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Vu HTT, Nguyen TA, Nguyen TTH, Nguyen AT, Tran D, Nguyen H, Hinton L, Pham T. A national program to advance dementia research in Vietnam. BMC Health Serv Res 2024; 24:156. [PMID: 38302993 PMCID: PMC10832103 DOI: 10.1186/s12913-024-10608-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/16/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND As Vietnam and other low- and middle-income countries (LMIC) experience a rapid increase in the number of people living with dementia, an acute need exists to strengthen research capacity to inform policy, improve care and support, and develop national dementia plans. We describe the development and early outcomes of an National Institutes of Health (NIH)/National Institute on Aging (NIA)-funded national dementia research capacity building program in Vietnam. METHODS The research capacity building program commenced in 2019 and has three components: (1) Vietnam Alzheimer's and other dementias research Network (VAN), (2) a mentored pilot grant program, and (3) research training, networking, and dissemination activities. The pilot grant program funds Vietnamese researchers for one to two years to conduct research focusing on Alzheimer's Disease and Alzheimer's Disease Related Dementias (AD/ADRD). Grants are reviewed and scored using NIH criteria, and priority is given to pilot grants with policy relevance and potential for future funding. An international pool of high-income country (e.g., United States, Australia, and United Kingdom) mentors has been engaged and mentors paired with each funded project. Training and networking activities include workshops on AD/ADRD research topics and regular meetings in conjunction with Vietnam's annual national dementia/geriatric conferences. Dissemination is facilitated through targeted outreach and the creation of a national network of institutions. RESULTS Over four years (2019-2023), we received 62 applications, reviewed 58 applications, and funded 21 projects (4-5 per year). Funded investigators were from diverse disciplines and institutions across Vietnam with projects on a range of topics, including biomarkers, prevention, diagnosis, neuropsychological assessment, family caregiver support, dementia education, and clinical trials. A network of 12 leading academic and research institutions nationwide has been created to facilitate dissemination. Six research training workshops have been organized and included presentations from international speakers. Grantees have published or presented their studies at both national and international levels. The mentoring program has helped grantees to build their research skills and expand their research network. CONCLUSION This research capacity building program is the first of its kind in Vietnam and may serve as a useful model for other LMIC.
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Affiliation(s)
- Huyen Thi Thanh Vu
- Department of Geriatrics, Hanoi Medical University, 1 Ton That Tung Street, Dong Da District, Hanoi, Vietnam.
- National Geriatric Hospital, Hanoi, Vietnam.
| | - Tuan Anh Nguyen
- National Ageing Research Institute, Melbourne, Australia
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, Australia
- Health Strategy and Policy Institute, Ministry of Health of Vietnam, Hanoi, Vietnam
| | - Thu Thi Hoai Nguyen
- Department of Geriatrics, Hanoi Medical University, 1 Ton That Tung Street, Dong Da District, Hanoi, Vietnam
- National Geriatric Hospital, Hanoi, Vietnam
| | - Anh Trung Nguyen
- Department of Geriatrics, Hanoi Medical University, 1 Ton That Tung Street, Dong Da District, Hanoi, Vietnam
- National Geriatric Hospital, Hanoi, Vietnam
| | - Duyen Tran
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, USA
| | - Huong Nguyen
- School of Nursing, University of Minnesota, Minneapolis, MN, USA
| | - Ladson Hinton
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, USA
| | - Thang Pham
- Department of Geriatrics, Hanoi Medical University, 1 Ton That Tung Street, Dong Da District, Hanoi, Vietnam
- National Geriatric Hospital, Hanoi, Vietnam
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Shi J, Chen X, Hu H, Ung COL. Benchmarking Drug Regulatory Systems for Capacity Building: An Integrative Review of Tools, Practice, and Recommendations. Int J Health Policy Manag 2023; 12:8100. [PMID: 38618782 PMCID: PMC10699822 DOI: 10.34172/ijhpm.2023.8100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 09/30/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Benchmarking has been increasingly used on drug regulatory systems to achieve sustainable pharmaceutical system strengthening. This study aimed to identify the scope, tools and benefits of benchmarking regulatory capacities and the most recent development in such phenomenon. Method: This study employed an integrative and critical review of the literature and documents on benchmarking drug regulatory capacities identified from 6 databases and 5 websites of related organizations and government agencies in compliance with the Preferred Reporting Items for Systematic Review (PRISMA) guidelines. RESULTS Forty-three studies and 6 documents about regulatory benchmarking published between 2005 and 2022 were included in this review. Five benchmarking assessment tools or programmes recommended or adopted by international organizations or government agencies had been identified, which collectively covered 12 major regulatory functions (4 at system level and 8 at operational level) involving 9 indicator categories and 382 sub-indicators. Benchmarking drug regulatory systems was reportedly employed at national, regional and international levels for either internal assessment (mostly on regulatory system establishment, drug review process and post marketing surveillance) or external evaluation (mostly on regulatory standards, drug review process and pharmacovigilance systems) to assess current status, monitor performance, determine major challenges and inform actions for capacity building. Priority of actions in areas such as regulatory process, resources allocation, cooperation and communication, and stakeholder engagement have been suggested for strengthening drug regulatory systems. Nevertheless, the evidence about benchmarking in optimizing regulatory capacities remained underreported. CONCLUSION This integrative review depicted a framework for decision-makers about why and how benchmarking drug regulatory systems should be undertaken. For effective benchmarking, well-informed decisions about the goals, the scope, the choice of reference points and benchmarking tools are essential to guide the implementation strategies. Further studies about the positive effects of regulatory benchmarking are warranted to engage continuous commitment to the practice.
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Affiliation(s)
- Junnan Shi
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao SAR, China
| | - Xianwen Chen
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao SAR, China
| | - Hao Hu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao SAR, China
- Centre for Pharmaceutical Regulatory Sciences, University of Macau, Macao SAR, China
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Carolina Oi Lam Ung
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao SAR, China
- Centre for Pharmaceutical Regulatory Sciences, University of Macau, Macao SAR, China
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macao SAR, China
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Hartman J, Dholakia K. An Exploratory Study of Physical Therapists From High-Income Countries Practising Outside of Their Scope in Low and Middle-Income Countries. JOURNAL OF BIOETHICAL INQUIRY 2023; 20:543-562. [PMID: 37861947 DOI: 10.1007/s11673-023-10305-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 12/03/2022] [Indexed: 10/21/2023]
Abstract
PURPOSE To quantify how often physical therapists from high-income countries (HIC) travelling to low- and middle-income countries (LMIC) practise outside their scope of practice, in what circumstances, and their likelihood of doing the same in the future. METHODS An exploratory descriptive study using a survey. RESULTS One hundred and twenty-six licensed physical therapists from around the world participated. Physical therapists typically spent less than a month (73.8 per cent) in LMIC; 67.5 per cent believed that physical therapists practise outside of their scope, and 31.7 per cent reported doing so. Reasons were believing that something is better than nothing (47.5 per cent ), a mismatch between the physical therapist's and host's expectations (40.0 per cent ), and preserving their relationship with the host (25.0 per cent ). It was deemed appropriate by 64.5 per cent to practise outside of their scope in some situations and 53.8% considered repeating the activity in the future. Half of the respondent's first experience in LMIC occurred as a student or in their first decade of practice. CONCLUSIONS Working in LMIC requires a keen understanding of the risks and challenges associated with such experiences. To ensure best practice, a skill set that consists of critical self-reflection, systems thinking, and structural competency combined with clinical competency and accountability is imperative.
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Affiliation(s)
- J Hartman
- Department of Family Medicine and Community Health, Doctor of Physical Therapy Program, University of Wisconsin, School of Medicine and Public Health, 5110 Medical Sciences Center, 1300 University Ave, Madison, WI, 53706, USA.
| | - K Dholakia
- Institute for Physical Therapy Education, Widener University, One University Place, Chester, PA, 19013, USA
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Chauhan AS, Sharma D, Mehndiratta A, Gupta N, Garg B, Kumar AP, Prinja S. Validating the rigour of adaptive methods of economic evaluation. BMJ Glob Health 2023; 8:e012277. [PMID: 37751935 PMCID: PMC10533726 DOI: 10.1136/bmjgh-2023-012277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 08/29/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND There has been a lot of debate on how to 'generalise' or 'translate' findings of economic evaluation (EE) or health technology assessment (HTA) to other country contexts. Researchers have used various adaptive HTA (aHTA) methods like model-adaptation, price-benchmarking, scorecard-approach, etc., for transferring evidence from one country to other. This study was undertaken to assess the degree of accuracy in results generated from aHTA approaches specifically for EE. METHODS By applying selected aHTA approaches, we adapted findings of globally published EE to Indian context. The first-step required identifying two interventions for which Indian EE (referred to as the 'Indian reference study') has been conducted. The next-step involved identification of globally published EE. The third-step required undertaking quality and transferability check. In the fourth step, outcomes of EE meeting transferability standards, were adapted using selected aHTA approaches. Lastly, adapted results were compared with findings of the Indian reference study. RESULTS The adapted cost estimates varied considerably, while adapted quality-adjusted life-years did not differ much, when matched with the Indian reference study. For intervention I (trastuzumab), adapted absolute costs were 11 and 6 times higher than the costs reported in the Indian reference study for control and intervention arms, respectively. Likewise, adapted incremental cost and incremental cost-effectiveness ratio (ICER) were around 3.5-8 times higher than the values reported in the Indian reference study. For intervention II (intensity-modulated radiation therapy), adapted absolute cost was 35% and 12% lower for the comparator and intervention arms, respectively, than the values reported in the Indian reference study. The mean incremental cost and ICER were 2.5 times and 1.5 times higher, respectively, than the Indian reference study values. CONCLUSION We conclude that findings from aHTA methods should be interpreted with caution. There is a need to develop more robust aHTA approaches for cost adjustment. aHTA may be used for 'topic prioritisation' within the overall HTA process, whereby interventions which are highly cost-ineffective, can be directly ruled out, thus saving time and resources for conducting full HTA for interventions that are not well studied or where evidence is inconclusive.
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Affiliation(s)
- Akashdeep Singh Chauhan
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepshikha Sharma
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Nidhi Gupta
- Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, India
| | - Basant Garg
- National Health Authority, Ayushman Bharat PM-JAY, Government of India, New Delhi, India
| | - Amneet P Kumar
- Department of Women and Child Development, Government of Haryana, Panchkula, Haryana, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Mundy L, Maddern G. HTA capacity building in Asia: towards one goal. Int J Technol Assess Health Care 2023; 39:e56. [PMID: 37581298 DOI: 10.1017/s0266462323000405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
OBJECTIVES The aim of the 2022 Health Technology Assessment International (HTAi) Asia Policy Forum (APF) was to discuss experiences and challenges around health technology assessment (HTA) capacity building for both HTA agencies and companies in the Asia region and to identify possible solutions as part of a capacity building roadmap. METHODS Discussions during the 2022 APF, informed by a pre-meeting survey of HTA agencies and industry attendees from the region, form the basis of this paper. RESULTS HTA is an essential element of priority-setting in healthcare; however, the scarcity of skilled technical HTA practitioners is a rate-limiting step in the conduct of HTA. The lack of investment in HTA and the political will to mandate the use of HTA in decision-making may be due to a lack of understanding of the value of the HTA process, and how HTA is interpreted and used in the healthcare decision-making process. CONCLUSIONS Increased demand for HTA is created when the value of HTA is recognized. HTA capacity-building challenges may be mitigated by educating stakeholders, particularly policymakers, on the value of, and the need to invest in, HTA as a transparent process to ensure equitable access to health care for all. Investigating a means of funding and implementing an HTA intern program between agencies, in partnership with industry, to facilitate a supportive environment to foster HTA skills and knowledge, build capacity or strengthen existing capacity should be a priority.
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Affiliation(s)
- Linda Mundy
- School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Guy Maddern
- Chair, HTAi Asia Policy Forum, Discipline of Surgery, University of Adelaide, The Queen Elizabeth Hospital, Woodville South, Australia
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Status and Trends of Physical Activity Surveillance, Policy, and Research in 164 Countries: Findings From the Global Observatory for Physical Activity-GoPA! 2015 and 2020 Surveys. J Phys Act Health 2023; 20:112-128. [PMID: 36535269 PMCID: PMC10115485 DOI: 10.1123/jpah.2022-0464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/29/2022] [Accepted: 11/05/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Physical activity (PA) surveillance, policy, and research efforts need to be periodically appraised to gain insight into national and global capacities for PA promotion. The aim of this paper was to assess the status and trends in PA surveillance, policy, and research in 164 countries. METHODS We used data from the Global Observatory for Physical Activity (GoPA!) 2015 and 2020 surveys. Comprehensive searches were performed for each country to determine the level of development of their PA surveillance, policy, and research, and the findings were verified by the GoPA! Country Contacts. Trends were analyzed based on the data available for both survey years. RESULTS The global 5-year progress in all 3 indicators was modest, with most countries either improving or staying at the same level. PA surveillance, policy, and research improved or remained at a high level in 48.1%, 40.6%, and 42.1% of the countries, respectively. PA surveillance, policy, and research scores decreased or remained at a low level in 8.3%, 15.8%, and 28.6% of the countries, respectively. The highest capacity for PA promotion was found in Europe, the lowest in Africa and low- and lower-middle-income countries. Although a large percentage of the world's population benefit from at least some PA policy, surveillance, and research efforts in their countries, 49.6 million people are without PA surveillance, 629.4 million people are without PA policy, and 108.7 million live in countries without any PA research output. A total of 6.3 billion people or 88.2% of the world's population live in countries where PA promotion capacity should be significantly improved. CONCLUSION Despite PA is essential for health, there are large inequalities between countries and world regions in their capacity to promote PA. Coordinated efforts are needed to reduce the inequalities and improve the global capacity for PA promotion.
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Coxe KA, Pence EK, Kagotho N. Social Work Care in Traumatic Brain Injury and Substance Use Disorder Treatment: A Capacity-Building Model. HEALTH & SOCIAL WORK 2021; 46:277-288. [PMID: 34652414 DOI: 10.1093/hsw/hlab023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Co-occurring traumatic brain injury (TBI) and substance use disorders (SUD) are a major public health concern, yet TBI is often underrecognized within SUD treatment organizations. Social workers in these organizations are well positioned to deliver tailored treatment, but little is known about what social workers are doing to address the needs of these clients. The purpose of this study was to examine current social work practices in providing care to clients with co-occurring TBI and SUD. Using grounded theory methodology, authors conducted semistructured interviews with 17 licensed social workers employed in various SUD treatment settings. Transcript coding was conducted through an iterative process and data were analyzed using NVivo (version 12.0). Results demonstrated that social workers lack basic knowledge on the relationship between TBI and SUD. Additional barriers to providing care included lack of skills to identify history of TBI, lack of community resources, poor agency collaboration, and access-to-care restrictions. Social workers identified their primary roles as advocacy, care coordination, and serving on multidisciplinary teams. These results informed development of a capacity-building model, with recommendations for social work situated in each level of the socioecological framework. This study has important implications for building workforce capacity and collaborative care systems to improve client outcomes.
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Hollingworth SA, Ruiz F, Gad M, Chalkidou K. Health technology assessment capacity at national level in sub-Saharan Africa: an initial survey of stakeholders. F1000Res 2021; 9:364. [PMID: 32595957 PMCID: PMC7309411 DOI: 10.12688/f1000research.23263.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Health technology assessment (HTA) is an effective tool for supporting priority setting (PS) in health. Stakeholder groups need to understand HTA appropriate to their role and to interpret and critique the evidence produced. We aimed to rapidly assess current health system priorities and policy areas of demand for HTA in Sub-Saharan Africa, and identify key gaps in data and skills to inform targeted capacity building. Methods: We revised an existing survey, delivered it to 357 participants, then analysed responses and explored key themes. Results: There were 51 respondents (14%, 30 full completions) across 14 countries. HTA was considered an important and valuable PS tool with a key role in the design of health benefits packages, clinical guideline development, and service improvement. Medicines were identified as a technology type that would especially benefit from the application of HTA. Using HTA to address safety issues (e.g. low-quality medicines) and value for money concerns was particularly highlighted. The perceived availability and accessibility of suitable local data to support HTA varied widely but was mostly considered inadequate and limited. Respondents also noted a need for training support in research methodology and data gathering. Conclusions: While important in raising awareness of HTA as a tool for PS, this study had a low response rate, and that respondents were self-selected. A more refined survey will be developed to support engagement strategies and capacity building.
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Affiliation(s)
| | - Francis Ruiz
- School of Public Health, Imperial College London, London, UK
- London School of Hygeine and Tropical Medicine, London, UK
| | - Mohamed Gad
- School of Public Health, Imperial College London, London, UK
- London School of Hygeine and Tropical Medicine, London, UK
| | - Kalipso Chalkidou
- School of Public Health, Imperial College London, London, UK
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
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Culyer AJ, Chalkidou K. Organising Research and Development for evidence-informed health care: some universal characteristics and a case study from the UK. HEALTH ECONOMICS, POLICY, AND LAW 2021; 16:489-504. [PMID: 33843559 PMCID: PMC8460448 DOI: 10.1017/s1744133121000074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 07/13/2020] [Accepted: 01/20/2021] [Indexed: 11/19/2022]
Abstract
Research and Development (R&D) in health and health care has several intriguing characteristics which, separately and in combination, have significant implications for the ways in which it is organised, funded and managed. We review the characteristics, some of which apply under most circumstances and others of which may be context-specific, explore their implications for the organisation and management of health-related R&D, and illustrate the main features from the UK experience in the 1990s.
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Affiliation(s)
- Anthony J. Culyer
- University of York – Centre for Health Economics, York, United Kingdom of Great Britain and Northern Ireland
| | - Kalipso Chalkidou
- University of York – Centre for Health Economics, York, United Kingdom of Great Britain and Northern Ireland
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An Assessment of Government Capacity Building to Restrict the Marketing of Unhealthy Food and Non-Alcoholic Beverage Products to Children in the Region of the Americas. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168324. [PMID: 34444077 PMCID: PMC8394636 DOI: 10.3390/ijerph18168324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/26/2021] [Accepted: 07/30/2021] [Indexed: 11/17/2022]
Abstract
The Pan American Health Organization (PAHO) Strategic Plan 2020–2025 committed to reduce children’s consumption of energy-dense nutrient-poor food and beverage products high in fat, sugar and salt (HFSS) and promote healthy eating patterns to reduce malnutrition in all forms. This paper describes the capacity-building needs in PAHO’s Member States to restrict the marketing of HFSS food and beverages to children. We asked Ministries of Health officials or national institutes/departmental representatives (n = 35) to complete a 28-item web-based survey (January to July 2020). Capacity-building needs were assessed using an adapted version of the World Health Organization’s government capacity-building framework with three modules: public health infrastructure, policies and information systems. Notable achievements for the PAHO’s Plan of Action were identified. State representatives reported strong infrastructure and information systems; however, policy improvements are needed to increase comprehensive national responses. These include using a constitutional health and human rights approach within the policies, policies that document conflict of interest from non-state actors, and strengthening regulatory oversight for digital media platforms. These findings provide baseline data and we suggest priorities for further action to strengthen national governments’ capacity-building and to accelerate the development, implementation, and monitoring systems to restrict the marketing of HFSS food and non-alcoholic beverages to children in the region of the Americas.
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Hollingworth S, Fenny AP, Yu SY, Ruiz F, Chalkidou K. Health technology assessment in sub-Saharan Africa: a descriptive analysis and narrative synthesis. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2021; 19:39. [PMID: 34233710 PMCID: PMC8261797 DOI: 10.1186/s12962-021-00293-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/24/2021] [Indexed: 11/16/2022] Open
Abstract
Background Countries in Sub-Saharan Africa (SSA) are moving towards universal health coverage. The process of Health Technology Assessment (HTA) can support decisions relating to benefit package design and service coverage. HTA involves institutional cooperation with agreed methods and procedural standards. We systematically reviewed the literature on policies and capacity building to support HTA institutionalisation in SSA. Methods We systematically reviewed the literature by searching major databases (PubMed, Embase, etc.) until June 2019 using terms considering three aspects: HTA; health policy, decision making; and SSA. We quantitatively extracted and descriptively analysed content and conducted a narrative synthesis eliciting themes from the selected literature, which varied in study type and apporach. Results Half of the 49 papers identified were primary research studies and mostly qualitative. Five countries were represented in six of ten studies; South Africa, Ghana, Uganda, Cameroon, and Ethiopia. Half of first authors were from SSA. Most informants were policy makers. Five themes emerged: (1) use of HTA; (2) decision-making in HTA; (3) values and criteria for setting priority areas in HTA; (4) involving stakeholders in HTA; and (5) specific examples of progress in HTA in SSA. The first one was the main theme where there was little use of evidence and research in making policy. The awareness of HTA and economic evaluation was low, with inadequate expertise and a lack of local data and tools. Conclusions Despite growing interest in HTA in SSA countries, awareness remains low and HTA-related activities are uncoordinated and often disconnected from policy. Further training and skills development are needed, firmly linked to a strategy focusing on strengthening within-country partnerships, particularly among researchers and policy makers. The international community has an important role here by supporting policy- relevant technical assistance, highlighting that sustainable financing demands evidence-based processes for effective resource allocation, and catalysing knowledge-sharing opportunities among countries facing similar challenges. Supplementary Information The online version contains supplementary material available at 10.1186/s12962-021-00293-5.
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Affiliation(s)
- Samantha Hollingworth
- School of Pharmacy, University of Queensland, 20 Cornwall St, Woolloongabba, Brisbane, QLD, 4102, Australia. .,Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Ama Pokuaa Fenny
- Institute of Statistical, Social and Economics Research, University of Ghana, Accra, Ghana
| | - Su-Yeon Yu
- National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Francis Ruiz
- iDSI, London School of Hygiene and Tropical Medicine, London, UK
| | - Kalipso Chalkidou
- The Global Fund To Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
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Nemzoff C, Ruiz F, Chalkidou K, Mehndiratta A, Guinness L, Cluzeau F, Shah H. Adaptive health technology assessment to facilitate priority setting in low- and middle-income countries. BMJ Glob Health 2021; 6:bmjgh-2020-004549. [PMID: 33903175 PMCID: PMC8076924 DOI: 10.1136/bmjgh-2020-004549] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Cassandra Nemzoff
- International Decision Support Initiative, Center for Global Development, London, UK
| | - Francis Ruiz
- International Decision Support Initiative, Center for Global Development, London, UK.,Global Health and Development Group, Imperial College London Department of Infectious Disease Epidemiology, London, UK
| | - Kalipso Chalkidou
- International Decision Support Initiative, Center for Global Development, London, UK.,Global Health and Development Group, Imperial College London Department of Infectious Disease Epidemiology, London, UK
| | - Abha Mehndiratta
- International Decision Support Initiative, Center for Global Development, London, UK
| | - Lorna Guinness
- International Decision Support Initiative, Center for Global Development, London, UK.,London School of Hygiene and Tropical Medicine, London, UK
| | - Francoise Cluzeau
- International Decision Support Initiative, Center for Global Development, London, UK
| | - Hiral Shah
- International Decision Support Initiative, Center for Global Development, London, UK.,MRC Center for Global Infectious Disease Analysis, Imperial College London Department of Infectious Disease Epidemiology, London, UK
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Kim T, Sharma M, Teerawattananon Y, Oh C, Ong L, Hangoma P, Adhikari D, Pempa P, Kairu A, Orangi S, Dabak SV. Addressing Challenges in Health Technology Assessment Institutionalization for Furtherance of Universal Health Coverage Through South-South Knowledge Exchange: Lessons From Bhutan, Kenya, Thailand, and Zambia. Value Health Reg Issues 2021; 24:187-192. [PMID: 33838558 PMCID: PMC8163602 DOI: 10.1016/j.vhri.2020.12.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 10/19/2020] [Accepted: 12/06/2020] [Indexed: 12/03/2022]
Abstract
Health Technology Assessment (HTA), a tool for priority setting, has emerged as a means of ensuring the sustainability of a Universal Health Coverage (UHC) system. However, setting up an effective HTA system poses multiple challenges and knowledge exchange can play a crucial role in helping countries achieve their UHC targets. This article reports the results of the discussion during a preconference session at the 2019 HTAsiaLink Conference, an annual gathering of HTA agencies in Asia, which supports knowledge transfer and exchange among HTA practitioners. As part of this discourse, 3 main HTA challenges were identified based on experiences of selected countries in Asia and Africa, namely Bhutan, Kenya, Thailand, and Zambia: availability of funding, building technical capacity, and achieving buy-in among stakeholders for successful translation of HTA research into UHC policy. The potential solutions identified through this South-South engagement included establishing a legal mandate for HTA, building local technical capacity through partnerships and enhancing strategic communication with stakeholders to increase awareness, among others. South-South Knowledge Exchange can therefore be instrumental in sharing lessons learned from common challenges and offer potential solutions to address capacity building initiatives for HTA in LMICs.
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Affiliation(s)
- Taeyoung Kim
- Health Intervention and Technology Assessment Program, Nonthaburi, Thailand
| | - Manushi Sharma
- Health Intervention and Technology Assessment Program, Nonthaburi, Thailand
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Nonthaburi, Thailand; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Cecilia Oh
- HIV, Health and Development Team, United Nations Development Programme, Bangkok, Thailand
| | - Leslie Ong
- HIV, Health and Development Team, United Nations Development Programme, Bangkok, Thailand
| | - Peter Hangoma
- Department of Health Policy and Management, University of Zambia, Lusaka, Zambia
| | - Deepika Adhikari
- Essential Medicines and Technology Division, Department of Medical Services, Ministry of Health, Thimphu, Bhutan
| | - Pempa Pempa
- Essential Medicines and Technology Division, Department of Medical Services, Ministry of Health, Thimphu, Bhutan
| | - Angela Kairu
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Stacey Orangi
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
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Sharma M, Teerawattananon Y, Luz A, Li R, Rattanavipapong W, Dabak S. Institutionalizing Evidence-Informed Priority Setting for Universal Health Coverage: Lessons From Indonesia. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2021; 57:46958020924920. [PMID: 32513029 PMCID: PMC7285939 DOI: 10.1177/0046958020924920] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Planning and administering Universal Health Coverage (UHC) policies involve complex and critical decisions, especially in resource-scarce and densely populated settings such as Indonesia. Increasing investments alone do not ensure success and sustainability of UHC, and defining priorities is imperative. In 2013, Indonesia formally embarked on its journey of institutionalizing priority setting with technical assistance from the International Decision Support Initiative (iDSI), which is a global network of organizations in pursuit of evidence-based priority setting. This article provides a perspective for countries in pursuit of institutionalization of evidence-informed policy setting systems and sheds light on the factors conducive to the development of health technology assessment (HTA). It explores the main actors and the context of priority setting in Indonesia and articulates strategies and key outcomes and impact using the theory of change (ToC).
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Affiliation(s)
- Manushi Sharma
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Thailand
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Thailand.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Alia Luz
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Thailand
| | - Ryan Li
- Imperial College London, United Kingdom
| | | | - Saudamini Dabak
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Thailand
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15
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Gopinathan U, Ottersen T, Cyr PR, Chalkidou K. Evidence-Informed Deliberative Processes for HTA Around the Globe: Exploring the Next Frontiers of HTA and Best Practices Comment on "Use of Evidence-informed Deliberative Processes by Health Technology Assessment Agencies Around the Globe". Int J Health Policy Manag 2021; 10:232-236. [PMID: 32772012 PMCID: PMC8167266 DOI: 10.34172/ijhpm.2020.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/21/2020] [Indexed: 11/14/2022] Open
Abstract
This comment reflects on an article by Oortwijn, Jansen, and Baltussen about the use and features of ‘evidence-informed deliberative processes’ (EDPs) among health technology assessment (HTA) agencies around the world and the need for more guidance. First, we highlight procedural aspects that are relevant across key steps of EDP, focusing on conflict of interest, the different roles of stakeholders throughout a HTA and public justification of decisions. Second, we discuss new knowledge and models needed to maximize the value of deliberative processes at the expanding frontiers of HTA, paying special attention to when HTA is applied in primary care, employed for public health interventions, and is produced through international collaboration.
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Affiliation(s)
- Unni Gopinathan
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Trygve Ottersen
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Pascale-Renée Cyr
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Kalipso Chalkidou
- Global Health Development Group, Imperial College London School of Public Health, London, UK.,Center for Global Development Europe, London, UK
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16
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Downey L, Dabak S, Eames J, Teerawattananon Y, De Francesco M, Prinja S, Guinness L, Bhargava B, Rajsekar K, Asaria M, Rao N, Selvaraju V, Mehndiratta A, Culyer A, Chalkidou K, Cluzeau F. Building Capacity for Evidence-Informed Priority Setting in the Indian Health System: An International Collaborative Experience. HEALTH POLICY OPEN 2020; 1:100004. [PMID: 33392500 PMCID: PMC7772949 DOI: 10.1016/j.hpopen.2020.100004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 12/09/2019] [Accepted: 02/17/2020] [Indexed: 11/16/2022] Open
Abstract
India's rapid economic growth has been accompanied by slower improvements in population health. Given the need to reconcile the ambitious goal of achieving Universal Coverage with limited resources, a robust priority-setting mechanism is required to ensure that the right trade-offs are made and the impact on health is maximised. Health Technology Assessment (HTA) is endorsed by the World Health Assembly as the gold standard approach to synthesizing evidence systematically for evidence-informed priority setting (EIPS). India is formally committed to institutionalising HTA as an integral component of the EIPS process. The effective conduct and uptake of HTA depends on a well-functioning ecosystem of stakeholders adept at commissioning and generating policy-relevant HTA research, developing and utilising rigorous technical, transparent, and inclusive methods and processes, and a strong multisectoral and transnational appetite for the use of evidence to inform policy. These all require myriad complex and complementary capacities to be built at each level of the health system . In this paper we describe how a framework for targeted and locally-tailored capacity building for EIPS, and specifically HTA, was collaboratively developed and implemented by an international network of priority-setting expertise, and the Government of India.
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Affiliation(s)
- L.E. Downey
- Global Health and Development, School of Public Health, Imperial College London, London, United Kingdom
- Corresponding author at: Imperial College London, St Mary’s Hospital, Praed Street, London W2 1NY, United Kingdom.
| | - S. Dabak
- Health Intervention Technology Assessment Program (HITAP), Bangkok, Thailand
| | - J. Eames
- Health Intervention Technology Assessment Program (HITAP), Bangkok, Thailand
| | - Y. Teerawattananon
- Health Intervention Technology Assessment Program (HITAP), Bangkok, Thailand
| | - M. De Francesco
- Global Health and Development, School of Public Health, Imperial College London, London, United Kingdom
| | - S. Prinja
- School of Public Health, Post Graduate Medical Institute of Health Education and Research (PGIMER) Chandigarh, India
| | - L. Guinness
- Global Health and Development, School of Public Health, Imperial College London, London, United Kingdom
| | - B. Bhargava
- Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - K. Rajsekar
- Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - M. Asaria
- London School of Economics and Political Science, London, United Kingdom
| | - N.V. Rao
- Global Health and Development, School of Public Health, Imperial College London, London, United Kingdom
| | - V. Selvaraju
- Global Health and Development, School of Public Health, Imperial College London, London, United Kingdom
| | - A. Mehndiratta
- Global Health and Development, School of Public Health, Imperial College London, London, United Kingdom
| | - A. Culyer
- Centre for Health Economics, University of York, York, United Kingdom
| | - K. Chalkidou
- Global Health and Development, School of Public Health, Imperial College London, London, United Kingdom
- Centre for Global Development Europe, London, United Kingdom
| | - F.A. Cluzeau
- Global Health and Development, School of Public Health, Imperial College London, London, United Kingdom
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17
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Gheorghe A, Gad M, Ismail SA, Chalkidou K. Capacity for health economics research and practice in Jordan, Lebanon, the occupied Palestinian territories and Turkey: needs assessment and options for development. Health Res Policy Syst 2020; 18:99. [PMID: 32883285 PMCID: PMC7469424 DOI: 10.1186/s12961-020-00586-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 06/07/2020] [Indexed: 12/29/2022] Open
Abstract
Background Capacity for health economics analysis and research is indispensable for evidence-informed allocations of scarce health resources; however, little is known about the experience and capacity strengthening preferences of academics and practitioners in the Eastern Mediterranean region. This study aimed to assess the needs for strengthening health economics capacity in Jordan, Lebanon, the occupied Palestinian territories and Turkey as part of the Research for Health in Conflict in the Middle East and North Africa (R4HC) project. Methods We combined a bibliometric analysis of health economics outputs based on a literature search conducted across seven databases with an online survey of academic researchers and non-academic practitioners. The records included in the bibliometric analysis were original studies and reviews with an explicit economic outcome related to health, disease or disability, had at least one author in Jordan, Lebanon, Palestine or Turkey, and were published between January 2014 and December 2018. Two types of analyses were conducted using VOSviewer software, namely keyword co-occurrence and co-publication networks across countries and organisations. The online survey asked academic researchers, analysts and decision-makers – identified through the bibliometric analysis and regional professional networks – about previous exposure to and priorities for capacity development in health economics. Results Of 15,185 records returned by the literature search, 566 were included in the bibliometric analysis. Organisations in Turkey contributed more than 80% of records and had the broadest and most diverse network of collaborators, nationally and internationally. Only 1% (n = 7) of studies were collaborations between researchers in two or more different jurisdictions. Cost analysis, cost-effectiveness analysis and health system economics were the main health economics topics across the included studies. Economic evaluations, measuring the economic burden of disease and health equity, were reported by survey respondents (n = 80) as the most important areas to develop in. Short courses, learn-by-doing and mentoring from an experienced professional were, in aggregate, the most preferred learning styles. Conclusions Existing pockets of health economic expertise in the region can constitute the base of future capacity development efforts. Building confidence toward applying specific methods and trust toward stimulating cross-jurisdiction collaborations appear essential components for sustainably developing health economics capacity.
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Affiliation(s)
- Adrian Gheorghe
- Global Health and Development, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom.
| | - Mohamed Gad
- Global Health and Development, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Sharif A Ismail
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom.,Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Kalipso Chalkidou
- Global Health and Development, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom.,Center for Global Development, London, United Kingdom
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18
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Uzochukwu BSC, Okeke C, O'Brien N, Ruiz F, Sombie I, Hollingworth S. Health technology assessment and priority setting for universal health coverage: a qualitative study of stakeholders' capacity, needs, policy areas of demand and perspectives in Nigeria. Global Health 2020; 16:58. [PMID: 32641066 PMCID: PMC7346669 DOI: 10.1186/s12992-020-00583-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/17/2020] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Health technology assessment (HTA) is an effective tool to support priority setting and generate evidence for decision making especially en route to achieving universal health coverage (UHC). We assessed the capacity needs, policy areas of demand, and perspectives of key stakeholders for evidence-informed decision making in Nigeria where HTA is still new. METHODS We surveyed 31 participants including decision makers, policy makers, academic researchers, civil society organizations, community-based organizations, development partners, health professional organizations. We revised an existing survey to qualitatively examine the need, policy areas of demand, and perspectives of stakeholders on HTA. We then analyzed responses and explored key themes. RESULTS Most respondents were associated with organizations that generated or facilitated health services research. Research institutes highlighted their ability to provide expertise and skills for HTA research but some respondents noted a lack of human capacity for HTA. HTA was considered an important and valuable priority-setting tool with a key role in the design of health benefits packages, clinical guideline development, and service improvement. Public health programs, medicines and vaccines were the three main technology types that would especially benefit from the application of HTA. The perceived availability and accessibility of suitable local data to support HTA varied widely but was mostly considered inadequate and limited. Respondents needed evidence on health system financing, health service provision, burden of disease and noted a need for training support in research methodology, HTA and data management. CONCLUSION The use of HTA by policymakers and communities in Nigeria is very limited mainly due to inadequate and insufficient capacity to produce and use HTA. Developing sustainable and institutionalized HTA systems requires in-country expertise and active participation from a range of stakeholders. Stakeholder participation in identifying HTA topics and conducting relevant research will enhance the use of HTA evidence produced for decision making. Therefore, the identified training needs for HTA and possible research topics should be considered a priority in establishing HTA for evidence-informed policy making for achieving UHC particularly among the most vulnerable people in Nigeria.
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Affiliation(s)
- Benjamin S C Uzochukwu
- Department of Community medicine, College of Medicine, University of Nigeria Enugu Campus Nigeria, Enugu, Nigeria
| | - Chinyere Okeke
- International Decision Support Initiative (iDSI), Global Health and Development Group, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.
| | - Niki O'Brien
- International Decision Support Initiative (iDSI), Global Health and Development Group, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Francis Ruiz
- International Decision Support Initiative (iDSI), Global Health and Development Group, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Issiaka Sombie
- West Africa Health Organisation, Organisation Ouest Africaine de la Santé, 175 avenue Ouezzin Coulibaly, Bobo-Dioulasso 01, 01 BP 153, Burkina Faso
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19
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Hollingworth SA, Ruiz F, Gad M, Chalkidou K. Health technology assessment capacity at national level in sub-Saharan Africa: an initial survey of stakeholders. F1000Res 2020; 9:364. [PMID: 32595957 DOI: 10.12688/f1000research.23263.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Health technology assessment (HTA) is an effective tool to support priority setting (PS) in health. Stakeholder groups need to understand HTA appropriate to their role and to interpret and critique the evidence produced. We aimed to rapidly assess current health system priorities and policy areas of demand for HTA in Sub-Saharan Africa, and identify key gaps in data and skills to inform targeted capacity building. Methods: We revised an existing survey, delivered it to 357 participants, then analysed responses and explored key themes. Results: There were 51 respondents (14%) across 14 countries. HTA was considered an important and valuable PS tool with a key role in the design of health benefits packages, clinical guideline development, and service improvement. Medicines were identified as a technology type that would especially benefit from the application of HTA. Using HTA to address safety issues (e.g. low-quality medicines) and value for money concerns was particularly highlighted. The perceived availability and accessibility of suitable local data to support HTA varied widely but was mostly considered inadequate and limited. Respondents also noted a need for training support in research methodology and data gathering. Conclusions: While important in raising awareness of HTA as a tool for PS, this study had a low response rate, and that respondents were self-selected. A more refined survey will be developed to support engagement strategies and capacity building.
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Affiliation(s)
| | - Francis Ruiz
- School of Public Health, Imperial College London, London, UK
| | - Mohamed Gad
- School of Public Health, Imperial College London, London, UK
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20
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Ahmed A, Daily JP, Lescano AG, Golightly LM, Fasina A. Challenges and Strategies for Biomedical Researchers Returning to Low- and Middle-Income Countries after Training. Am J Trop Med Hyg 2020; 102:494-496. [PMID: 31912776 DOI: 10.4269/ajtmh.19-0674] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
The brain drain of professionals from low- and middle-income countries (LMICs) to developed countries is well documented and partially due to the challenges faced by biomedical researchers to establish themselves back at home, after training abroad. These challenges may result in the loss of highly trained individuals from LMICs and reduce the availability of local expertise to develop/inform best practices in health care and to direct locally relevant research. The path of training of LMIC researchers in high-income countries is well documented. However, strategies for a successful reintegration of biomedical researchers back to their home research institutions in LMICs are less clear. We report observations of workshops addressing repatriation needs of researchers returning to their home countries after training abroad during the American Society of Tropical Medicine and Hygiene (ASTMH) 2017 and 2018 annual meetings. Strategies proposed include maintaining connections with the home research institution, ideally through collaborations, planning 18 months ahead before returning with grants applications submitted, and engaging in networking throughout the training period. In addition to presenting our observations, we hope to build a network to facilitate this process, compile resources, and identify expertise within the ASTMH to develop robust strategies to allow young biomedical researchers to flourish in LMICs.
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Affiliation(s)
- Ayman Ahmed
- World Reference Center for Emerge, Emerging Viruses and Arboviruses, University of Texas, Medical Branch, Galveston, Texas.,Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
| | | | - Andres G Lescano
- Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
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21
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Hollingworth SA, Downey L, Ruiz FJ, Odame E, Dsane-Selby L, Gyansa-Lutterodt M, Nonvignon J, Chalkidou K. What do we need to know? Data sources to support evidence-based decisions using health technology assessment in Ghana. Health Res Policy Syst 2020; 18:41. [PMID: 32345297 PMCID: PMC7189587 DOI: 10.1186/s12961-020-00550-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 03/17/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Evidence-based decision-making for prioritising health is assisted by health technology assessment (HTA) to integrate data on effectiveness, costs and equity to support transparent decisions. Ghana is moving towards universal health coverage, facilitated mainly by the National Health Insurance Scheme (NHIS) established in 2003. The Government of Ghana is committed to institutionalising HTA for priority-setting. We aimed to identify and describe the sources of accessible data to support HTA in Ghana. METHODS We identified and described data sources encompassing six main domains using an existing framework. The domains were epidemiology, clinical efficacy, costs, health service use and consumption, quality of life, and equity. We used existing knowledge, views of stakeholders, and searches of the literature and internet. RESULTS The data sources for each of the six domains vary in extent and quality. Ghana has several large data sources to support HTA (e.g. Demographic Health Surveys) that have rigorous quality assurance processes. Few accessible data sources were available for costs and resource utilisation. The NHIS is a potentially rich source of data on resource use and costs but there are some limits on access. There are some data on equity but data on quality of life are limited. CONCLUSIONS A small number of quality data sources are available in Ghana but there are some gaps with respect to HTA based on greater use of local and contextualised information. Although more data are becoming available for monitoring, challenges remain in terms of their usefulness for HTA, and some information may not be available in disaggregated form to enable specific analyses. We support recent initiatives for the routine collection of comprehensive and reliable data that is easily accessible for HTA users. A commitment to HTA will require concerted efforts to leverage existing data sources, for example, from the NHIS, and develop and maintain new data (e.g. local health utility estimates). It will be critical that an overarching strategic and mandatory approach to the collection and use of health information is developed for Ghana in parallel to, and informed by, the development of HTA approaches to support resource allocation decisions. The key to HTA is to use the best available data while being open about its limitations and the impact on uncertainty.
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Affiliation(s)
| | - Laura Downey
- School of Public Health, Imperial College London, London, United Kingdom
| | | | - Emmanuel Odame
- Policy Planning, Monitoring and Evaluation, Ministry of Health, Accra, Ghana
| | | | | | | | - Kalipso Chalkidou
- iDSI, Imperial College London, London, United Kingdom
- Center for Global Development, London, United Kingdom
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Murunga VI, Oronje RN, Bates I, Tagoe N, Pulford J. Review of published evidence on knowledge translation capacity, practice and support among researchers and research institutions in low- and middle-income countries. Health Res Policy Syst 2020; 18:16. [PMID: 32039738 PMCID: PMC7011245 DOI: 10.1186/s12961-019-0524-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 12/23/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Knowledge translation (KT) is a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically sound application of knowledge to yield beneficial outcomes for society. Effective KT requires researchers to play an active role in promoting evidence uptake. This paper presents a systematised review of evidence on low- and middle-income country (LMIC) researchers' KT capacity, practice and interventions for enhancing their KT practice (support) with the aim of identifying gaps and informing future research and interventions. METHODS An electronic search for peer-reviewed publications focusing on LMIC researchers' KT capacity, practice and support across all academic fields, authored in English and from the earliest records available to February 2019, was conducted using PubMed and Scopus. Selected studies were appraised using the Mixed Methods Appraisal Tool, data pertaining to publication characteristics and study design extracted, and an a priori thematic analysis of reported research findings completed. RESULTS The search resulted in 334 screened articles, of which 66 met the inclusion criteria. Most (n = 43) of the articles presented original research findings, 22 were commentaries and 1 was a structured review; 47 articles reported on researchers' KT practice, 12 assessed the KT capacity of researchers or academic/research institutions and 9 reported on KT support for researchers. More than half (59%) of the articles focused on sub-Saharan Africa and the majority (91%) on health research. Most of the primary studies used the case study design (41%). The findings suggest that LMIC researchers rarely conduct KT and face a range of barriers at individual and institutional levels that limit their KT practice, including inadequate KT knowledge and skills, particularly for communicating research and interacting with research end-users, insufficient funding, and inadequate institutional guidelines, structures and incentives promoting KT practice. Furthermore, the evidence-base on effective interventions for enhancing LMIC researchers' KT practice is insufficient and largely of weak quality. CONCLUSIONS More high-quality research on researchers' KT capacity, practice and effective KT capacity strengthening interventions is needed. Study designs that extend beyond case studies and descriptive studies are recommended, including better designed evaluation studies, e.g. use of realist approaches, pragmatic trials, impact evaluations, implementation research and participatory action research.
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Affiliation(s)
- Violet Ibukayo Murunga
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, L69 3BX United Kingdom
- Liverpool School of Tropical Medicine, Center for Capacity Research, Pembroke Place, Liverpool, L35QA United Kingdom
- African Institute for Development Policy, 6th Floor, Block A, Westcom Point Bldg, Mahiga Mairu Ave Off Waiyaki Way, Westlands, Nairobi, Kenya
| | - Rose Ndakala Oronje
- African Institute for Development Policy, 6th Floor, Block A, Westcom Point Bldg, Mahiga Mairu Ave Off Waiyaki Way, Westlands, Nairobi, Kenya
| | - Imelda Bates
- Liverpool School of Tropical Medicine, Center for Capacity Research, Pembroke Place, Liverpool, L35QA United Kingdom
| | - Nadia Tagoe
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
- Office of Grants and Research, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Justin Pulford
- Liverpool School of Tropical Medicine, Center for Capacity Research, Pembroke Place, Liverpool, L35QA United Kingdom
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El Achi N, Papamichail A, Rizk A, Lindsay H, Menassa M, Abdul-Khalek RA, Ekzayez A, Dewachi O, Patel P. A conceptual framework for capacity strengthening of health research in conflict: the case of the Middle East and North Africa region. Global Health 2019; 15:81. [PMID: 31779660 PMCID: PMC6883714 DOI: 10.1186/s12992-019-0525-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 11/01/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In conflict settings, research capacities have often been de-prioritized as resources are diverted to emergency needs, such as addressing elevated morbidity, mortality and health system challenges directly and/or indirectly associated to war. This has had an adverse long-term impact in such protracted conflicts such as those found in the Middle East and North Africa region (MENA), where research knowledge and skills have often been compromised. In this paper, we propose a conceptual framework for health research capacity strengthening that adapts existing models and frameworks in low- and middle-income countries and uses our knowledge of the MENA context to contextualise them for conflict settings. METHODS The framework was synthesized using "best fit" framework synthesis methodology. Relevant literature, available in English and Arabic, was collected through PubMed, Google Scholar and Google using the keywords: capacity building; capacity strengthening; health research; framework and conflict. Grey literature was also assessed. RESULTS The framework is composed of eight principal themes: "structural levels", "the influence of the external environment", "funding, community needs and policy environment", "assessing existing capacity and needs", "infrastructure and communication", "training, leadership and partnership", "adaptability and sustainability", and "monitoring and evaluation"; with each theme being supported by examples from the MENA region. Our proposed framework takes into consideration safety, infrastructure, communication and adaptability as key factors that affect research capacity strengthening in conflict. As it is the case more generally, funding, permissible political environments and sustainability are major determinants of success for capacity strengthening for health research programmes, though these are significantly more challenging in conflict settings. Nonetheless, health research capacity strengthening should remain a priority. CONCLUSION The model presented is the first framework that focuses on strengthening health research capacity in conflict with a focus on the MENA region. It should be viewed as a non-prescriptive reference tool for health researchers and practitioners, from various disciplines, involved in research capacity strengthening to evaluate, use, adapt and improve. It can be further extended to include representative indicators and can be later evaluated by assessing its efficacy for interventions in conflict settings.
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Affiliation(s)
- Nassim El Achi
- Conflict Medicine Program, Global Health Institute, American University of Beirut, Beirut, 1107 2020 Lebanon
| | - Andreas Papamichail
- School of Politics & International Relations, Queen Mary University of London, London, E1 4NS UK
| | - Anthony Rizk
- Conflict Medicine Program, Global Health Institute, American University of Beirut, Beirut, 1107 2020 Lebanon
| | - Helen Lindsay
- Conflict Medicine Program, Global Health Institute, American University of Beirut, Beirut, 1107 2020 Lebanon
| | - Marilyne Menassa
- Conflict Medicine Program, Global Health Institute, American University of Beirut, Beirut, 1107 2020 Lebanon
| | - Rima A. Abdul-Khalek
- Conflict Medicine Program, Global Health Institute, American University of Beirut, Beirut, 1107 2020 Lebanon
| | | | - Omar Dewachi
- Conflict Medicine Program, Global Health Institute, American University of Beirut, Beirut, 1107 2020 Lebanon
| | - Preeti Patel
- Department of War Studies, King’s College London, London, WC2R 2LS UK
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24
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Implementing health technology assessment in Ghana to support universal health coverage: building relationships that focus on people, policy, and process. Int J Technol Assess Health Care 2019; 36:8-11. [PMID: 31775950 DOI: 10.1017/s0266462319000795] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Ghana is one of the few African countries to enact legislation and earmark significant funding to establish universal health coverage (UHC) through the National Health Insurance Scheme, although donor funds have declined recently. Given a disproportionate level of spending on medicines, health technology assessment (HTA) can support resource allocation decisions in the face of highly constrained budgets, as commonly found in low-resource settings. The Ghanaian Ministry of Health, supported by the International Decision Support Initiative (iDSI), initiated a HTA study in 2016 to examine the cost-effectiveness of antihypertensive medicines. We aimed to summarize key insights from this work that highlights success factors beyond producing purely technical outputs. These include the need for capacity building, academic collaboration, and ongoing partnerships with a broad range of experts and stakeholders. By building on this HTA study, and with ongoing interactions with iDSI, HTAi, WHO, and others, Ghana will be well positioned to institutionalize HTA in resource allocation decisions and support progress toward UHC.
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O'Brien N, Li R, Isaranuwatchai W, Dabak SV, Glassman A, Culyer AJ, Chalkidou K. How can we make better health decisions a Best Buy for all?: Commentary based on discussions at iDSI roundtable on 2 nd May 2019 London, UK. Gates Open Res 2019; 3:1543. [PMID: 31633086 PMCID: PMC6784300 DOI: 10.12688/gatesopenres.13063.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2019] [Indexed: 11/25/2022] Open
Abstract
The World Health Organization (WHO) resolution calling on Member States to work towards achieving universal health coverage (UHC) requires them to prioritize health spending. Prioritizing is even more important as low- and middle-income countries transition from external aid. Countries will have difficult decisions to make on how best to integrate and finance previously donor-funded technologies and health services into their UHC packages in ways that are efficient and equitable, and operationally and financially sustainable. The International Decision Support Initiative (iDSI) is a global network of health, policy and economic expertise which supports countries in making better decisions about how best to spend public money on healthcare. In May 2019, iDSI convened a roundtable entitled
Why strengthening health systems to make better decisions is a Best Buy. The event brought together members of iDSI, development partners and other organizations working in the areas of evidence-informed priority-setting, resource allocation, and purchasing. The roundtable participants identified key challenges and activities that could be undertaken by the broader health technology assessment (HTA) community: • to develop a new publication package on premium estimation and budgeting, actuarial calculations and risk adjustment, provider payment modalities and monitoring of quality in service delivery • to call on the WHO to redouble its efforts in accordance with the 2014 Health Intervention and Technology Assessment (HITA) World Health Assembly resolution to support countries in developing priority setting and HTA institutionalization, and to lead by example through introducing robust HTA processes in its own workings • to develop a single Theory of Change (ToC) for evidence-informed priority setting, to be agreed by the major organizations working in the areas of priority setting and HTA.
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Affiliation(s)
- Niki O'Brien
- Global Health and Development Group, Imperial College London, London, UK
| | - Ryan Li
- Global Health and Development Group, Imperial College London, London, UK
| | - Wanrudee Isaranuwatchai
- Centre for Excellence in Economic Analysis Research (CLEAR), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | | | | | | | - Kalipso Chalkidou
- Global Health and Development Group, Imperial College London, London, UK.,Center For Global Development, London, UK
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O'Brien N, Li R, Isaranuwatchai W, Dabak SV, Glassman A, Culyer AJ, Chalkidou K. How can we make better health decisions a Best Buy for all?: Commentary based on discussions at iDSI roundtable on 2 nd May 2019 London, UK. Gates Open Res 2019; 3:1543. [PMID: 31633086 PMCID: PMC6784300 DOI: 10.12688/gatesopenres.13063.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2019] [Indexed: 06/07/2024] Open
Abstract
The World Health Organization (WHO) resolution calling on Member States to work towards achieving universal health coverage (UHC) has increased the need for prioritizing health spending. Such need will soon accelerate as low- and middle-income countries transition from external aid. Countries will have to make difficult decisions on how best to integrate and finance previously donor-funded technologies and health services into their UHC packages in ways that are equitable, and operationally and financially sustainable. The International Decision Support Initiative (iDSI) is a global network of health, policy and economic expertise which supports countries in making better decisions about how best and how much to spend public money on healthcare. iDSI core partners include Center For Global Development, China National Health Development Research Center, Clinton Health Access Initiative, Health Intervention and Technology Assessment Program, Thailand / National Health Foundation, Imperial College London, Kenya Medical Research Institute, and the Norwegian Institute of Public Health. In May 2019, iDSI convened a roundtable entitled Why strengthening health systems to make better decisions is a Best Buy. The event brought together members of iDSI, development partners and other organizations working in the areas of evidence-informed priority-setting, resource allocation and purchasing. The roundtable participants identified key challenges and activities that could be undertaken by the broader health technology assessment (HTA) community to further country-led capacity building, as well to foster deeper collaboration between the community itself. HTA is a tool which can assist governments and development partners with evaluating alternative investment options in a defensible and accountable fashion. The definition and scope of HTA, and what it can achieve and support, can be presented more clearly and cohesively to stakeholders. Organizations engaging in HTA must develop deeper collaboration, and integrate existing collaborations, to ensure progress in developing HTA institutionalization globally is well organized and sustainable.
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Affiliation(s)
- Niki O'Brien
- Global Health and Development Group, Imperial College London, London, UK
| | - Ryan Li
- Global Health and Development Group, Imperial College London, London, UK
| | - Wanrudee Isaranuwatchai
- Centre for Excellence in Economic Analysis Research (CLEAR), Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | | | | | | | - Kalipso Chalkidou
- Global Health and Development Group, Imperial College London, London, UK
- Center For Global Development, London, UK
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Defining capacity building in the context of HTA: a proposal by the HTAi Scientific Development and Capacity Building Committee. Int J Technol Assess Health Care 2019; 35:362-366. [DOI: 10.1017/s0266462319000631] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectivesTo develop a definition of “capacity building” relevant to Health Technology Assessment international (HTAi).MethodsA review of capacity building activities undertaken by HTAi members, members of the International Network of Agencies for Health Technology Assessment (INAHTA), and regional HTA networks was compared against general literature on capacity building definitions and frameworks. The findings were reviewed by the HTAi Scientific Development and Capacity Building Committee. Furthermore, the Executive Committee and Interest Groups of HTAi provided input on the draft final paper.ResultsThe literature demonstrated the need for a definition of capacity building specific to HTA. In the context of HTAi, it was necessary for the definition to cover (i) the broadest range of HTA-related activities, (ii) multiple stakeholders involved in the HTA process, and (iii) the spectrum of activities that compose capacity building. We propose the following definition of HTA capacity building: The process by which individuals and organizations develop or strengthen abilities related to understanding, providing input to, conducting, or utilizing HTA for health policy and decision making, as well as, developing awareness and support in the environment within which HTA is being used.ConclusionA definition of HTA-related capacity building that was intended to provide clarity about what this term means to HTAi was developed. As HTA is context-dependent, a need for further work to develop an operationalization “menu” relevant to the specific needs in which HTA is being used was identified.
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Abstract
OBJECTIVES Health technology assessment (HTA) is a cost-effective resource allocation tool in healthcare decision-making processes; however, its use is limited in low-income settings where countries fall short on both absorptive and technical capacity. This paper describes the journey of the introduction of HTA into decision-making processes through a case study revising the National Essential Medicines List (NEMLIT) in Tanzania. It draws lessons on establishing and strengthening transparent priority-setting processes, particularly in sub-Saharan Africa. METHODS The concept of HTA was introduced in Tanzania through revision of the NEMLIT by identifying a process for using HTA criteria and evidence-informed decision making. Training was given on using economic evidence for decision making, which was then put into practice for medicine selection for the NEMLIT. During the revision process, capacity-building workshops were held with reinforcing messages on HTA. RESULTS Between the period 2014 and 2018, HTA was introduced in Tanzania with a formal HTA committee being established and inaugurated followed by the successful completion and adoption of HTA into the NEMLIT revision process by the end of 2017. Consequently, the country is in the process of institutionalizing HTA for decision making and priority setting. CONCLUSION While the introduction of HTA process is country-specific, key lessons emerge that can provide an example to stakeholders in other low- and middle-income countries (LMICs) wishing to introduce priority-setting processes into health decision making.
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Kapiriri L, Lee NM, Wallace LJ, Kwesiga B. Beyond cost-effectiveness, morbidity and mortality: a comprehensive evaluation of priority setting for HIV programming in Uganda. BMC Public Health 2019; 19:359. [PMID: 30935380 PMCID: PMC6444420 DOI: 10.1186/s12889-019-6690-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 03/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While there has been progress in controlling the HIV epidemic, HIV still remains a disease of global concern. Some of the progress has been attributed to increased public awareness and uptake of public health interventions, as well as increased access to anti- retroviral treatment and the prevention of vertical HIV transmission. These interventions would not have been possible without substantial investments in HIV programs. However, donor fatigue introduces the need for low income countries to maximize the benefits of the available resources. This necessitates identification of priorities that should be funded. Evaluating prioritization processes would enable decision makers to assess the effectiveness of their processes, thereby designing intervention strategies. To date most evaluations have focused on cost-benefit analyses, which overlooks additional critical impacts of priority setting decisions. Kapiriri & Martin (2010) developed and validated a comprehensive framework for evaluating PS in low income countries. The objective of this paper report findings from a comprehensive evaluation of priority setting for HIV in Uganda, using the framework; and to identify lessons of good practice and areas for improvement. METHODS This was a qualitative study based on forty interviews with decision makers and policy document review. Data were analysed using INVIVO 10, and based on the parameters in Kapiriri et al's evaluation framework. RESULTS We found that HIV enjoys political support, which contributes to the availability of resources, strong planning institutions, and participatory prioritization process based on some criteria. Some of the identified limitations included; undue donor and political influence, priorities not being publicized, and lack of mechanisms for appealing the decisions. HIV prioritization had both positive and negative impacts on the health system. CONCLUSIONS The framework facilitated a more comprehensive evaluation of HIV priority setting. While there were successful areas, the process could be strengthened by minimizing undue influence of external actors, and support the legitimate institutions to set priorities and implement them. These should also institute mechanisms for publicizing the decisions, appeals and increased accountability. While this paper looked at HIV, the framework is flexible enough to be used in evaluating priority setting for other health programs within similar context.
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Affiliation(s)
- Lydia Kapiriri
- Department of Health, Aging and Society KTH-236, McMaster University, Main Street West, Hamilton, ON, 1280, Canada.
| | - Na-Mee Lee
- Global Health program, McMaster University, Hamilton, ON, Canada
| | - Lauren Jean Wallace
- Department of Health, Aging and Society, McMaster University, Hamilton, ON, Canada
| | - Brendan Kwesiga
- World Health Organisation, Uganda Country Office, Kampala, Uganda
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Isaranuwatchai W, Li R, Glassman A, Teerawattananon Y, Culye AJ, Chalkidou K. Disease Control Priorities Third Edition: Time to Put a Theory of Change Into Practice Comment on "Disease Control Priorities Third Edition Is Published: A Theory of Change Is Needed for Translating Evidence to Health Policy". Int J Health Policy Manag 2019; 8:132-135. [PMID: 30980627 PMCID: PMC6462203 DOI: 10.15171/ijhpm.2018.115] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 11/17/2018] [Indexed: 01/17/2023] Open
Abstract
The Disease Control Priorities program (DCP) has pioneered the use of economic evidence in health. The theory of change (ToC) put forward by Norheim is a further welcome and necessary step towards translating DCP evidence into better priority setting in low- and middle-income countries (LMICs). We also agree that institutionalising evidence for informed priority-setting processes is crucial. Unfortunately, there have been missed opportunities for the DCP program to challenge ill-judged global norms about opportunity costs and too little respect has been shown for the wider set of local circumstances that may enable, or disable, the productive application of the DCP evidence base. We suggest that the best way forward for the global health community is a new platform that integrates the many existing development initiatives and that is driven by countries’ asks.
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Affiliation(s)
- Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Centre for Excellence in Economic Analysis Research, St. Michael's Hospital, Toronto, ON, Canada
| | - Ryan Li
- School of Public Health, Imperial College London, London, UK
| | | | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Anthony J Culye
- Department of Economics and Related Studies and Centre for Health Economics, University of York, York, UK
| | - Kalipso Chalkidou
- School of Public Health, Imperial College London, London, UK.,Center for Global Development, London, UK
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Cho S, Lee H, Yoon S, Kim Y, Levin PF, Kim E. Community health needs assessment: a nurses' global health project in Vietnam. Int Nurs Rev 2018; 65:505-514. [PMID: 29574755 DOI: 10.1111/inr.12443] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Global health has been directed to providing solutions to various health issues cross-nations, and nurses have received wide recognition as a key health workforce to reduce health disparities globally. Nurses involved in global health research are required to implement evidence-based global nursing practices based on the assessments of local health needs. AIM To assess health needs and to suggest future interventions in rural communities of Vietnam. METHODS A multifaceted rapid participatory appraisal with information pyramid was used applying mixed methods from six sources: existing record review, surveys of community residents, surveys of healthcare providers, focus group discussions with community leaders, informal discussions with governmental health administrators and observations of community health station (CHS) facilities. RESULTS The majority used the CHSs as primary health facilities with high satisfaction for services currently provided. However, there were needs for the stations to provide more comprehensive services including chronic diseases, and for healthcare providers to improve their competences. Community leaders showed high interest in health information for chronic diseases and strong commitment to involvement in the activities for health of their communities. The findings suggest future interventions in the areas of the enhancement of CHS' functions, human resources and the self-care capacity of community residents. CONCLUSION AND POLICY IMPLICATIONS The rapid participatory appraisal approach emphasizing community participation and partnership was a useful tool to compile accurate information about the current needs of the community on health, the preparedness of healthcare services to meet community's demands and about community capacity. This process is fundamental to nurses, who initiate global health projects in resource-limited international countries, to generate evidences regarding practice, research and policy for taking responsibilities in promoting the sustainable development goals.
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Affiliation(s)
- S Cho
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Korea
| | - H Lee
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Korea
| | - S Yoon
- National Medical Center, Seoul, Korea
| | - Y Kim
- Jhpiego/USA, an affiliate of Johns Hopkins University, Baltimore, MD, USA
| | - P F Levin
- Rush University College of Nursing, Chicago, IL, USA
| | - E Kim
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Korea
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Luz A, Santatiwongchai B, Pattanaphesaj J, Teerawattananon Y. Identifying priority technical and context-specific issues in improving the conduct, reporting and use of health economic evaluation in low- and middle-income countries. Health Res Policy Syst 2018; 16:4. [PMID: 29402314 PMCID: PMC5800077 DOI: 10.1186/s12961-018-0280-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 01/10/2018] [Indexed: 12/12/2022] Open
Abstract
Background The use of economic evaluation in healthcare policies and decision-making, which is limited in low- and middle-income countries (LMICs), might be promoted through the improvement of the conduct and reporting of studies. Although the literature indicates that there are many issues affecting the conduct, reporting and use of this evidence, it is unclear which factors should be prioritised in finding solutions. This study aims to identify the top priority issues that impede the conduct, reporting and use of economic evaluation as well as potential solutions as an input for future research topics by the international Decision Support Initiative and other movements. Methods A survey on issues regarding the conduct, reporting and use of economic evaluation as well as on potential solutions was conducted using an online questionnaire among researchers who have experience in conducting economic evaluations in LMICs. The respondents were requested to consider the list of issues provided, rank the most important ones and propose solutions. A scoring system was applied to derive the ranking of difficulties according to researchers’ responses. Issues were grouped into technical and context-specific difficulties and analysed separately as a whole and by region. Results Researchers considered the lack of quality local clinical data, poor reporting and insufficient data to conduct the analysis from the chosen perspective as the most important technical difficulties. On the other hand, the non-integration of economic evaluations into decision-making was considered the most important context-specific issue. Finally, context-specific issues were considered the larger barrier to the use of economic evaluation. Conclusion The technical issues that were considered most important were closely linked with the lack of an appropriately functioning information system as well as the capacity to generate essential contextual information (e.g. data and locally relevant utility values), especially when the methodology is complex. To overcome this, simpler approaches to collect data that yields information of comparable quality to more rigorous methods should be developed. The international community can play a major role through research on methodologies feasible for LMIC settings as well as in building research capacity in countries. Context-specific issues, which were recognised as larger barriers, should be improved in parallel. Electronic supplementary material The online version of this article (10.1186/s12961-018-0280-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alia Luz
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Health, Nonthaburi, Thailand
| | - Benjarin Santatiwongchai
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Health, Nonthaburi, Thailand.
| | - Juntana Pattanaphesaj
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Health, Nonthaburi, Thailand
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Health, Nonthaburi, Thailand
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MacQuilkan K, Baker P, Downey L, Ruiz F, Chalkidou K, Prinja S, Zhao K, Wilkinson T, Glassman A, Hofman K. Strengthening health technology assessment systems in the global south: a comparative analysis of the HTA journeys of China, India and South Africa. Glob Health Action 2018; 11:1527556. [PMID: 30326795 PMCID: PMC6197020 DOI: 10.1080/16549716.2018.1527556] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 09/19/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Resource allocation in health is universally challenging, but especially so in resource-constrained contexts in the Global South. Pursuing a strategy of evidence-based decision-making and using tools such as Health Technology Assessment (HTA), can help address issues relating to both affordability and equity when allocating resources. Three BRICS and Global South countries, China, India and South Africa have committed to strengthening HTA capacity and developing their domestic HTA systems, with the goal of getting evidence translated into policy. Through assessing and comparing the HTA journey of each country it may be possible to identify common problems and shareable insights. OBJECTIVES This collaborative paper aimed to share knowledge on strengthening HTA systems to enable enhanced evidence-based decision-making in the Global South by: Identifying common barriers and enablers in three BRICS countries in the Global South; and Exploring how South-South collaboration can strengthen HTA capacity and utilisation for better healthcare decision-making. METHODS A descriptive and explorative comparative analysis was conducted comprising a Within-Case analysis to produce a narrative of the HTA journey in each country and an Across-Case analysis to explore both knowledge that could be shared and any potential knowledge gaps. RESULTS Analyses revealed that China, India and South Africa share many barriers to strengthening and developing HTA systems such as: (1) Minimal HTA expertise; (2) Weak health data infrastructure; (3) Rising healthcare costs; (4) Fragmented healthcare systems; and (5) Significant growth in non-communicable diseases. Stakeholder engagement and institutionalisation of HTA were identified as two conducive factors for strengthening HTA systems. CONCLUSION China, India and South Africa have all committed to establishing robust HTA systems to inform evidence-based priority setting and have experienced similar challenges. Engagement among countries of the Global South can provide a supportive platform to share knowledge that is more applicable and pragmatic.
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Affiliation(s)
- Kim MacQuilkan
- Priority Cost Effective Lessons for System Strengthening South Africa (PRICELESS SA), Faculty of Health Sciences, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Peter Baker
- Global Health and Development Group, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Laura Downey
- Global Health and Development Group, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Francis Ruiz
- Global Health and Development Group, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Kalipso Chalkidou
- Global Health and Development Group, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Shankar Prinja
- School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kun Zhao
- Division of Health Technology Assessment and Policy Evaluation, China National Health Development Research Center (CHNHDR), Ministry of Health, Beijing, China
| | - Thomas Wilkinson
- Priority Cost Effective Lessons for System Strengthening South Africa (PRICELESS SA), Faculty of Health Sciences, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | | | - Karen Hofman
- Priority Cost Effective Lessons for System Strengthening South Africa (PRICELESS SA), Faculty of Health Sciences, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
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Abstract
With aid budgets shrinking in richer countries and more money for healthcare becoming available from domestic sources in poorer ones, the rhetoric of value for money or improved efficiency of aid spending is increasing. Taking healthcare as one example, we discuss the need for and potential benefits of (and obstacles to) the establishment of a national institute for aid effectiveness. In the case of the UK, such an institute would help improve development spending decisions made by DFID, the country's aid agency, as well as by the various multilaterals, such as the Global Fund, through which British aid monies is channelled. It could and should also help countries becoming increasingly independent from aid build their own capacity to make sure their own resources go further in terms of health outcomes and more equitable distribution. Such an undertaking will not be easy given deep suspicion amongst development experts towards economists and arguments for improving efficiency. We argue that it is exactly because needs matter that those who make spending decisions must consider the needs not being met when a priority requires that finite resources are diverted elsewhere. These chosen unmet needs are the true costs; they are lost health. They must be considered, and should be minimised and must therefore be measured. Such exposition of the trade-offs of competing investment options can help inform an array of old and newer development tools, from strategic purchasing and pricing negotiations for healthcare products to performance based contracts and innovative financing tools for programmatic interventions.
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Affiliation(s)
- Kalipso Chalkidou
- Global Health and Development Group, Institute of Global Health Innovation, Imperial College London, London, SW7 2AZ, UK
| | - Anthony J. Culyer
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, M5T 3M6, Canada
- Department of Economics & Related Studies, University of York, York, YO10 5DD, UK
| | | | - Ryan Li
- Global Health and Development Group, Institute of Global Health Innovation, Imperial College London, London, SW7 2AZ, UK
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