1. 1 HTA - CHALLENGES FOR EMERGING COUNTRIES Sivalal Sadasivan, Monash University, Sunway Campus, Malaysia

2. 2 INTRODUCTION emerging economies - challenges of –scarce resources –limitless health care needs need to ensure scarce resources used optimally - maximal benefits to community solution - use HTA in policy making & decision making - national & institutional levels many emerging economies - no HTA

3. 3 LACK OF RESOURCES insufficient expenditure on health care – grappling with setting up basic infrastructure inequitable distribution of resources e.g. emphasis on curative services high disease burden especially communicable diseases “reactive” management of health care inadequate manpower

4. 4 LACK OF AWARENESS economies unaware of benefits of HTA lack of evidence-based culture demands for latest technologies from healthcare providers & community lack of awareness on potential dangers, lack of efficacy, poor economic value - strong marketing strategies by manufacturers/ distributors lack of awareness on effective technologies in public sector mushrooming private sector competing through technologies

5. 5 LACK OF REGULATION many economies – no legislation to control technologies especially medical devices, medical & surgical procedures private hospitals/clinics not regulated lack of regulation on numbers/location of expensive/sophisticated technologies

6. 6 POLITICAL FRAMEWORK economies – HTA efforts initiated – change of government/leader/personnel → change of policy lack of political will political system/healthcare system not conducive e.g. predominant fee-for-service private sector financing mechanisms – lack of health insurance system centralised/decentralised systems

7. 7 LACK OF ACCEPTANCE OF HTA top policy makers/decision makers not convinced on need/benefits of HTA – insufficient/ineffective “marketing” of HTA policy makers not accepting HTA conclusions/ recommendations lack of acceptance by clinicians experience based approach - no faith in EBM lack of local/regional “success stories”

8. 8 LACK OF IMPLEMENTATION OF HTA lack of effective implementation plan no effective dissemination strategy lack of commitment by policy makers/decision makers controversial issues – local cultural issues lack of resources – involves introduction of expensive technologies e.g. immunisation, inhalers for bronchial asthma

9. 9 LACK OF TRAINING lack of trained manpower/insufficient core group of trained personnel no follow up training lack of mentoring programmes insufficient/poor quality/inappropriate training e.g. different training required for users of HTA vs. doers of HTA insufficient personnel trained in specialized areas e.g. health economics, literature search

10. 10 LACK OF SUSTAINED EFFORTS tendency to “drop off” – determination to persevere against odds strong commitment lacking lack of support – resources, personnel inadequate networking failure to carry out modifications to suite local requirements/constraints

11. 11 SOME SUGGESTED STRATEGIES adopt/adapt HTA reports from other countries/agencies seek mentorship/job attachments/on-the- job training opportunities local workshops using local examples/ situations careful selection of appropriate personnel obtain support from top management – “marketing” by external agencies – HTAi, INAHTA, WHO

12. 12 SOME SUGGESTED STRATEGIES joint assessments with established HTA agencies careful selection of initial HTA topics to facilitate acceptability “marketing” of benefits brought about by HTA recommendations e.g. cost savings, withdrawing/not allowing unsafe/ineffective technologies

13. 13 SOME SUGGESTED STRATEGIES involvement of top policy makers/decision makers use of “ambassadors”

14. 14 CONCLUSION HTA communities - make efforts to introduce HTA in countries lacking HTA HTA communities - provide support to HTA agencies in early stages Need to sustain/protect global resources & protect communities