Challenges and limitations to adopting health technology assessment in the South African context

Abstract

Healthcare systems across nations develop in response to the social, economic and political situations of each country. Nevertheless, all health systems cater to the health needs and wellbeing of their population. This is achieved through both the delivery and financing of services to ensure patient access to health services and technologies. However, all countries, no matter whether developed or developing, are faced with finite resources. To achieve the maximum health benefits for the public, decisions need to be made on the organisation of the health-service delivery system, the type of interventions to be offered and the manner of service delivery. There are two distinct parts to a decision-making process: the collection and synthesis of evidence, as part of a health-technology assessment (HTA), and the appraisal of the evidence, framing the recommendations to a given context. HTA is a multidisciplinary study that provides information on the introduction and diffusion of the technology in question, as well as information on price, reimbursement and the appropriate targeting of the technology for effective clinical practice. There are various methods and frameworks available to conduct HTAs. Here, we showcase the European network for Health Technology Assessment (EUnetHTA) Core Model, developed in Europe, that is used fully, partially or adaptively by European countries. As decision-making is the process of selection of the best possible course of action among all the available options, those making decisions need tools to consider multiple factors in a consistent, transparent and reproducible manner, for example, by using multiple-criteria decision analysis. However, it is important to consider that these tools were developed in countries with health systems very different to those of South Africa and low- to middle-income nations, which raises the question of their limitations and the adaptations necessary to fit to the health-system needs of these countries.