Health technology assessment in sub-Saharan Africa: a descriptive analysis and narrative synthesis
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
Cost Effectiveness and Resource Allocation
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 beneft 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 identifed 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 frst 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) specifc examples of progress in
HTA in SSA. The frst 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, frmly
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 fnancing demands evidence-based processes for efective resource allocation, and cata‑
lysing knowledge-sharing opportunities among countries facing similar challenges.
Description
Research Article
Keywords
Health technology assessment, Sub Saharan Africa, Decision making, Capacity building, Policy making, Priority setting, Narrative synthesis