Health Technology Assessment for Universal Health Coverage Results of Policy Brief Sophie Werko, International Relation Manager at Swedish Agency for HTA and Assessment of Social Services; Adham Ismail,Team Leader, Essential Medicine and Health Technologies, WHO/EMRO; and Mouna Jameleddine, Director of HTA Department at National Authority for Assessment and Accreditation,Tunisia

Objectives To present briefly relevant information that can help in better understanding regional HTA situation , need, and relevant policies To suggest possible policy options to support HTA

Global Commitment “A time to urgently and significantly scale up efforts to accelerate transition towards Universal Access and availability to affordable and quality healthcare services in line with SDGs” Achieving UHC includes access to safe ,effective and affordable essential medicines and vaccines for all

What is HTA? Multidisciplinary process to evaluate the clinical, social, economic, organizational and ethical issues of a health intervention or health technology in a systematic, transparent, unbiased and robust manner Decision making and priority setting for: Buying – benefit package – public health programs – health interventions – procurement – pricing of medicines To increase value for money from scarce public resources and help to control medical expenditures 

Need for HTA Most HICs now require HTA as part of their decision making processes HTA is developing at an uneven rate across countries, role differs from one country to the other Limited resources of developing countries mandate rational decision making about investments of new and emerging technologies

Medicines, Vaccines & other Health Technologies consume approximately 20-60%* of health budget in LMICs. Well over 50% of expenditure on Medicines, Vaccines & other Health Technologies is wasted due to one reason or the other. * Source: Regulatory System Strengthening, WHA Documents, EB134/29, January 2014.

Types of decisions informed by HTA Organization/Individual Types of decisions informed Government agencies , parliaments Regulatory approval, reimbursement, public health programs, research funding Health Care professionals Adoption of technologies , practice guidelines Hospital and other healthcare administrators Equipment procurement, availability of procedures, service delivery Private sector insurance Scope and extent of coverage Manufacturing Industry Product development, marketing

Types of decisions informed by HTA (Cont.) Organization/Individual Types of decisions informed Patient, carers and their representatives Guidance for treatment and support access to services , shared decision making with health care professional Information for future decisions on healthcare General public, citizens Judges decisions after demands for the use of high cost healthcare technologies Legal professionals Information for future healthcare professionals, decisions on research Academia , >

MENA –Regional Context Dynamic Political environment Economic changes and budget constrains Demographic transition and rise in NCDs High out of pocket expenditure Inconsistent quality of care

Regional Context Out of pocket expenditure levels are high reaching 64% in LMICs in HICs–(2014), 31% in UMICs and 13.5% in HICs Government health spending is variable often limited How to get best value for money spending?

Transition for Transformation Implementing complex reforms Finding ways for sustainable financing of health systems Finding ways of sustainable financing of population demands

Mapping of EMR HTA (2014): Survey Results 52% indicated that they perform HTA or HTA-like activities Most activities were related to clinical effectiveness and economic evaluations (67% and 62% respectively); The remaining 48% (not performing HTA-like activities) Over 50% do not know if there are future plans to develop HTA programmes in their national entities. Almost 75% indicated that using HTA in the decision-making process will be their biggest obstacle.

Prerequisites for successful implementation of HTA programs : • Political will and acceptance of HTA as an integrated system for routine evaluation of health technologies • Strong financial commitment and support from governments to establish national HTA programmes • Adequate human resources and means of enhancing their HTA-related knowledge and skills • Presence of reliable health information systems that will be able to generate valid and accurate data.

HTA institutionalization pillars Capacity building Analysis of system needs Legal and technical framework HTA Networking Funds Political will Involving key stakeholders

Challenges to HTA institutionalization Misunderstanding of the role of HTA Lack of political will Traditional ways of governing Resistance to change Long time to establish HTA Lack of financial resources to perform HTA Lack of knowledge about evidence-based medicine Lack of human resources Conflicts of interest Low quality of data Transparency issues  

Recommendations and the way forward Develop an over-arching HTA policy to support policy decisions on health interventions and facilitate more rational use of resources Countries to carry out national HTA mapping surveys Countries to raise awareness of current HTA status and/or to advocate for adopting HTA Countries should link HTA efforts to ongoing policy priorities and initiatives in the country National HTA units should start small regarding staffing and budget. Countries should identify specific HTA areas where assistance is required, for example, training on the HTA process, literature surveys, format and production of HTA reports, etc.

The Role of MENA HPF Four areas have been identified in which MENA HPF can fulfill an important role : 1. Address national organizations of health reforms in different countries and assist them in drafting effective strategies, identify the important areas of research, including allocation of scarce health resources across competing interest groups 2. Assess readiness of health systems 3. Provide a venue for the exchange of experiences and for networking to help the achievement of universal health coverage 4. Together with WHO, MENA HPF should focus on building HTA capacity and on monitoring progress towards HTA. This could be done through the development of an agenda to support decision-making and the development of a framework of indicators for measurements. It would thus serve as a platform to generate evidence to help policy-making.

Thank you