI) is a global network of health, policy and economic expertise, which seeks to support countries to make better decisions about efficient spending on healthcare. iDSI has been working in Africa since 2013 to develop local capacity and support implementation of robust HTA processes.

There is growing interest across the continent but little is known about the current HTA landscape. We rapidly assessed current health system priorities and policy areas of demand for HTA in Sub-Saharan Africa, to identify key gaps in data and skills to inform targeted capacity building.  We revised an existing survey, delivered it to 357 participants, then analysed responses and explored key themes. There were 51 respondents (14% response rate) across 14 countries.

We found that HTA is an important and valuable priority-setting tool with a key role in designing health benefits packages, developing clinical guidelines, and improving services.  Medicines were a technology type that would especially benefit from using HTA. Participants highlighted that HTA can be used to address safety issues (e.g. low quality medicines) and explore value for money. Local data to support HTA – including its availability and accessibility – was widely considered inadequate and limited. Participants outlined the need for training support in research methodology and data gathering.

A growing interest in HTA

This is, as far as we know, the first survey of the HTA landscape in Africa. Despite the low response rate, we received in-depth responses from many respondents. Their views were as individuals so may not reflect those of particular agencies or governments.  Our results are similar to the results from the African region in the WHO Global Survey on Health Technology Assessment by National Authorities. They also found that the main barriers were a lack of qualified human resources, funding, and information.

Priority setting is inevitable: the question is not whether, but rather how, to set them. Although HTA is not widely used in Africa, there is growing political commitment and policy interest. The interest in using HTA to support priority-setting decisions for medicines, devices, and vaccines is welcome as these are high cost items in a country’s health budget. The use of HTA is even more important in the context of two current challenges: donor funding and COVID-19.  As many countries in Africa grow, they will need to reduce their reliance on donor funds, especially in health. COVID-19 has exposed some weakness in health systems and the need to consider not only maintaining the essential package of health services such as for malaria, childhood immunisation, and TB, but to also consider the costs – and cost-effectiveness – of testing and treating patients with COVID-19.

There are growing numbers of economic evaluations in Africa but only one in four of the first authors of these evaluations were affiliated with African institutions. The main challenge is being able to produce high quality evidence and share knowledge among institutions. Perhaps these challenges could be helped if countries pooled their resources and harmonised policies in health, as they have done for medicines regulations with the African Union. Our survey is an important first step in raising awareness of HTA as a tool for priority setting in Africa. We will develop a more refined survey to support increased engagement and building capacity.

This article is included in the International Decision Support Initiative gateway on F1000Research.