Transcript HEALTH TECHNOLOGY ASSESSMENT INSIGHTS FROM PAKISTAN

HTA in PAKISTAN
An Overview
Dr Assad Hafeez
Coordinator
HTA Forum Pakistan
OBJECTIVES
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Need of HTA in Pakistan
Process & experience of HTA forum
Lessons learnt in non governmental
sector
Future directions
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Population: 170 million
– Provinces: 4
– Districts: 134
– Villages: 50,000
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Poverty: 32%
Per capita income: US $ 1000
Literacy rate: 50%
HDI ranking: 140
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Health budget: 0.6% of GDP
 THE: US $ 18
 GHE: US $ 6
 OPE: US $ 12
Private sector:
 80% health care (mostly curative)
 Unregulated
Health insurance and social security nets
Poorly functioning health system
MDG
indicator
Baseline
1990
Current
status
Targets
2015
Under 5 mortality
140
98
52
IMR
120
78
40
MMR
550
276
140
Births SBAs
18%
34%
90%
HIV prevalence
<0.1
<0.1
<0.1
TB cases detected &
cured
-
55%
85%
Malaria
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45%
75%
& treatment
prevention
Major challenges in health sector
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High infant, child and maternal mortality
High burden of communicable disease
Meager resources for health
Poorly functioning health systems
Unregulated private sector
Human resource capacity and management
Knowledge divide
Policy dilemma
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Do more for less
Changing scenarios
The need for HTA in Pakistan
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Shrinking resources with rising costs
Push & Pull of manufacturers & vested interests
Rapidly emerging technologies
Role of unregulated private sector
Ambiguous policies with poor capacity to achieve
evidence based decisions
– Gullible consumers
– Others
HTA Forum Pakistan
– Visit of President ISTAHC to Pakistan 2001
– Group of professionals dedicated to promotion of
“culture of evidence based” practices
– Clinicians, academics, managers, policy makers,
nurses, public health specialist, epidemiologists,
others
– Non governmental set up
Objectives of HTA Forum
– Exchange of experience
– Prioritize country needs
– Sensitize and develop liaison with national and
international stakeholders
– Organize activities leading to better
understanding of the role of HTA for Pakistan
– Capacity development along with developing &
conducting small scale technologies assessments
Activities
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Regular meetings
Presentations at various forums
Research and publication of reports
Identification of priority areas
Capacity building
Establishment of linkages
Identification of focal persons in various areas
Trainings and seminars
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Regular meetings
– Brainstorming sessions
– Various institutions
– 2-3 month interval
– Presentation of studies
– Continuing education
– Future directions and planning
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Presentations at various forums
– National forums
– International forums
– Local gatherings
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Identification of priority areas
– Consensus building exercise
Diagnostics
 Drugs and medicines
 Equipment procurement
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Capacity building
– Trainings by experts
– Health Services Academy
– College of physicians and surgeons
Pakistan
– International meetings/workshops
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Establishment of linkages
– World Health Organization
– HTAi
– National Health Policy Unit
– MoH
– Academic institutions
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Identification of focal persons in various
areas
– Geographical
– Institutions
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MoH
DoH
Professional associations
Teaching hospitals
District hospitals
General practice
University (public private)
Nursing association
Others
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Research and publication of reports
– No of publications in local medical
journals
– Small technologies assessments in
institutions and regions
Routine pre op CXR in young patients
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Method: prospective study
Conclusion: ineffective technology
Impact: routine CXR abandoned
resulting in annual saving of one
million Rs
CT scan in advanced abdominal tumors
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Method: prospective study
Conclusion: in our setting where U/S
has confirmed the extent of disease,
CT scan is unnecessary, as
laprotomy/lprocopy has to be carried
out to confirm diagnoses or do
palliative procedures.
Impact: Unnecessary CT scans
stopped (costs 100 US$ per patient)
Ritual circumcision:
Timing and pre-op investigations
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Method: Literature search
Conclusion:
– For routine circumcision
best time to operate is first 10 to 72 hours
 no pre-op screening for coagulation disorders
is required
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Impact:
results published
 Set of pre-op investigations require approx
US$ 10
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Use of multi vitamins in routine prescriptions
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Method: prospective design
Conclusion: On basis of the evidence
collected, multivitamin tablets use was
found to be in-effective technology, in
our settings
Impact: Rs 0.5 million saved in one
hospital annually
Diagnostic effectiveness study at
metropolitan corporation Lahore
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Method: prospective study
Result:
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The equipment was inappropriately placed
Ineffectively used
No positive impact on health of users
Very high operating costs
Impact:
– review of policy by MCL was carried out
– Redistribution of resources and appropriate
training was put in place to improve efficiency
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Trainings and seminars
– Local meetings
– International seminar/workshop
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First HTA workshop/seminar 2004
– MoH, WHO, PIMS, Network
– Objectives:
– Advocacy
– Capacity building
– Future direction and recommendations
– Participants:
– 150 seminar
– 25 workshop
– Outcome:
– Workshop report
– List of recommendations
– Group of trained people
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Strengths of HTA initiative in Pakistan
– Independent status
– Linkages
– Scope of work
– Motivated work force
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Requirements
– Simple and short assessments
– Adaptations
– Economic analysis
– Diagnostics, drugs, equipment.
– District perspective
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Challenges and barriers
– Involvement of MoH and donors in a more
sustainable way
– Better understanding of effect of evidence on
decisions making in policy and practice
– Increase and improve patient & professional
participation
– Improve dissemination tools, language and
timing
– Adapt to local circumstances and values
(flexibility)
Lessons learnt
– Reputed NGOs should be involved in HTA
process in developing countries
– Strong linkages required
– Local capacity building important
– Small scale studies help in achieving
ultimate goal
– “Hot issues” to be addressed early
Future directions
– “Rational Diagnostic Program” at district
level.
– Diagnostic procurement SOPs at tertiary
hospitals
– Clinical Practice Guidelines
– Inclusion in curriculum of post graduate
courses
– Newsletter/publications
Conclusions
– Poorly resourced countries need HTA
more urgently
– Multi pronged approach required to
achieve results
– Organizations like HTAi and WHO can
play a significant role in this direction