1. 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

2. 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

3. 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

4. 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 

5. 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

6. 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.

7. 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

8. 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 ,
>

9. 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

10. 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?

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

12. 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.

13. 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.

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

15. 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

16. 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.

17. 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.

18. Thank you