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Health technology status update in a nutshell why it matters in South Africa

 Health Technology assessment is becoming more important as the number and types of devices that are launched in the health system increases. The main drivers of this process are safety, enabling technologies and a persistent perception that technology is better. 

The contribution of health technology advances to the Health CPI is presently estimated as adding an above CPI increase of about 1%. That amounts to a very large figure!
So where are we? 

In brief the status of the maturity of the process is:
  • Not much has changed since 2010 in medical schemes and managed care organisations, as well as with device manufacturers.
  • The South African Department of Health has made some changes and took some initiatives to regulate devices, such as draft legislation on process, and setting up a registry of local manufacturers. Processes are most probably in their infancy.
  • There may be more entities that do HTA in South Africa, than there was in 2010. However the quality of the people who evaluate health technology has not necessarily improved due to:
    • Losses
    • Promotions
    • Other pressures from clients
  • Whether the quality of HTA has changes substantially, is debatable.
  • There are more frequent references to international approaches when we take local decisions: e.g. Cochrane or Hayes.
    • Evidence-based approach more sought after.
    • International approaches, applied in a relevant and health system practical manner, has some value.
  • There is a real need for a common approach in the industry.
    • Collaboration – legal framework for collaboration, if any, need to be understood.
    • Non-collaboration is most probably the slow and unintelligent way to go.
    • Combination of approaches for collaboration on large ticket items, is most probably the process that must be promoted.
    • Opportunities may arise through the medical advisors group, SAMED and funders, to get to a uniform approach.
    • Time line and quality discussions.
  • The South African experience does not differ materially from international experience in health systems comparable to our private system (developing countries with tiered systems).

Critical pathways:
  • Submissions from device manufacturers to some funding entity or central entity to evaluate the submission:
    • This is here to stay.
    • There is room to simplify the process (e.g. a practical, tiered approach to technologies).
  • Time for evaluation and to final decision:
    • Can be shorter.
    • Can be more effective in giving definite answers
  • Quality of inputs from device manufacturers and distributors from funders or evaluators:
    • Can be improved.
      • Communication to the device manufacturer can be more transparent, granular and of higher quality.
      • A properly defined appeals process is needed.
  • Clear mandates are needed about funding of devices.
    • Communicated to the funder and managed care organisations' operational units.
    • Communicated to the device industry.

What the health system needs:
  • Technology challenges will be abundant:
    • Media utilisation and interconnectivity will play a role.
    • More technologies per time frame.
    • More technologies per diagnosis/ disease area.
  • In South Africa we will need a relevant, practical and executable NHI:
    • Affordability, Quality and Access are the BIG words.
    • We expect a rigorous controlled environment that will determine the integrity of the system.
      • the ethical fibre of what we do and how we do it, must be totally defendable.
      • commercial processes to deploy may be investigated.
    • Although we may have an emerging, legally defined process, this will take time to permeate completely for evaluation of technologies.
      • 4 - 10 years may be enough time to ensure such a system
      • Competitions Commissioner will play a role in defining the process.

USB Executive Development is offering a 5 day programme in Health Technology Assessment starting on 16 September 2013.

Manie de Klerk is the General Manager: Out-of-hospital at Metropolitan Health Risk Management. He is also the lead facilitator on the Health Technology Assessment programme. For more information about this article please contact Prof Manie de Klerk at
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