Supporting next steps for HTA institutionalisation
Ghana has embarked on a programme to initiate and institutionalise Health Technology Assessment (HTA) to inform policy making, priority setting for health interventions, reimbursement, pricing of pharmaceuticals and other health technologies. To support this goal of HTA institutionalisation, in 2019 the Minister of Health inaugurated the HTA Steering Committee, Technical Working Group and Secretariat to oversee the development of HTA under the auspices of the Ghana Ministry of Health. The membership of the Steering Committee is cross agency, with representation from the most relevant agencies, for example, the Ministry of Health, The National Health Insurance Authority, The Ghana Health Service and the Ministry of Finance, to name a few.

In 2021, the Ministry of Health finalised its strategic plan for HTA, whose primary aim is to strengthen the science and practice of HTA in support of evidence-based decisions for improved health in Ghana (1). The specific objectives of the strategy are to:

· Establish country structures required to institutionalize HTA in Ghana in line with country policy direction

· Strengthen the science and practice of HTA in Ghana in order to produce quality evidence, informed effective decisions and efficient practice based on agreeable standards for conduction, dissemination and use of HTA

· Provide support for and deploy evidence-based priority setting in policy prioritization, selection of medicines and health technologies, reimbursements, pricing, resource allocation and procurement; with initial emphasis on health care outcomes, cost and reimbursements.

Ongoing activities:

Capacity assessment and tailored capacity development for HTA
– NIPH developed a survey instrument to assess the (technical) skills conduct an HTA, such as, information retrieval, clinical evidence synthesis and health economics. The Ghana HTA TWG assessment was completed in March 2021 following ethical clearance from the Ghana Health Service Ethics Review Committee.

HTA on Diabetes management (led by Imperial/LSHTM)
– Understanding current practice of managing diabetes in Ghana
– Benchmarking to cross-examine key aspects of findings with international best practice
– Scoping for de-novo interventions and modelling likely health economic impact

HTA on childhood cancers (led by NIPH)
– Assess the impact of the extension of the current NHIS list of cancer medicines to cover childhood cancers

iDSI core partner, the Global Health and Development Group at Imperial College London collaborated with University of Southampton, academia and government in Ghana to produce an HTA study, modelling different policy scenarios for the cost-effective management of hypertension under the current National Health Insurance Scheme (NHIS). These included representatives from the Ministry of Health, National Health Insurance Authority, University of Ghana, and Kwame Nkrumah University of Science and Technology.

The study included economic evaluation and budget impact analysis of main classes of anti-hypertensive medicines currently used for uncomplicated, essential hypertension in Ghana.

Impact of hypertension HTA

• The study was presented by iDSI representatives at the Ghana National Health Summit in 2017. Results included evidence-informed formulated policy scenarios as a means for achieving cost effective management of hypertension for Ghanaian policy makers. See more details on impact of study on policy making for cost-saving and health maximising scenarios in Ghana here.
• In 2018 the Ghanaian government signed an Aide Memoire cementing the role of HTA in optimising drug procurement and supply chains for UHC, reflecting discussions and conclusions from the 2018 National Health Summit and containing commitments of health partners towards providing quality healthcare for Ghanaians.
• The study also resulted in a strategic plan for HTA institutionalisation and a National Medicines Policy in Ghana, which promoted the responsible use of medicines by healthcare providers and consumers and reaffirmed the government’s commitment towards UHC and the role that HTA plays in ensuring control over national budgets and optimal resource allocation.

In September 2018 iDSI and Health Technology Assessment international (HTAi) hosted a first-of-its-kind event in Accra, Ghana – the first interdisciplinary event including academic, government, private and public sectors focused on health technology assessment (HTA) and related sustainable resource allocation policies in Sub-Saharan Africa. The two-day event set out to address the difficulties that low- and middle-income countries face in attempting to attain UHC, and put the spotlight specifically on how HTA can provide solutions. Almost 100 policy representatives from across Africa and Europe attended workshops that provided an overview of HTA, covering core technical components and how HTA could be integrated within a broader decision-making process.

As Ghana is moving beyond aid while still facing with an increasing disease burden relating to both infectious and non-communicable diseases, and the threat of pandemics, HTA needs to be ‘institutionalised’ so that evidence-informed resource allocation becomes the norm rather than the exception. This is a necessary step for achieving and sustaining UHC. The donor-driven domestic resource mobilisation agenda and the accompanying calls for strategic purchasing and efficiencies can only be implemented through addressing wasteful spending and ensuring the value for money of new prospective investments.

In 2018, colleagues from the Ministry of Health, Ghanaian universities (Kwame Nkrumah University of Science and Technology and University of Ghana), the Global Fund for AIDS, TB and Malaria, and iDSI (Global Health and Development Group; Norwegian Institute of Public Health, NIPH) discussed how to work together to implement the government’s vision for embedding HTA into decision-making within the wider health system.