Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-11-27T04:12:29.509Z Has data issue: false hasContentIssue false

Addressing the challenges of implementing a Health Technology Assessment Policy Framework in South Africa

Published online by Cambridge University Press:  13 August 2020

Debjani Mueller*
Affiliation:
Department of Health Care Management, Berlin University of Technology, Berlin, Germany Charlotte Maxeke Research Cluster, Johannesburg, South Africa
*
Author for correspondence: Debjani Mueller, E-mail: dbmueller7@yahoo.de

Abstract

Objective

South Africa's commitment to progressively achieve universal health coverage can lead to the effective and appropriate use of Health Technology Assessment (HTA) to strengthen the healthcare system. The study aimed to analyze the challenges faced in the formal implementation and utilization of HTA in the public health sector.

Methods

Review and analysis of health technology policies and legislation introduced in South Africa since 1965 serves as the backbone of this study. Walt and Gilson's health policy triangle framework and Kingdon's model were used for data analysis. In addition, a semi-structured survey was conducted among key stakeholders, including those attending HTA workshops that were held in 2016 and 2017.

Results

The document review identified appropriate legislative and policy framework for informing healthcare decisions. Survey participants (n = 55) reported limited political support, local capacity, and awareness of HTA as barriers to implementing HTA. They noted that adequate financial resources and availability and sharing of quality data are primary drivers for HTA development. Effective governance, collaboration, and cooperation between key stakeholders of the healthcare system were suggested as possible ways forward for the institutionalization of HTA.

Conclusion

The South African government's goal to introduce the national health insurance program provides an excellent opportunity to formally introduce the use of HTA in decision making. Individual capacity development supported by institutional and organizational environments is urgently needed to achieve its full potential.

Type
Policy
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Goodman, CS. HTA101. Introduction to Health Technology Assessment. National Library of Medicine, Bethesda, MD, USA; 2014. Available from: http://www.nlm.nih.gov/nichsr/hta101/HTA_101_FINAL_7-23-14.pdf (accessed January 20, 2018)Google Scholar
Kristensen, FB, Husereau, D, Huić, M, Drummond, M, Berger, ML, Bond, K et al. Identifying the need for good practices in health technology assessment: Summary of the ISPOR HTA council working group report on good practices in HTA. Value Health. 2019;22:1320.CrossRefGoogle Scholar
World Health Organisation. Resolution WHA67.23. Health intervention and technology assessment in support of Universal Health Coverage. In: Sixty-seventh World Health Assembly. Resolutions and decisions; 2014. http://apps.who.int/medicinedocs/documents/s21463en/s21463en.pdf (accessed March 1, 2018)Google Scholar
World Health Organisation. BRICS Seek value for money as health-care costs rise. Bull W H O. 2014;92:392–3.CrossRefGoogle Scholar
Oortwijn, W, Broos, P, Vondeling, H, Banta, D, Todorova, L. Mapping of health technology assessment in selected countries. Int J Technol Assess Health Care. 2013;29:424–34.CrossRefGoogle ScholarPubMed
MacQuilkan, K, Baker, P, Downey, L, Ruiz, F, Chalkidou, K, Prinja, S et al. Strengthening health technology assessment systems in the global south: A comparative analysis of the HTA journeys of China, India and South Africa. Glob Health Action. 2018;11:1527556. doi: 10.1080/16549716.2018.1527556.CrossRefGoogle ScholarPubMed
Lessa, F, Ferraz, MB. Health technology assessment: The process in Brazil. Rev Panam Salud Publica. 2017;41:e25.Google ScholarPubMed
Marsh, K. Establishment of health technology assessment in Russia: An interview with Vitaly Omelyanovsky. Bethesda, MD: Evidence Forum; 2015. Available from: http://www.evidera.com/newsletter/oct-2015 (accessed December 15, 2018)Google Scholar
Chen, Y, He, Y, Chi, X, Wei, Y, Shi, L. Development of health technology assessment in China: New challenges. Biosci Trends. 2018;12:102–08.CrossRefGoogle ScholarPubMed
Govender, M, Letshokgohla, ME, Basu, D. Health technology assessment—a new initiative in South Africa. S Afr Med J. 2010;100:334.CrossRefGoogle ScholarPubMed
Perumal-Pillay, VA, Suleman, F. Selection of essential medicines for South Africa—an analysis of in-depth interviews with national essential medicines list committee members. BMC Health Serv Res. 2017;17:17. Available from: https://doi.org/10.1186/s12913-016-1946-9 (accessed January 15, 2020).CrossRefGoogle Scholar
Croce, D, Mueller, D, Tivey, D. Challenges and limitations to adopting health technology assessment in the South African context. S Afr J Public Health. 2017;2:2629. Available from: 10.7196/SHS.2017.v2.i2.58 (accessed January 15, 2020)Google Scholar
World Bank. Current health expenditure (% of GDP)—South Africa; 2016. Available from: https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?locations=ZA&name_desc=false (accessed January 15, 2020).Google Scholar
Maphumulo, WT, Bhengu, BR. Challenges of quality improvement in the healthcare of South Africa post-apartheid: A critical review. Curationis. 2019;42:a1901. Available from: https://doi.org/10.4102/curationis.v42i1.1901 (accessed January 15, 2020).CrossRefGoogle ScholarPubMed
Walt, G, Shiffman, J, Schneider, H, Murray, SF, Brugha, R, Gilson, L. ‘Doing’ health policy analysis: Methodological and conceptual reflections and challenges. Health Policy Plan. 2008;23:308–17. https://doi.org/10.1093/heapol/czn024.CrossRefGoogle ScholarPubMed
Kingdon, J. Agenda, alternatives and public policies. Boston, MA: Little Brown; 1984.Google Scholar
Wild, C, Stricka, M, Patera, N. Guidance for the development of a National HTA strategy. Health Policy Technol. 2017;6:339–47.CrossRefGoogle Scholar
Mueller, D, Tivey, D, Croce, D. Health-technology assessment: Its role in strengthening health systems in developing countries. S Afr J Public Health. 2017;2:611. Available from: doi: 10.7196/SHS.2017.v2i1.50 (accessed January 15, 2020).Google Scholar
Bijlmakers, L, Mueller, D, Kahveci, R, Chen, Y, Van der Wilt, G. Integrate-HTA: A low and middle-income country perspective. Int J Technol Assess Health Care. 2017;33:599604.CrossRefGoogle ScholarPubMed
Oliver, K, Innvar, S, Lorenc, T, Woodman, J, Thomas, J. A systematic review of barriers to and facilitators of the use of evidence by policymakers. BMC Health Serv Res. 2014;14:1.CrossRefGoogle ScholarPubMed
Luz, A, Santatiwongchai, B, Pattanaphesaj, J, Teerawattananon, Y. Identifying priority technical and context-specific issues in improving the conduct, reporting and use of health economic evaluation in low- and middle-income countries. Health Res Policy Syst. 2018;16:112.Google ScholarPubMed
World Health Organization. 2015 Global Survey on Health Technology Assessment by National Authorities. Main findings; 2015. https://www.who.int/health-technology-assessment/MD_HTA_oct2015_final_web2.pdf?ua=1 (accessed October 1, 2018).Google Scholar
Mueller, D, Guttiérez-Ibarluzea, I, Schuller, T, Chiumente, M, Ahn, J, Pichon-Riviere, A et al. Capacity building in agencies for efficient and effective health technology assessment. Int J Technol Assess Health Care. 2016;32:292–9.CrossRefGoogle ScholarPubMed
Kristensen, FB, Lampe, K, Wild, C, Cerbo, M, Goettsch, W, Becla, L. The HTA core model—10 years of developing an international framework to share multidimensional value assessment. Value Health. 2017;20:244–50.CrossRefGoogle Scholar
Babigumira, JB, Jenny, AM, Bartlein, R, Stergachis, A, Garrison, LP. Health technology assessment in low- and middle-income countries: A landscape assessment. J Pharm Health Serv Res. 2016;7:3742.CrossRefGoogle Scholar
Supplementary material: File

Mueller supplementary material

Mueller supplementary material 1

Download Mueller supplementary material(File)
File 19.2 KB
Supplementary material: File

Mueller supplementary material

Mueller supplementary material 2

Download Mueller supplementary material(File)
File 24.7 KB