HTA capacity building in developing and transitional countries Andrei Issakov Health Technology and Facilities Planning Department for Health System Governance and Service Delivery World Health Organization, Geneva

Stewardship (direction & oversight) Financing (collecting, pooling and purchasing) FUNCTIONS THE SYSTEM PERFORMS GOALS OF THE SYSTEM Health Fairness in financial contribution Responsiveness Resource generation (physical, human, knowledge) Service provision (individual & collective) Functions and Goals of Health System INPUTSINPUTS Coverage Efficiency Quality INTERMEDIATE GOALS Which info? Which knowledge? Which evidence?

HTA provides critical input into policy- and decision-making by offering evidence-based information on policy and practice alternativesHTA provides critical input into policy- and decision-making by offering evidence-based information on policy and practice alternatives There are multiple solutions and a wide spectrum of strategies for most health problemsThere are multiple solutions and a wide spectrum of strategies for most health problems Health sector generally has to do more with less resourcesHealth sector generally has to do more with less resources

Dedicated and coordinated approaches to implementing HTA are still rare in developing countries despite clear and overwhelming needDedicated and coordinated approaches to implementing HTA are still rare in developing countries despite clear and overwhelming need Policies, decisions and practices are based on evidence to a limited extentPolicies, decisions and practices are based on evidence to a limited extent Priority setting is poorPriority setting is poor Results are disseminated on a small scale, and implementation is not adequately supportedResults are disseminated on a small scale, and implementation is not adequately supported

Drowning in data! Just too much of it and often not what is neededJust too much of it and often not what is needed Multiple parallel demandsMultiple parallel demands Information goes up and never comes downInformation goes up and never comes down Key consumers of information not being served:Key consumers of information not being served: Policy makersPolicy makers Health ManagersHealth Managers Service ProvidersService Providers General publicGeneral public

"Know-do" gap "Know-do" gap

Limited awareness among policy-makers and health professionals - lack of conducive policy environmentLimited awareness among policy-makers and health professionals - lack of conducive policy environment Scant expertise, and financial and technical resources to obtain evidence and translate data into policy and clinical practiceScant expertise, and financial and technical resources to obtain evidence and translate data into policy and clinical practice Scarce data & research on local practices, local feasibility and acceptabilityScarce data & research on local practices, local feasibility and acceptability Conservative academia and medical establishment - vested interests and resistance to changeConservative academia and medical establishment - vested interests and resistance to change Consumer lobby (professional societies, watch dog groups, informed public, media, …) doesn't exist or lacks influenceConsumer lobby (professional societies, watch dog groups, informed public, media, …) doesn't exist or lacks influence

Profound changes are needed in the way how HTA is organized, and HTA findings and recommendations are disseminated, implemented and converted into evidence- based policies and clinical practiceProfound changes are needed in the way how HTA is organized, and HTA findings and recommendations are disseminated, implemented and converted into evidence- based policies and clinical practice Implementation of evidence-based policies and guidelines requires incentives to change behaviourImplementation of evidence-based policies and guidelines requires incentives to change behaviour Local feasibility often requires system changes, hence high level of awareness and political will is neededLocal feasibility often requires system changes, hence high level of awareness and political will is needed

Promote awareness and buy-in opinion leaders who should become the champions of HTAPromote awareness and buy-in opinion leaders who should become the champions of HTA Gain greater acceptability for HTA, influencing and changing current thinking and behaviour of policy- makers and health professionalsGain greater acceptability for HTA, influencing and changing current thinking and behaviour of policy- makers and health professionals Institutionalize and build capacity for HTAInstitutionalize and build capacity for HTA Promote and facilitate the incorporation of HTA results and recommendations into decision-making at policy, managerial and clinical levelsPromote and facilitate the incorporation of HTA results and recommendations into decision-making at policy, managerial and clinical levels Incorporate HTA principles, concepts and practices into undergraduate and postgraduate curricula for health professionals and health care managersIncorporate HTA principles, concepts and practices into undergraduate and postgraduate curricula for health professionals and health care managers

Link these efforts to broad health systems strengtheningLink these efforts to broad health systems strengthening Build on existing experiences, initiatives and success storiesBuild on existing experiences, initiatives and success stories Global & regional advocacy by WHO, HTAi, INAHTA, EUnetHTA, WHO Collaborating Centres for HTA, World Bank, …Global & regional advocacy by WHO, HTAi, INAHTA, EUnetHTA, WHO Collaborating Centres for HTA, World Bank, … Mainstream professional development and capacity building through fostering international exchanges, involvement in international fora, organizing targeted workshops, etc.Mainstream professional development and capacity building through fostering international exchanges, involvement in international fora, organizing targeted workshops, etc. Support the identification of needs, problems, priorities, solutions, and appropriate tools or methodologiesSupport the identification of needs, problems, priorities, solutions, and appropriate tools or methodologies Strengthen and expand international and regional networks, and foster partnerships and collaboration with leading international and national HTA institutions/organizationsStrengthen and expand international and regional networks, and foster partnerships and collaboration with leading international and national HTA institutions/organizations Facilitate the link of existing and emerging national institutions to international HTA hubs (HTAi, INAHTA, EUnetHTA, WHO Collaborating Centres)Facilitate the link of existing and emerging national institutions to international HTA hubs (HTAi, INAHTA, EUnetHTA, WHO Collaborating Centres) Increase accessibility of available tools through international sources (WHO, INAHTA, HTAi, EUnetHTA, World Bank, …), and encourage their update, renewal, web availability, ….Increase accessibility of available tools through international sources (WHO, INAHTA, HTAi, EUnetHTA, World Bank, …), and encourage their update, renewal, web availability, ….

Use of HTA products/tools Source: WHO CC for HTA, University of Ottawa

In 2001, the number of internet users was: per 1000 people in high-income countries 36.8 per 1000 people in middle-income countries 1.8 per 1000 people in low-income countries (UNDP 2003) Many tools are freely available, how to make them accessible? High degree of web based products Digital divide