Embrace Evidence-Based Decision Making in Health Technology Assessment: Stakeholders Told
By Kemunto Ogutu
The University of Nairobi Center for Epidemiological Modelling and Analysis (CEMA), in collaboration with Health Intervention and Technology Assessment Program (HITAP) in
Thailand and Imperial College London, concluded its 5-day, in-person introductory training on Health Technology Assessment (HTA) on Friday 26th July.
The event, hosted at the University of Nairobi Towers, left participants inspired and equipped with vital skills for the future of healthcare decision-making.
It brought together an eclectic mix of healthcare managers, public health professionals, researchers, and postgraduate students.
Dr. Tabitha Okech, a Health Technology Assessment specialist at CEMA, explained the motivation behind the training.
Kenya is on a journey towards Universal Health coverage. This will require development of health systems that provide equitable access to health services for all citizens. Additional resources will be required to meet this goal. “However, many times, countries are not able to fund all the health interventions through health insurance. Determining what to include in the health benefits packages given the existing budget limitations, may be of priority. These priorities may be set based on criteria such as burden of disease, equity considerations and the budget impact of reimbursing the health technologies/ interventions,” she said.
The training aimed to equip stakeholders with systematic, reproducible HTA processes for transparency and accountability.
"Evidence shows that when available health services are expensive and financial protection is inadequate, many vulnerable people are pushed into deep poverty following catastrophic expenditures due to seeking healthcare," Dr. Okech explained.
Social health insurance is a viable option where people contribute to the insurance fund translating out-of-pocket payments to prepayment. This provides greater financial protection through risk sharing and pooling of funds, and ensures equitable coverage and access to health services to large populations.
A Dive into the World of HTA
The sessions blended historical insights and hands-on learning, providing a comprehensive understanding of HTA’s role in healthcare. The facilitators were experts in epidemiology, data, and HTA processes, and used various methods, from lectures to practical sessions. Participants explored the evolution of HTA, highlighting the epidemiological, economic, and social methodologies crucial for healthcare decision-making.
Dr. Saudamini Dabak, the Head of the International Unit at HITAP and a facilitator at the training, described HTA as an essential tool that all countries should embrace. "HTA helps determine what interventions or technologies provide good value for money for the health sector. We all have unlimited wants but limited supplies, which prompts the need to invest in ways that give the most value for money," she explained.
Evidence-Based Decision-Making
Dr. Panchanok Muenkaew, an Associate at HITAP, spoke about the parallels between HTA in Thailand and Kenya, and how participants could practically implement the lessons taught.
She explained that Thailand uses HTA to help policymakers decide what drugs to add to a benefits package. "HTA is very important because it is evidence-based. The process is participatory and involves not just the government, but also civil societies. Once you learn what HTA is, you can incorporate the details and strategies," she said.
Ms. Idah Kinya, a Health Economist from the Kenyatta University Teaching, Referral & Research Hospital (KUTRRH), expressed her joy in being part of the training. "This training has come at a good time, considering we were dealing with an economy where resources were limited and health needs were increasing." She emphasized that HTA is a process and while the country might not yet have achieved all its goals in this field, it is headed in the right direction.
Ms. Kinya urged the government to involve technocrats and people with interest and experience in HTA when formulating healthcare policies. "As HTA experts, we were still in the process of providing more evidence, and we hope that evidence will be incorporated," she said.
Ms. Njoki Mboce, a lawyer who attended the training, highlighted the multidisciplinary nature of the program, which enabled her to link scientific work with policy development. "There is value in appreciating data-driven decisions. It eliminates concerns about corruption, commercial sense, and other issues. If you understand the processes leading to interventions, you can better articulate them in legislation and policy," she said.
Embracing Social and Ethical Dimensions
Mr. Raphael Indimuli, a researcher at the University of Nairobi Institute for Development Studies (IDS), expressed satisfaction with the program. “It has been a reflection of what goes into the kind of policy decisions that we make. If we gather good evidence, decision-making becomes much easier. All stakeholders must be involved in HTA,” he said. Mr. Indimuli has been working on social aspects surrounding health insurance and the uptake among informal workers to improve inclusion.
The training also emphasized the importance of incorporating social, ethical, and equity considerations into assessment processes.
Prof. Thumbi Mwangi, the co-director at CEMA, noted that the training deliberately incorporated stakeholders from various fields. "We were very deliberate to think beyond just numbers because life does not work only in numbers. We appreciate that there are ethical issues, social issues, and legal issues that must be part of this inclusive HTA process," he said.
Participants discussed real-world case studies, exploring how these factors influence healthcare outcomes. They also explored various HTA decision-making frameworks, learning to identify implementation challenges and develop strategies for long-term success.
Looking Ahead
Dr. Okech termed the training a success and hopes that participants will use the knowledge they gathered to initiate HTA processes and impact policies in their workplaces.
"We hope this is the start of many training sessions to educate different levels of personnel. We aim to train policymakers to understand and support the process, and reach out to different stakeholders, from patient groups to civil societies, to help them understand the process and their role," she said.
Dr. Okech disclosed that while CEMA received significant interest from applicants, they could only admit a limited number due to the practical sessions.
She hopes that in the future, they will have the capacity to train more people and mentioned plans to offer modules, online courses, and sessions to continue imparting knowledge on the HTA process.
“CEMA has highly skilled personnel who can help gather evidence required by stakeholders in HTA processes. If there is a need for epidemiological modelling, economic modelling, equity questions, or ethics issues concerning adopting health technologies, whether new or old, CEMA can use data to inform that decision. We look forward to providing technical assistance," she said.
Dr. Okech stressed that HTA is a collaborative effort. Whether you are a health economist, epidemiologist, or bioethicist, HTA brings everyone on board. When starting in this field, you need to think about how to collaborate with other experts.