1. The document discusses the evolution of health technology assessment (HTA) from its origins in responding to decision-maker needs to its current role in knowledge mobilization and supporting universal health coverage. 2. Key aspects of mature HTA systems include assessing a wide range of health technologies, strong stakeholder involvement, and knowledge translation activities. 3. For HTA to be effective, it requires both scientific expertise to conduct assessments and links to decision-making through governance and stakeholder participation.

1. Key principles
for conducting
an HTA
process:
Knowledge
mobilisation
for UHC
Reiner Banken reiner.banken@inesss.qc.ca
Renée Latulippe
Monique Fournier
Cairo, Egypt, Dec 2, 2014
Second Inter-Country
Meeting on Health
Technology Assessment
EMRO/WHO

2. 2
The origin of Health Technology
Assessment
Request of the US Congress Senate Committee on
Human Resources to OTA in 1974:
« whether a reasonable amount of justification should
be provided before costly new medical technologies
and procedures are put into general use»
•Knowledge Pull from Decision-makers
•Paradigm of Evidence-informed decision-making
•HTA Institutions as Boundary Organisations

3. 3
The “natural history” of health
technology assessment: emergence,
consolidation, and expansion.
• Emergence: need expressed by decision-makers in a context
of depoliticizing allocation decisions in times of increasing
resource constraints, importance of leaders, development of
the scientific know-how, high cost medical device focused,
little stakeholder involvement,
• Consolidation: more structured organizational HTA systems,
priority setting, enlargement of scope of technologies,
increased stakeholder involvement
• Expansion: multiple disciplines, multiple products, political
recognition, HTA system, strong stakeholder involvement,
investment into Knowledge translation
Battista RN, Hodge MJ . Int J Technol Assess Health Care.
2009 Jul;25 Suppl 1:281-4.

4. 4
HTA in the 21 century – A
perspective from Political Science
• HTA has developed in a relatively depoliticized environment … buffered
from the capricious impacts of electoral politics.
• HTA in all the countries began with relatively politically innocuous studies
of technologies recognized to be of major import to national health
systems or researcher-initiated studies.
• However, with increased focus in health systems on explicit determination
of health benefits baskets, the role of HTA has become more high profile.
This means that political accountability for the entire HTA process will
increase.
• The implication is that future management of HTA programs will require
self-conscious attention to the building of institutions capable of handling
the delicate process of integrating science and politics in health policy.
Citation from the abstract of Chinitz. Health technology
assessment in four countries: response from political science.
IJTAHC 20:1 (2004), 55–60

5. 5
HTA for UHC: Moving from technical
advice for decision-making to
mediation through science
Use of health technology assessment approaches in order to inform and steer
decision-making in moving towards universal health coverage and to improve
access to essential, quality-assured and affordable medical products. (WHO
Resolution on Health intervention and technology assessment in support of universal health
coverage, 2014)
Efficient and participatory health systems require the commitment of society,
with clear mechanisms for inclusion, transparency, and accountability, as well
as multisectoral participation, dialogue, and consensus among the
different social actors, and firm, long-term political commitment from authorities
responsible for formulating policies, legislation, regulations, and strategies for
comprehensive, timely, quality services. (PAHO Resolution on UHC, 2014)

6. 6
HTA processes for UHC
Producing HTA as a common good through
independent, rigorous and participative
processes.
HTA as a knowledge mobilization process

7. HHTTAA ffoorr ddeecciissiioonn--mmaakkiinngg ((iinn tthhee ‘‘9900ss))
The 4 pillars of HTA
Interdisciplinary Approach
Knowledge Synthesis
Knowledge Transfer
Decision
making
Source : Battista RN, Hodge MJ. The evolving paradigm of health technology
assessment: reflections for the millennium CMAJ 1999; 160 (10) : 1464-67

8. 8
Conclusions
HTA's purpose is to solve a problem by mobilizing the types of evidence required
and the concerned actors, in order to support political, organizational or clinical
decision-making. HTA relies on the mediation between contextual, colloquial and
scientific evidence, as well as on interactions with stakeholders for
recommendation making. Defining HTA as a knowledge mobilization process
might contribute to consider the different orders of knowledge, the social, political
and ethical dimensions, and the interactions with stakeholders, among the
essential components required to respond to the preoccupations, needs and
contexts of all actors concerned with the evaluation question's issues.

9. 9
HTA today: Science for Action

10. PATIENTS EXPERTS OF LIVING WITH AN ILLNESS
GOVERNANCE
PATIENTS-AS-ADVISORS
- Care
PATIENTS PARTNERS
POPULATION
PATIENTS-AS-CO
RESEARCHERS
- Research
PATIENTS-AS-CO
RESEARCHERS
- Research
CCOO--DDEESSIIGGNN
ACTION
RESEARCH
ACTION
RESEARCH
EXPERIENCE
COLLECTORS
EXPERIENCE
COLLECTORS
QUALITY
FACILITATION
PATIENTS-AS-ADVISORS
- Care
PATIENTS-AS-COACHS
PATIENTS-AS-COACHS
- Trainers of trainers
- Trainers of trainers
PATIENTS-AS-TRAINERS
- Education
PATIENTS-AS-TRAINERS
- Education
CO-DESIGN
TRAINING
MENTORSHIP

11. 11
Some thoughts in the room….
• This looks interesting intellectually, but …
• He has no idea of my reality…
• I knew HTA was complicated, but this looks even worse
than I thought.
• There is no way that I can convince anybody to
implement HTA if this is what it means.
• He is crazy …
• …

12. 12
Responses to the questions

13. 13
Messages from the evolution of
HTA
1. The use of HTA in Health Systems is evolving over time.
2. Institutions (rules, organisations, legal frameworks) are
important and should enable HTA to evolve.
3. Mature HTA systems include a wide range of health
technologies and interventions to be assessed, strong
stakeholder involvement and knowledge mobilisation
activities.
4. The development of HTA takes place in a political arena; the
objectives and processes have to be clear from the start.

14. 14
No HTA without good Science, but
no Impact without Stakeholder
Participation and Governance
• If you do not have the human resources to do scientific
knowledge synthesis, you cannot do HTA.
• If you do not have good links to decision-making, you
can do HTA, but it will not be effective.
• If you do not have strong stakeholder participation and
health systems governance, HTA will not be effective
for Universal Health Coverage.

15. 15
“Start small, have a clear audience and
scope, and address important questions”
(Lavis et al 2008, Synthesis of findings from a multi-method study of
organizations that support the use of research evidence)

16. 16
Dedicated resources for HTA
1-2 persons
HTA Knowledge
Mobilizer
Putting HTA
into Context
HTA Unit/
Agency
4-5 persons
>9 persons
Dedicated
Resources
HTA
Committee
HTA
System

17. 17
Human resources and objectives
1-2 persons
4-5 persons
>9 persons
Team with health
economist, librarian and
social scientist.
Translation of HTA
knowledge produced
elsewhere into the local
decision-making context.
Clinician champion with
scientific background in
knowledge synthesis. Receptor
for HTA knowledge produced
elsewhere. Second person could
act as an HTA Knowledge
mobilizer and support an HTA
Committee.
Multidisciplinary team
for HTA Knowledge
Synthesis and Knowledge
Mobilisation

18. 18
HTA should be part of a culture of
Health Care Resource Stewardship
If we want to achieve the goals of efficiency and equity through
technology use, we must move from a perspective of technology
adoption and technology management to pathway management
with a perspective of resource stewardship.
Resource stewardship
A culture where resource scarcity is openly
acknowledged and recognized as a shared
responsibility.
Stirling Bryan. It’s time to break our addiction to adoption: Reframing HTA as the
cornerstone of ‘resource stewardship’.
https://www.youtube.com/watch?v=d6zJe2x6gNM
see also
https://www.researchgate.net/publication/260485842_Breaking_the_addiction_to_technology_adoption

19. 19
Strategies for EMRO
• Developping scientific capacity for knowledge synthesis in
collaboration with universities, the Cochrane Collaboration,
and other Health Systems Research initiatives.
• Using country or region specific Policy Windows.
• Regional communities of practice in HTA.
• Capacity building with existing HTA networks, such as
INAHTA.
• Promoting the need for HTA with policy makers and funding
agencies , but also the necessary conditions of rigor,
independence and transparency

20. 20
Conclusion
• HTA informs decision-making, but it also mediates
between clinical, patient, management and political
perspectives.
• HTA Systems need institutions (organisations, legal
frameworks, dedicated resources)
• HTA relies on strong stakeholder participation and
health systems governance in order to contribute
significantly to Universal Health Coverage.