The workshop brought together over 30 experienced decision makers from a wide range of backgrounds including senior clinicians from leading Jordanian Institutions, the High Health Council, the Jordanian FDA, the Royal Medical Services, academia, the Ministry of Health and health insurance, the Jordanian Medical Association, the Joint Procurement Department, civil society and patient organisations, WHO, pharmaceutical manufacturers, and the World Bank.
Outline of the workshop
Drawing on its experience in developing best practice standards and informing purchasing decisions for technologies in the British National Health Service (NHS), NICE and its academic partners from Brunel University, provided an outline of the methodologies and processes used to inform decision-making in the UK and broader international context. By the end of the three-days, participants had gained a first-hand experience of how NICE’s principles of transparency, inclusiveness and methodological rigour are applied to inform coverage decisions in the UK.
Day 1 provided an overview of methods for assessing the clinical and cost-effectiveness of medical technologies and clinical practices, built around a case study of NICE’s guidance on the management of hypertension in primary care. Participants reviewed real world material including meta-analyses data and the economic model used by NICE decision makers.
Day 2 started with an overview of resource allocation approaches as applied in different healthcare systems. The main part of the day focused on processes and governance structures for using evidence to inform policy decisions based on the NICE and other international models. Participants discussed processes for identifying and engaging with stakeholders, consultation and contestability arrangements and the use of societal value judgements, in addition to clinical effectiveness and efficiency considerations. Issues related to implementation and impact assessment were also discussed, using real examples from the NHS.
Day 3 was devoted to how to ‘Jordanise‘ NICE and international HTA/quality standard development and policy-making experience. After a brief summary of issues arising from the previous two days, senior Jordanian policy makers explained the current processes for updating the Rational Drug List (JFDA RDU) and described progress with the Medicines Transparency Alliance (MeTA secretariat) pilot in Jordan. Having set the scene, break out groups discussed what the next steps should be for systematically applying principles of evidence-based policy making in the Jordanian system.
The key questions were:
- Institutional arrangements and co-ordination functions
- Capacity building and awareness raising amongst key stakeholders
- Pilot study to test the applicability of the methods and processes and inform current and future policy reforms
Conclusion and next steps
This meeting brought together an exciting and varied range of key players who demonstrated enormous enthusiasm and commitment to improving the transparency, governance and efficiency of Jordanian healthcare systems.
Despite problems of fragmentation and capacity limitations, Jordan has the necessary high-level policy commitment, senior clinician buy-in and domestic commercial sector engagement to build on the existing structures and initiatives, such as the RDU and RDL of JFDA, MeTA, local Standard Treatment Guidelines, the Joint Procurement Department and the High Health Council. The high level commitment to extending coverage to the whole of the population through national health insurance makes the use of HTA processes and quality standards and methods all the more important.
There was strong consensus across all stakeholder groups that the best way of going ahead would be through a pragmatic hands-on pilot to test out the methodology and process principles of using evidence to inform policy.
According to the participants, any such initiative should be driven by existing rather than new structures and co-ordinated by the High Health Council and involving JFDA, MoH (Clinical Pharmacy Directorate), MeTA, local universities, RMS, the health insurance and JPD. In order to deliver on this agenda, increased capacity in health economics and better understanding of the core principles by clinicians and policy makers is required. Furthermore, the pilot should focus on one or more high burden of disease area, where there is potential for significant health gain and/or efficiency savings. Conditions for success include a good evidence base, including international guidelines and analyses that can be adapted to the local setting and a range of alternative treatment options, including low price pharmaceuticals. The deliverable would be a standard treatment guideline that could be applied across the different systems in Jordan and that may include an assessment of specific pharmaceutical options. This could inform the process of updating the RDL for a related class of drugs.
Overall, NICE can contribute to two key areas of health policy currently undergoing reform in Jordan:
- best practice standard treatment guidelines, including harmonisation of existing ones and methods and processes of adapting or developing new ones in high burden of disease areas and
- rational drug list, including the methods and processes of making and listing and delisting decisions, considerations of cost-effectiveness and of affordability.
In delivering on both these objectives, the role of civil society involvement and raising awareness in patients and the general public is of central importance as a drive to improve transparency and enhance implementation of evidence-informed policies.
There was broad agreement that NICE and its academic partners could work with Jordanians on designing, delivering and evaluating the pilot. Specific aspects of NICE’s contribution include:
- Technical assistance on methodology for topic selection, HTA and clinical guideline development in the pilot disease area
- Support with training in evaluative techniques, and capacity building amongst clinicians, policy makers and technical staff. This may include hands-on training as part of the pilot and/or study tours to London to observe committee meetings
- Access to NICE material, including evidence tables, systematic reviews and economic models as well as completed guidance, to be used as a starting point in the pilot
- Strategic advice on processes for stakeholder involvement, contestability and conflict of interest policies
- Dissemination, implementation and monitoring support after the pilot is completed
What became apparent throughout the three days was that there is a strong momentum for enhancing the use of clinical and economic evidence to inform healthcare policy in Jordan. There is high-level political support and active interest from clinicians to use the UK and broader international experience in applying these techniques in the local setting. In order to take advantage of this momentum, we need to develop a plan of action, including identifying key Jordanian and international partners and a source of funding in order to implement the pilot.