Institutionalising HTA under NHI
iDSI has been advising on the institutionalisation of HTA and evidence-informed priority-setting as part of the ongoing NHI reforms, by participating in the Health Services Benefits advisory working group, under the auspices of the Minister of Health; and is now working with the Council for Medical Schemes to strengthen private sector regulation. Our input has included detailed costed, short and long-term options for the National Department of Health to incubate an HTA unit, with a view to establishing a standalone HTA agency in the long term. Other iDSI analysis included a framework for health benefits design, a review of South African clinical guidelines, a legal and policy framework and a topic selection framework to inform the move towards NHI.
Through PRICELESS SA, an academic unit based at the University of Witwatersrand with technical expertise in health economics and policy influence, iDSI has also undertaken activities to build increased understanding and capacity for priority-setting among policymakers. For example, in March 2017 PRICELESS hosted a three-day training event on Health Benefits Package design and economic evaluation for South African policymakers. This was followed by a policy dialogue specifically for those involved with the NHI benefits package design.
iDSI input and support for policy dialogue have been pivotal to the NHI planning process with the resultant HTA agency and supporting committees specifically identified in the NHI Bill, and funding committed for an HTA Unit to be incubated within the National Department of Health as part of the 2018 Budget of R368m (US$27.3m) dedicated towards an interim NHI Fund. A national HTA agency could ultimately help to inform the listing, pricing, reimbursement of medicines and health services, and the regulation of public and private providers.
iDSI estimates that for a national HTA agency in South Africa, an annual investment of US$1.5m to finance 20 full-time staff to produce 20 HTA studies and 5 clinical guidelines (for high-burden diseases such as diabetes) could generate approximate savings of US$200m, based on return-on-investment trends of HITAP in Thailand (US$133 per dollar) – or up to an equivalent 91,633 disability-adjusted life years (DALYs) averted based on the York tool for estimating health opportunity costs, through evidence-informed price negotiations and improved clinical care pathways.
Building capacity for HTA and the foundations of an iDSI Southern African regional hub
South Africa’s strong technical and research capacity and policy influence among Sub-Saharan African nations makes it well placed as a spearhead for HTA regionalisation, as well as the generation of funding for policy-relevant research.
iDSI, initially through PRICELESS SA, has been laying the foundation for an Southern African regional hub through scoping, capacity-building and networking activities. Through these efforts iDSI has begun supporting governments across Sub-Saharan Africa to develop the skills and capacity necessary to conduct and review HTAs.
In 2018, iDSI conducted a survey of HTA capacity in sub-Saharan Africa. The information generated from the survey is being used to further understand capacity across the region and to plan future activities in Southern Africa to respond to capacity gaps. The results of the survey were presented at the iDSI/HTA International Setting Priorities Fairly event in September 2018.
iDSI has formed links with networks such as the Collaborative Africa Budget Reform Initiative and the African Health Economics and Policy Association; and begun engaging with Tanzania and Zambia to introduce evidence-informed principles and methods into Essential Medicines List review and fiscal policy, nurturing the political will for HTA and broadening the impact of iDSI expertise. An important development has been the Master’s level educational programmes at Wits University where a health economics module was included as part of the Masters in Public Health for the first time in 2018. The majority of the 120 applicants were from South Africa and other sub-Saharan African countries, demonstrating demand for formal education in this area.
South Africa Policy Dialogue on Designing and Adjusting the Health Services Package for Universal Health Coverage in South Africa
South African clinical practice guidelines: A landscape analysis
South Africa National Health Bill 2018
Consolidated spending plans 2018 from South Africa National Treasury
Government notice/Terms of Reference for the national health insurance work streams 2015
PRICELESS and the IDSI Sub-Saharan African Hub: Together for better decisions and better health
iDSI policy brief: Supporting Tanzania to prioritise its Essential Medicines List
Effective capacity-building strategies for health technology assessment: A rapid review of international experience