Stakeholder and HITAP members stand alongside the Health Secretary of Bhutan during the opening ceremony of the Stakeholder Consultation.
Photo: HITAP.

Guided by the concept of Gross National Happiness, the Constitution of Bhutan mandates the Government to provide “free access to basic public health services in both modern and traditional medicine.” This inclusive approach towards health care extends even to specialty treatments that require patients to travel outside of the country. However, escalating health care costs are posing a significant challenge to the sustainability of this approach.

To address this issue and optimize use of limited funds, it is crucial to allocate resources based on evidence. Health Technology Assessment (HTA) serves as a valuable tool to evaluate the clinical and cost-effectiveness of health technologies. In Bhutan, it can play a vital role in informing decision-making while supporting the country’s commitment to achieving universal health coverage.

The Bhutan Ministry of Health’s Health Intervention and Technology Assessment Division (HITAD) has been working with the Health Intervention and Technology Assessment Program (HITAP), with support from the United Nations Development Programme-led Access and Delivery Partnership (ADP), to develop a HTA framework that is tailored to the unique needs and context of Bhutan. This context specific framework will serve as a tool to ensure effective and equitable allocation of limited resources to health interventions and technologies, and will contribute to efforts to institutionalize HTA in Bhutan.

From 29 May to 2 June 2023, HITAP and HITAD co-organized a stakeholder consultation to introduce the newly developed HTA framework to stakeholders from across relevant sectors and collect their feedback. The consultation sought to ensure the suitability of the framework for Bhutan.

The participants deliberated, discussed and agreed upon each element of the proposed HTA framework, which covered topics ranging from the suggested sequence of steps in the HTA process for Bhutan to the roles and responsibilities of the involved stakeholders and the criteria for prioritization.

Dr. Sonam Jamtsho, an ear, nose and throat surgeon at the Jigme Dorji Wangchuck National Referral Hospital in Bhutan, emphasized the need for urgent adoption of HTA in Bhutan. Since we have a very resource constrained economy, the decisions we make regarding which health technologies we decide to introduce, keep or disinvest, have to be evidence-based,” he said.  

HTA is not new to Bhutan. The country embarked on its HTA journey in the early 2000s with the establishment of the Essential Drug Program. In 2008, the national HTA body, then known as the Essential Medicines and Technology Division and now called HITAD, was established. Since then, Bhutan has made significant progress, including the publication of national HTA process guidelines, conducting economic evaluations of the rota virus vaccine and pneumococcal conjugate vaccine, and an ongoing study to estimate the cost-effectiveness threshold for Bhutan. The continued support of ADP and other international partners has been pivotal in achieving these milestones.

Despite these achievements, the process of institutionalization has faced various challenges. Key issues include insufficient funding and technical capacity, as well as the need to bridge the gap between research outcomes and policy implementation while securing support from stakeholders. To successfully advance the institutionalization of HTA, it is essential to identify the country’s strengths and capitalize on opportunities.

In pursuit of overall governance reforms in Bhutan, the Parliament of the Kingdom of Bhutan passed the Civil Service Reform Act of Bhutan in 2022. This legislative action led to the restructuring, consolidation and establishment of various agencies under the Government of Bhutan. The reorganizations and reforms within the Ministry of Health offer a pivotal opportunity to advance HTA institutionalization. Taking advantage of this moment, the stakeholder consultation served as an ideal platform to present and refine the HTA framework, and effectively advocate for its adoption and expedite the integration process.

Political commitment and stakeholder buy-in is crucial for the institutionalization of HTA frameworks in any setting. Following the stakeholder consultation, the newly developed HTA framework was formally presented for appraisal and endorsement by the High-Level Committee for the Health Sector. This body of decision-makers, chaired by the Minister of Health, are the key users of HTA and their endorsement will be pivotal for the furtherance of HTA in the country.

The HTA framework will be revised based on the feedback received from the High-Level Committee and is slated for implementation in the upcoming fiscal year. This marks yet another significant milestone in Bhutan's HTA journey showcasing their commitment to evidence-based decision-making and a healthier future for all.