Supporting implementation of HTA in low-and middle-income countries
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The Norwegian Institute of Public Health (NIPH) is collaborating with low-and middle-income countries (LMIC) and global organisations to support evidence-informed decision making, including local implementation of health technology assessments (HTA) and HTA institutionalization on the African continent.
We provide support to partners that mainly focuses on the analysis-step of the HTA process, however we also give advice across the other different steps, as illustrated in the figure.
All countries face difficult choices deciding which new medical technologies, medicines, preventive measures and practices to introduce into the health system. Based within the Division for Health Services of NIPH, our field of expertise is to support policy makers in low- and middle-income countries to make better informed decisions, realize universal health coverage (UHC), and Sustainable Development Goal 3: Ensure healthy lives and promote well-being for all ages.
With a focus on evidence synthesis and health technology assessments (HTA), our team is specialized in providing evidence for decision support, striving to assist the strengthening of evidence-based, sustainable and equitable choices in healthcare. Our team provides support for building models for scientific and technical cooperation on HTA. HTA is the primary decision support aid NIPH uses as it enables the most systematic, transparent and evidence-based approach towards comparing alternative interventions based upon pre-defined criteria of interest to decision-makers.
Our approach
Our efforts are focused on locally and regionally identified and driven activities related to HTA processes, guidance and relevant tools and products for producing and using HTA. See Technical guidance for HTA in LMIC produced by our team.
Steps of the HTA process
We offer support to partner countries across all steps of the HTA process, as illustrated in the figure.
HTA capacity building and HTA institutionalization in Africa
We support our partners in building and strengthening their capacity with evidence synthesis and HTA both by engaging our own scientific experts and by mobilizing competencies from African institutions, such as the Ghana Ministry of Health and the University of Ghana, the Kenya Medical Research Institute, and the Ethiopian Public Health Institute. Currently, our activities mainly consist in building skills by organizing workshops in collaboration with Africa CDC on how to perform systematic reviews on the clinical effectiveness and safety of health technologies and interventions as well as by supporting the production of rapid reviews on selected topics. In parallel with these activities, we support Africa CDC in developing a framework for institutionalization of HTA on the African continent.
Rapid and adaptive methods to support LMICs developing HTAs
Under resource constraints, it is challenging to develop new HTAs that require expertise and significant time investments. Therefore, approaches suited low-resource settings such as using rapid or adaptive HTA methods that transfer existing HTAs, may offer opportunities to find and use relevant evidence to inform decisions. We are also supporting partners in producing reviews based on already existing systematic reviews. A scoping review from our team provides an overview of HTA methods, approaches, or tools to transfer HTAs. These could be further applied in settings with limited HTA capacity. For more information, see the publication from our team on Considerations for transferability of HTAs. Our team have also discussed this topic and presented our work at the Priorities 2022 Conference and in a panel session at the HTAi Conference in 2022.
HTA topic selection and prioritization in LMICs
In LMIC with constraint healthcare budgets, it is key to ensure the right use of resources to HTA topics that are of national/regional importance. Thus, it is important to have well-defined processes for Topic Identification, Selection, and Prioritization (TISP). In settings where HTA is emerging or not yet institutionalized, there is limited normative guidance on how to implement TISP. Our team has produced a scoping review on the options for Topic Identification, Selection and Prioritization for HTA. We are also striving for an increased focus on the importance of the TISP-step in the HTA process when institutionalizing HTA in LMICs. Our team have published a commentary “Is it the Right Topic?” emphasizing that the TISP can be a simple process and that a formalized process facilitates HTA recommendations that better align with local priorities. We have also organized several panel sessions on TISP including at the HTAi Conferences in 2025 and 2024, and at the Priorities 2024 Conference.
Aspects of implementation in partnerships LMIC
We share our expertise and support LMICs in conducting rapid reviews and adapting HTA to national contexts and establishing local working processes. In addition, we contribute to templates and tools to serve LMIC and global actors.
Our work includes:
- tailored capacity building
- technical collaborations
- co-productions
- guidance, tools and resources
- sustainability, institutionalization and evaluation
Partners
Countries
- Ghana - the Ghana Ministry of Health and the University of Ghana
- Ethiopia – The Ethiopian Public Health Institute
Organisations
- Africa Centres of Disease Control and Prevention
Our networks
- World Health Organization (WHO) Headquarters, regional and national offices
- Core membership of the International Decision Support Initiative(iDSI)
- HTA sister organizations around the world members of the International Network for Agencies for HTA (INAHTA)
- Members of the Health Technology Assessment international(HTAi)
Our team
- Frode Forlans
- Bianca Lay
- Rigmor Berg
- Katrine Frønsdal
Funding
Our work is mainly financed by the Norwegian Agency for Development Cooperation (NORAD)
Resources and Publications
Commentary (2024) Is it the Right Topic? An Overlooked Stage in the Institutionalization of Health Technology Assessment
Technical Guidance (2023) Technical guidance for Health Technology Assessment in low-and middle-income countries
Report (2021) of Published literature on capacity building for skills related to health technology assessment in Ghana
Tool (2021) titled Instrument for the assessment of skills to conduct a Health Technology Assessment Version 1
Report from WHO Regional Office for Europe workshop 2020 on Current status of health intervention and technology assessment in the Balkan region https://www.euro.who.int/en/health-topics/Health-systems/health-technologies-and-medicines/publications/2020/current-status-of-health-intervention-and-technology-assessment-in-the-balkan-region-2020
Other dissemination activities
Panel session HTAi 2025 (Buenos Aires) titled: Topic Selection for HTA: An Overlooked Step in Decision-Making and Priority-setting in LMIC? (Katrine Frønsdal, NIPH)
Oral presentation HTAi 2024 (Seville) titled: Health Technology Assessment to sustain the Health Insurance Scheme: A case study on anaemia treatment in Ghana (Ivy Amankwah, Ghana Ministry of Health)
Oral presentation HTAi 2024 (Seville) titled: Development of a priority setting framework for benefit package reviews of the National health insurance scheme of Ghana (Ruby Mensah, University of Ghana)
Poster presentation HTAi 2024 (Seville) titled: HTA topics that respond to national needs: Considerations around the topic selection process when institutionalizing HTA (Katrine Frønsdal, NIPH)
Panel session HTAi 2024 (Bangkok) titled: Topic selection for HTA: An overlooked step in priority setting in LMIC? (Katrine Frønsdal, NIPH)
Panel session HTAi 2022 (Utrecht) titled: "How may the lifecycle approach feed into HTA capacity building strategies in Low- and Middle-Income Countries (LMICs)?" (Katrine Frønsdal, NIPH)
Oral presentation HTAi 2022 (Utrecht) titled: Tools That Can Aid Adaptive HTA To Ensure Rapid, Efficient, And Pragmatic Priority Setting: A Scoping Review (Lieke Heupink, NIPH)