By Julius Mugaga Tukacungurwa/Umoja Standard.
Kampala, Uganda: Makerere University School of Public Health won a SEED grant to do a landscape assessment to understand Uganda’s stand in terms of how Health Technology Assessment is being applied for decision making in the health sector.
The assessment unearthed a lot of attempts in the health sector to try and put in place structures for decision making especially on adoption of new technology like technical working groups in Ministry of Health, special standing committee for immunization particularly looking at vaccines when they enter Uganda and the Academia to put together efforts in providing evidence about quick reviews of whether someone should or not make decisions about the technologies.
This meant that there were efforts already on ground trying to help government in making decisions especially on adoption of new technologies.
Therefore, Health Technology Assessment (HTA) remains a strong pillar for healthcare decision making, a tool for priority setting and has emerged as a means of ensuring the sustainability of a Universal Health Coverage (UHC) system.
HTA plays a key role in determining which technologies receive approval and coverage, considering the dimensions of cost-effectiveness, budget impact, and feasibility.
Having succeeded in neighboring Kenya, other countries like Zambia, Thailand, Taiwan, stakeholders at Health Technology Assessment Short Course that is running at Golf Course Hotel in Kampala believed that HTA would be so essential for Uganda’s health sector and for driving the National Health Insurance agenda because it is evidence based.
It is against this background that Makerere University School of Public Health (MakSPH) went into a tripartite with Kenya Medical Research Institute (KEMRI)-Welcome Trust, Ministry of Health (MoH) to support initialization process of HTA and the training is aimed at shading light to different stakeholders on how the model is going to operate as they push for its institutionalization into Uganda’s Healthcare system.
Speaking at the training Professor Freddie Ssengoba stated that as a country and according to the Sustainable Development Goals (SDGs), there is need to ensure that everyone receives equitable healthcare but also their needs addressed and third parties achieve it in an affordable fashion.
“Affordability is to do with either the individual or a country paying. If the country like Uganda or the individuals are poor to afford as much healthcare as possible, ..are we taking something that is probably going to eat a lot of resources within us, make it even harder for us to provide care we need?”. Posed Prof. Ssengoba.
“If we say, lets get as many vaccines as they come out, you may find that some of these vaccines need to immunize like 3-4 million children and if each is sold at 3 dollars which is even subsidized, you may find, that alone is going to eat a lot of monies Uganda is going to pay for just ensuring we get vaccines”. He added.
He emphasized that ‘as we ensure that we are on the road to Universal Health Care (UHC), we need to pay attention to the technology we get into the system, its cost and the value its adding otherwise we may end up giving less and this where basically Health Technology Assessment (HTA) is needed’.
He emphasized that before Ugandans are enrolled on vaccines or other drugs, there is need to see whether on a long term, this is a good investment and affordable that the population is going to enjoy better welfare and the budget impact is not going to be negative to the country.
In the same regard, Professor Edwine Barasa, the Director of the Nairobi Programme of the Kenya Medical Research Institute, KEMRI-Wellcome Trust believes that Health Technology Assessment (HTA) is an approach to making priority decisions that are transparent, inclusive, explicit and evidence-based and is confident that in this way, it also solves wastage.
Professor Edwine Barasa, the Director of the Nairobi Programme of the Kenya Medical Research Institute, KEMRI-Wellcome Trust. By Julius Mugaga Tukacungurwa.
“Without HTA, we use resources within the health sector in the way that wastes them, so we keep on pouring resources in interventions and services that are not cost effective but when you use HTA, it allows you to select those interventions and services that benefit most people in the population, you end up using them optimally”. Said Prof. Barasa.
He gave an example that ‘if all I need is UGX100 to sort out a health problem, if I spend UGX300 that means I have wasted UGX200, therefore without HTA, we use resources in a wasteful way’.
Dr. Elizabeth Ekirapa Kiracho, a Senior Lecturer and Head, Department of Health Policy Planning and Management at the Makerere University School of Public Health stated that in Ugandan context, there is use of a wide range of healthcare services and different service delivery models to be able to provide them.
“If we typically begin to do Health Technology Assessment (HTA) before we introduce these different service delivery models, we are going to ensure that whatever model we take up is important and useful in terms of increasing reach and improve the quality of service and access to service”. Dr. Ekirapa mentioned.
She also cited the area of other technologies such as equipment and diagnostics as another avenue where the country spends much resources and with HTA, the government can decide which diagnostic its going to be taking up for example within the public sector.
However, Mr. Aliyi Walimbwa the Principal Health Planner at Ministry of Health expressed that HTA may be a good driver to the National Health Insurance Scheme (NHIS) that most Ugandans are yearning for.
He mentioned that, currently, in the formulation of NHIS policy, evidence used is not related to Health Technology Assessment (HTA) but seeks that HTA can run very fast to help us confirm or deny whether the country is ready for NHIS or not but so far, the Ministry has been using different evidences that have generated need for NHIS.
Mr. Aliyi Walimbwa the Principal Health Planner at Ministry of Health. By Julius Mugaga Tukacungurwa.
“If we are talking about National Health Insurance Scheme (NHIS), there are some elements of assessment that have not been well structured therefore when we apply Health Technology Assessment (HTA) to a policy like this, then we shall be able get whether it is feasible or not”. He stated.
Health Technology Assessment (HTA) therefore works in a situation of meagre or scarce resources which presses a need for taking choice and opportunity cost. It also calls for fairness- this means equity in allocation of resources and efficiency.
Uganda’s goal for Universal Health Coverage (UHC) is to provide at least 65% of its population quality healthcare and financial protection by 2030.