HTA in developing countries- Caribbean Perspective

It is apparent that developed countries engage in health technology assessments as means of informing decisions about programmes with major implications. One can see evidence for this in the membership of the International Network of Agencies for Heath Technology Assessment (INAHTA: http://www.inahta.org/inahta_web/index.asp) Some of those who accept that the use of HTA is of potential benefit have argued that HTA is not relevant to developing countries. (Attinger 1988) They suggest that this is so because HTA developed in response to the needs of developed countries and therefore may not be suitable for looking at the types of issues in the ways that may be appropriate to developing countries. They add that there may be the danger that if HTA is incorrectly applied to developing countries technologies would be adopted that work well in first world countries but for various reasons will not be of benefit in the third world. (PAHO 1989) There are some further challenges that may face developing countries wishing to engage in HTA.
Resource Limitation
Among the challenges facing developing countries is the issue of resource limitation. By this we refer to the relative and or absolute shortage of financial, human and other resources. These shortages may manifest themselves in terms of technical and administrative personnel, lack of infrastructure. In many third world countries the financial resources available are actually shrinking. (PAHO 1989). In terms of human resources a few issues need to be highlighted. Because of the relatively small sizes of some developing countries human resources can be particularly difficult. The cost of training health professionals can be quite steep. Some of the countries have experienced “brain drain” as many of their highly qualified nationals seek to better themselves financially in developed countries. Fortunately even is such regions there may be universities which provide for training areas of relevance to HTA such as public health, health economics and other clinical and allied heath disciplines. (PAHO 1997) This may be supported by investigations such as one into the possibility of Trinidad and Tobago (a developing country in the Caribbean) conducting Health Technology Assessment. That report suggested that the basic skills and expertise for HTA were available in the wider Caribbean region. (Banken 2001)
Morbidity patterns
Many of the health problems faced by the populations of the less-developed regions of the world are quite different from those in the more-developed ones due to eradication or significant reduction. In one situation (developing country) the technologies may be focusing on saving life at minimal cost while the other (developed country) may be aimed at making life more comfortable but adding very little if anything to the length. One of the implications of this is that technologies that are assessed in the developed world may be in fact of minimal relevance to the underdeveloped world. (PAHO 1989)Several developing countries have been seeing shifts in their illness profiles towards those of developed countries. ) To the extent that the illnesses that afflict the developing jurisdictions are similar to those of the developed world there may be a similarity in the interventions that should be considered in remedying them.
Cultural diversity
There is interaction between culture and the value system, resulting from this culture may affect the effectiveness of any particular. Culture affects the perception of health and disease and the acceptability of different forms of health interventions. This can be particularly seen in the case of technologies that require participation, such as education. (PAHO 1989) There are varying cultures in the Caribbean both within different states and within states as a result of the patterns of migration to the islands. In the two main groups in terms of numbers are those of East Indian ancestry and those of African ancestry. Differences still remain despite years of living together and intermarrying. As may be seen in religious affiliation and festivals. (PAHO 1998) Political systemsIt is suggested that because fewer of the developing countries are democracies it is less likely that there is a social force that keeps the leadership in check by open discussion of decisions and their implications. This is one of the reasons why the potential impact of a health technology assessment should be ascertained before deciding to conduct it. (PAHO 1989) All of the countries of the English-speaking Caribbean are democracies in terms of espousing the parliamentary system and the holding of periodic competitive, free and fair elections. In addition freedom of speech and freedom of the press contribute to a situation in which the leaders are required to justify their plans and actions. It is therefore likely that HTAs conducted or adopted will have significant positive impact. (PAHO 1998) Healthcare system structuresWhether the health care system is centrally controlled or not may affect the implications of doing HTA. There may be more potential for HTA findings to have wide reaching impacts in systems that are centrally controlled as opposed to situations where responsibility is fragmented. (PAHO 1998)Availability of information and dataIn many developing countries there is a severe lack of appropriate accurate timely local information. This contributes to making it particularly difficult to do any local HTA of value. (Paho 1998) Technological capacityAlthough some of the larger developing countries have produced some of their own health technologies a significant portion of the technologies used are imported from developed countries. The ability of these countries to create local solutions to local health challenges will be affected by, existing capacity, raw materials and expertise in all aspects of technology development. (Paho 1989) There is likely to be a range of abilities of developing countries to generate their own interventions. It is likely that in developing countries there needs to be dependence on developed countries for a significant amount of technology. Social technologies. This refers to ‘soft’ technologies such as capability in the following: information management capability, administration, and organisation in addition to legislation and regulation. It may be particularly important to put social technologies in developing countries through there is the possibility of them being more politically sensitive than “hard” technologies. (PAHO 1989) There is likely to be a range of capacities in the soft technologies. This may be an area in which countries may benefit from the assistance of international development agencies.

References
Attinger, E and Panerai, R. Transferability of Health Technology Assessment with particular emphasis on developing countries. International Journal of Technology Assessment in Health Care (INJTAHC) 4 (1988) 545-554
Banken, R. Consultancy on Health Technology Assessment. Final Report, November, 2001. Ministry of Health Trinidad and Tobago
Pan American Health Organisation (PAHO), Developing Health Technology Assessment in Latin America and the Caribbean, PAHO Division of Health Systems and Services Development, Washington, 1998 Online Resources
HTA 101 INTRODUCTION TO HEALTH TECHNOLOGY ASSESSMENTwww.nlm.nih.gov/nichsr/hta101/hta101.pdf
Etext on Health Technology Assessment (HTA) Information Resources compiled & edited by Leigh-Ann Topfer and Ione Auston http://www.nlm.nih.gov/nichsr/ehta/
National Coordinating Centre for Health Technology Assessment http://www.ncchta.org/Catalan Agency for Health Tecnology Assessment and Research http://www.aatrm.net/html/en/Du8/index.html
A special edition of reprints from the International Journel of Technology Assessment in Health Care with particular relevance to developing countries. http://www.mtppi.org/reports.php?repid=045Directory of Health Technology Assessment Organizations Worldwide published by Medical Technology & Practice Patterns Institute and WHO Washington, DC, 1998 http://165.158.1.110/english/hsp/hsptec3.htm
Technology assessment and transfer for district health systemshttp://www.who.int/health-services-delivery/performance/accreditation/20000629a.htm
November 25, 2004 Health Technology Assessment: Bridging Global Evidence to Local Issues: 3rd Asian Regional HTA Conference http://www.philhealth.gov.ph/qa/htaconference2004/
Maylaisia’s HTA programmehttp://www.moh.gov.my/Medical/HTA/overview.htm
1st HTA Workshop for Latin America Mexico City November 20 - 21, 2004www. aetmis.gouv.qc.ca/fr/publications/ congres/Abstract%20F-02A.pdfInternational Society of Technology Assessment in Health Care www.istahc.net
International Network of Agencies for Health Technology Assessment www.inahta.org