Indian delegates from Ministry of Health and Family Welfare visited HITAP
(HITAP, Thailand) On 23-25 January 2017, delegates from the Department of Health Research (DHR), Ministry of Health and Family Welfare, Government of India, visited HITAP to learn about the Health Technology Assessment (HTA) system in Thailand. During the discussion, the application of the Thai experience with HTA to the Indian context and plans for the development of HTA in India were highlighted.
DHR is setting up a priority setting body called the Medical Technology Assessment Board (MTAB). In its effort to establish HTA in the country, DHR has enlisted the support of the International Decision Support Initiative (iDSI) which was awarded a supplementary grant for this work. As part of this collaboration, DHR requested a study visit to HITAP in order to gain an in-depth understanding of the HTA system in Thailand. Four delegates representing the Core Committee of MTAB participated in the visit and came from DHR, the Post Graduate Institute of Medical Education and Research (PGIMER) and the National Health Systems Resource Centre (NHSRC).
Over the three-day study visit, the delegates were introduced to the universal healthcare coverage (UHC) system in Thailand, the channels for using HTA in decision making as well as HITAP’s role in the Thai health system. Presentations on the topics were made by HITAP as well as Mahidol University staff and there were rich discussions on the nuts-and-bolts of the various processes. Questions were raised on a range of topics such as the purchaser and provider split in the management of the Universal Health Coverage Scheme (UCS), stakeholders and activities involved in the topic nomination and selection process, challenges faced early on in the process, developing capacity for conducting HTA studies, the decision making process for the UCS benefits package and the National List of Essential Medicines (NLEM), issues of conflict of interest, among others. The delegates also had the opportunity to attend a meeting of the Sub-committee for the Development of the NLEM that coincided with their visit and observed first-hand the proceedings of the HTA process. The HITAP team responded to their questions on the background, content, composition and flow of the process on the following day.
Throughout the visit, the delegates discussed the application of the Thai experience with HTA to the Indian context. The delegates shared their plans for the development of HTA in India, saying that in addition to the MTAB, which will have an advisory role, there would be a Technical Appraisal Committee and a Secretariat with the Core Committee working with all three entities. There are three HTA studies in the pipeline and will be funded by the central government; these are, screening of cervical cancer, screening for breast cancer and screening for diabetes mellitus being led by PGIMER, NHSRC and the Public Health Foundation of India (PHFI), respectively. The delegates noted that there is demand for HTA from state level policymakers, although this is not captured in a systematic way at the time being. In identifying users of HTA, the role of central and state governments was also discussed. Contextual factors such as the low level of government spending on health as well as the low level of insurance coverage of the population in the country may have a bearing on the impact that HTA can have in the country.
The group discussed the way forward for the collaboration between DHR and HITAP, as part of iDSI. The focus would be on capacity building activities such as training on methodologies as well as supervision of HTA studies that will be conducted. The international HTA postgraduate program offered by Mahidol University, including recruitment of staff for the scholarships being offered by iDSI, was also discussed. Delegates were informed about and invited to the infectious disease modelling workshop being held in Thailand as well as the Thailand Research Fund (TRF) International Internship program to be launched by HITAP this year. Further, the delegates said that they would like to have DHR/MTAB become an HTAsiaLink member. DHR requested continuous support from HITAP, including review of the drafted Terms of Reference (ToRs) for committee members, joining technical committee meetings and drafting guidelines. In addition to requesting support on building data systems for HTA as was done in Thailand, the delegates expressed an interest in developing a national tariff for EQ-5D and HITAP’s advice on the same. A teleconference between all parties to plan future activities was agreed on.