New approaches to priority setting – health technology assessment in Indonesia
The development of new health technologies is frequently mismatched with their introduction and adaptation within health systems. This may be due to a lack of structured, evidenced-based approaches that are designed to align these three critical areas. Where new technologies are introduced, their sustainability may be uncertain due to a variety of reasons. This may include a lack of systematic evaluation and selection of new technologies that meet the needs of countries, limited financial planning, challenging infrastructure, inadequate human resources, or sub-optimal procurement planning and supply chain management. One solution with game-changing potential is the introduction of the ‘health technology assessment’ (HTA) approach – a systematic, evidence-based mechanism that evaluates and prioritizes new technologies from economic, social and ethical perspectives, recommends policies that enable adoption of technologies that meet countries’ needs, and supports rational resource allocation to sustain use of technologies.
In Indonesia, the HTA approach is the mainstay for one of the Access Delivery Partnership (ADP) strategic pathways. When the ADP held an initial stakeholder consultation, the Ministry of Health already had a HTA committee (HTAC) and expressed their interest to strengthen the HTAC’s capability and capacity in support of universal health coverage. Through secondary research and lessons from initiatives already underway, globally and in Indonesia, the ADP project has helped identify gaps in capacities related to evidence-based decision-making and structured priority setting for rational resource allocation for new health technologies. Learnings from Thailand – which has a long-established HTA mechanism – highlighted how HTA can inform selection of health technologies that address the needs of the largest number of people, and how budget impact and ethical and social considerations must also be taken into account in selecting health technologies. Experience shows that it takes time to build up local capacity and infrastructure for using HTA, and political will and commitment are therefore particularly important.
As part of a series of activities to support HTA capacity building in Indonesia, PATH1 and the Health Intervention and Technology Assessment Program (HITAP) conducted a study visit and training for Indonesian delegates in Bangkok, Thailand in early 2015. The delegates were introduced to various HTA-related topics, including:
epidemiology and repeated measure analysis (longitudinal data analysis);
theory and practice;
costing for health economic modeling and systematic review;
health outcome assessment;
health economic modeling; and
The training was designed to help participants develop specific capacities to support the planning and implementation of HTA on selected topics within the Indonesian context. This visit subsequently led to the piloting of HTA of two new health technologies by the HTAC: the use of sildenafil to treat pulmonary arterial hypertension, and renal dialysis (as opposed to hemodialysis) for the management of end-stage renal disease.
The ADP project continues to support Indonesia in institutionalizing HTA approaches and thedevelopment of a national HTA action plan. The ADP is currently working with the HTAC to finalize policy briefs that detailthe lessons learned and policy recommendations from the two pilot assessments. The HTA mechanism will be critical in assessing health technologies and selecting those that provide best value-for-money and promote health equity. This sytematic approach will inform decision-making on the national health insurance benefits package, which is critical as Indonesia moves towards universal health coverage by 2019.
 PATH is one of the three core ADP project partners, along with the United Nations Development Programme (UNDP) and the Special Programme for Research and Training in Tropical Diseases (TDR).
Aziza Mwisongo is Senior Program Officer in Health Systems Innovation and Delivery at PATH.
Photo credit: Nugroho Nurdikiawan Sunjoyo/ World Bank
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