Global Health Priorities

A joint research and capacity strengthening programme by Radboudumc and University College London

Category: country

  • Palestine

    Palestine

    Overview

    Project description will follow soon.

    Related Publications & Reports

    • coming soon
  • Saudi Arabia

    Saudi Arabia

    Overview

    Project description will follow soon.

    Related Publications & Reports

    • coming soon
    Saudi Arabia
  • Tanzania

    Tanzania

    Overview

    Tanzania was among the first low-income countries in sub-Saharan Africa to attempt to institutionalise a Health Technology Assessment (HTA) process. The country used the revision of its National Essential Medicines List (NEMLIT) as an entry point for evidence-informed decision making.

    Through collaboration between the Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC), PATH, PRICELESS SA, and the International Decision Support Initiative (iDSI), structured HTA processes were introduced into medicine selection, and a national HTA committee was subsequently established. The Tanzania experience represents a transition from a system with no formalised priority-setting mechanism toward an emerging, institutionalised, evidence-informed appraisal process embedded within the Ministry’s governance structures.

    Context & Objectives

    Prior to 2014, there was no formalised priority-setting mechanism in the Tanzanian health system: decisions were made in a bureaucratic fashion by program-specific committees, with little or no health economic evidence underpinning them. The NEMLIT itself had no adherence requirement in practice, and selection criteria historically covered efficacy, safety, availability, and WHO compliance – with no consideration of cost-effectiveness.

    As Tanzania pursued its commitment to Universal Health Coverage, the government aimed to:

    • Introduce HTA concepts and evidence-informed decision making into an existing, necessary process (the NEMLIT revision)
    • Build technical capacity in economic evaluation and evidence appraisal among clinicians, pharmacists and Ministry officials
    • Establish a formal HTA committee with a clear mandate and terms of reference
    • Incorporate cost-effectiveness explicitly into selection criteria for medicines

    Approach & Methods Used

    • Sensitisation and situational analysis of existing decision-making structures with PATH (2014–2015)
    • Introductory and technical workshops with HITAP (Thailand) and PRICELESS SA, identifying capacity gaps in PICO, literature appraisal and costing
    • Use of the 2017 NEMLIT revision as a practical demonstration project for HTA
    • Development of a Standard Operating Procedure embedding cost-effectiveness alongside efficacy and safety as formal selection criteria
    • Establishment of the Tanzanian Health Technology Assessment Committee (THTAC), with terms of reference and multidisciplinary membership
    • Baseline capacity survey of committee members to guide future capacity strengthening

    Outcomes

    By the end of 2017, the revised STG/NEMLIT had incorporated cost-effectiveness criteria for the first time, resulting in approximately 140 medicines removed and 170 new products added based on efficacy, safety, cost-effectiveness and regulatory registration. This was the first time cost-effectiveness had featured in Tanzania’s essential medicines selection process, and it produced the country’s first formal HTA committee.

    The 2018 capacity survey found that while THTAC members were well-qualified and experienced in clinical medicine, they had limited experience with economic evaluation, RCTs, or equity analysis, and expressed low confidence in core HTA methods such as ICER interpretation and willingness-to-pay thresholds – providing a concrete baseline for future capacity strengthening.

    Key lessons include:

    • A demonstration project that is a genuine institutional necessity (not just an academic exercise) is far more effective at generating demand for HTA than abstract advocacy
    • Strong, continuous engagement from multiple international partners combined with one consistent in-country focal point, was critical to sustaining political will despite staff turnover
    • Capacity building must precede the introduction of technical criteria like cost-effectiveness
    • Formal SOPs and guidance documents give legitimacy and continuity to the process beyond any single revision cycle
    • Institutionalisation is an ongoing process: committee capacity, dedicated financing, and links to reimbursement (NHIF) remain key unfinished challenges

    Related Publications & Reports

  • Tajikistan

    Tajikistan

    Overview

    Tajikistan is undertaking a comprehensive reform of its primary health care (PHC) system under the World Bank–financed Millati Solim Project. A central component of this reform is the development and costing of a revised Primary Health Care Benefit Package (PHC) to support the introduction of strategic purchasing and the establishment of a national Health Services Purchasing Structure.

    Beginning in 2026, Radboudumc and UCL support the Ministry of Health and Social Protection in reviewing, costing and defining the PHC benefit package as part of broader health financing reforms. The reform aims to align service entitlements with fiscal capacity while strengthening transparency and accountability in purchasing decisions.

    Context & Objectives

    The PHC benefit package reform forms part of Subcomponent 2.1 of the Millati Solim Project, which seeks to improve efficiency, equity and financial sustainability in Tajikistan’s health system. A key reform milestone requires the development, costing and formal approval of a revised State-Guaranteed Benefit Package (SGBP) for PHC.

    The objectives of our engagement are to:

    • Review the current PHC service delivery model and identify priority gaps
    • Define clear inclusion criteria for services and medicines
    • Estimate the full financial requirements of the revised package
    • Assess fiscal sustainability under different financing scenarios
    • Align the package with strategic purchasing reforms
    • Develop monitoring and evaluation mechanisms
    • Strengthen the legal and regulatory basis for implementation

    The reform is designed to ensure that PHC entitlements are clearly defined, financially feasible and institutionally anchored.

    Approach & Methods Used

    Our work is grounded in HTA methods, organised through Evidence-Informed Deliberative Processes (EDPs), ensuring that technical analysis is embedded within formal governance structures.

    The planned approach includes:

    • Epidemiological and service utilisation analysis to identify PHC priorities
    • Development of explicit inclusion criteria
    • Costing and resource modelling of services, medicines, workforce and infrastructure
    • Scenario analysis to assess budget implications and fiscal space
    • Design of financing and purchasing arrangements aligned with reform objectives
    • Stakeholder consultation and deliberation to ensure transparency and legitimacy
    • Development of monitoring indicators and implementation roadmap
    • Legal and regulatory drafting to formalise the revised benefit package

    Methods will be calibrated to available data, institutional capacity and reform timelines.

    Expected Outcomes

    The reform is expected to deliver:

    • A clearly defined and formally approved PHC benefit package
    • A costed financing plan aligned with strategic purchasing
    • An updated and rationalised medicines list
    • A monitoring and evaluation framework with measurable indicators
    • Strengthened institutional capacity for ongoing package revision
    • Legal and regulatory instruments to anchor implementation

    The Tajikistan engagement represents a forward-looking reform linking benefit package design, fiscal sustainability and purchasing reform within a coherent policy framework.

  • Ukraine

    Ukraine

    Overview

    Ukraine has institutionalised Health Technology Assessment (HTA) within its legislative framework, with the State Expert Centre (SEC) of the Ministry of Health responsible for conducting HTAs and supporting reimbursement and formulary decisions. As HTA was formally embedded only recently, sustainable capacity building became a national priority.

    We co-led the design and implementation of a comprehensive HTA training programme aimed at strengthening the skills of HTA doers, users and trainers. The initiative focused on building long-term institutional capacity to support transparent, evidence-informed reimbursement and benefit package decisions.

    Context & Objectives

    Following the formal legalisation of HTA in 2020, Ukrainian stakeholders expressed the need for a structured and comprehensive training programme to consolidate national HTA capacity. While earlier awareness-raising efforts had taken place, gaps remained in comparative effectiveness analysis, health economics, qualitative evidence synthesis, ethical analysis, and patient and public involvement.

    The objective was not only to train individual analysts, but to strengthen capacity at three levels:

    • Individual (HTA doers and users)
    • Organisational (institutional processes within SEC and Ministry of Health)
    • System-level (long-term sustainability through training-of-trainers)

    The programme aimed to create a self-sustaining national ecosystem for HTA embedded within formal governance structures.

    Approach & Methods Used

    • Training needs assessment
      Survey of 40 HTA stakeholders (83% response rate) to identify knowledge and skill gaps.
    • Development of a module training programme based on the identified needs (160 hours)
      1. Introduction to HTA
      2. Comparative effectiveness
      3. Cost-effectiveness and budget impact analysis
      4. Qualitative evidence synthesis
      5. Ethical and broader HTA domains
    • Active learning design
      Combination of lectures, practical exercises, self-study and applied assignments.
    • Evaluation of learning gains
      Pre- and post-module self-assessed confidence measurements showed consistent improvement across modules.
    • Train-the-trainer programme
      Twelve Ukrainian HTA professionals were trained to deliver future modules, strengthening sustainability and institutionalisation.

    Outcomes

    • 75 participants completed modules of the programme.
    • Improved learnings were identified across all components of the training.
    • Strong uptake of introductory HTA training among future trainers.
    • Capacity building must be phased and differentiated (users vs doers).
    • Long-term sustainability requires institutional embedding within universities and national governance structures.

    The experience demonstrates how tailored, competency-based HTA training can support sustainable institutionalisation of HTA in transition settings.

    Collaborating Partners

    Our work in Ukraine has been done in collaboration with the HTA department of the State Expert Center of the Ministry of Health in Ukraine.

    Key partners who have supported this work include:

    • Management Sciences for Health
    • Project Safe
    • Affordable
    • Effective Medicines for Ukrainians

    Related Publications & Reports

  • Lebanon

    Lebanon

    Overview

    In Lebanon, we co-developed the first formal Health Technology Assessment (HTA) framework for the National Social Security Fund (NSSF), establishing a structured and institutionalised process for reimbursement decisions. The framework was developed in collaboration with the NSSF Pharmacy Department and is presented as an official national HTA guidebook.

    Guided by the principles of Evidence-Informed Deliberative Processes (EDPs), the framework introduces explicit decision criteria, structured assessment and appraisal stages, and defined procedural steps for evaluating new health technologies. It constitutes a foundational step toward institutionalising transparent and standardised reimbursement decision-making within the NSSF.

    Approach & Methods Used

    Working closely with the NSSF, we:

    • Designed a formal HTA process including nomination, scoping, assessment and appraisal stages
    • Introduced explicit decision criteria: safety, incremental clinical benefit and budget impact
    • Structured appraisal around a deliberative decision tree
    • Embedded stakeholder communication and procedural transparency
    • Developed practical guidance for applicants submitting reimbursement requests
    • Established monitoring and process evolution mechanisms

    The framework balances methodological rigour with the fiscal realities of Lebanon’s economic crisis, prioritising cost-neutral or cost-saving technologies while gradually building institutional HTA capacity.

    Significance

    This guidebook represents the first published HTA framework in Lebanon and formalises decision-making processes that were previously implicit. It positions the NSSF to transition progressively toward a more comprehensive HTA system, including future integration of cost-effectiveness analysis.

    The Lebanon case demonstrates how EDP-based governance design can serve as an entry point for institutionalising HTA in fiscally constrained and politically complex environments.

    Collaborating Partners

    • National Social Security Fund (NSSF)
    • Roche

    Related Publications & Reports

    • National Social Security Fund. A guide to health technology assessment at the National Social Security Fund. Lebanon: National Social Security Fund; 2023. 
  • Kyrgyzstan

    Kyrgyzstan

    Overview

    In Kyrgyzstan, Radboudumc and UCL supported a comprehensive revision of the State-Guaranteed Benefits Programme (SGBP) through the application of an Evidence-Informed Deliberative Process (EDP) combined with the WHO Universal Health Coverage Compendium (UHCC). This reform represents the first full system-wide application of the UHCC globally to redesign a national health benefits package.

    Working closely with the Ministry of Health and the Mandatory Health Insurance Fund, we helped structure the revision to address long-standing weaknesses in entitlements, fiscal sustainability and alignment between policy commitments and available resources. Through structured governance, service-level costing and explicit prioritisation criteria, the reform resulted in a transparent and implementable benefits package grounded in fiscal reality.

    Context & Objectives

    Since its introduction in 2001, the SGBP lacked an explicit and standardised list of service entitlements. Benefits were described in general terms by level of care rather than by defined services. This contributed to high out-of-pocket payments (38% of total health expenditure), inconsistent access and budget misalignment.

    Under the national health strategy (SPHD2030), revising the SGBP became a priority. In 2023, the Ministry of Health and the Mandatory Health Insurance Fund initiated a full package revision (2023–2025), aiming to:

    • Define a clear and explicit service list
    • Align entitlements with fiscal space
    • Institutionalise structured priority setting
    • Improve transparency and governance
    • Strengthen progress toward universal health coverage

    The reform was embedded within the Primary Health Care Quality Improvement Programme and supported by development partners.

    Approach & Methods Used

    • Application of the Evidence-Informed Deliberative Process (EDP) framework
    • First system-wide use of the WHO UHCC to standardise service definitions
    • Mapping of existing and potential services into an inventory of 424 services
    • Establishment of Technical Working Groups and oversight by the Health Policy Council
    • Definition of explicit prioritisation criteria (including cost-effectiveness, burden of disease, equity and financial risk protection)
    • Service-level costing using a comprehensive non-personnel cost model and costing of services outside of the package (to inform tariffs)
    • Fiscal space analysis identifying USD 19 per capita in reallocatable funding
    • Development of policy scenarios to illustrate coverage–cost trade-offs
    • Implementation support of the benefits package and measurement of facility ‘readiness’ for the implementation

    Our Approach: The EDP Framework in Action

    We utilized the Evidence-Informed Deliberative Processes (EDPs) framework as our overarching approach, systematically operationalizing its core components to structure priority setting, ensure transparency, and maximize process legitimacy.

    1. Governance & Institutional Framework

    EDPs require a legitimate, transparent governance structure to oversee the priority-setting process and ensure institutional ownership.

    • Multilateral Oversight: Established specialized Technical Working Groups (TWGs) to drive the technical process, with centralized oversight managed by the Health Policy Council.
    • Standardized Architecture: Pioneered the first system-wide application of the WHO UHC Compendium (UHCC) to standardize service definitions across the entire health system.

    2. Explicit Decision Criteria

    A fundamental step in the EDP process is defining explicit, multi-dimensional criteria to guide choices beyond just clinical efficacy.

    • Multi-Criteria Framework: Grounded all deliberations in clear, explicit decision criteria, including cost-effectiveness, burden of disease, equity, and financial risk protection.

    3. Rigorous Evidence Generation

    EDPs rely on the best available local and global data to inform stakeholders during deliberation.

    • Comprehensive Service Mapping: Mapped existing and potential services into a robust, comprehensive inventory of 424 distinct interventions.
    • Advanced Service Costing: Developed a comprehensive non-personnel cost model for service-level costing, extending the analysis to services outside the package to inform future tariff structures.

    4. Deliberative Appraisal & Implementation Support

    The final stage translates evidence through a structured deliberative lens to match operational realities and map out future deployment.

    • Policy Scenario Modeling: Developed advanced policy scenarios to visually illustrate coverage–cost trade-offs, allowing decision-makers to navigate real-world fiscal constraints.
    • Fiscal Space Analysis: Executed explicit fiscal space analysis, successfully identifying USD 19 per capita in reallocatable funding.
    • Operational Readiness: Provided direct implementation support for the newly designed benefits package, systematically measuring facility “readiness” to ensure seamless deployment.

    Outcomes

    From 424 evaluated services, approximately 186 were classified as high priority. However, available fiscal space could finance only 66 services under a fully public funding model. Scenario modelling showed:

    • Universal public coverage of 186 services would require USD 53.76 per capita
    • Budget-constrained coverage of 66 services would cost USD 21.16 per capita
    • A mixed public–private financing model could retain 186 services at USD 47.74 per capita

    Key lessons include:

    • Explicit service definitions are essential for coherent benefit design
    • Comprehensive costing fundamentally shapes prioritisation outcomes
    • Fiscal dialogue is as important as technical appraisal
    • Large gaps between ambition and fiscal capacity require political decision-making beyond technical analysis

    Kyrgyzstan demonstrates that comprehensive benefits package redesign is feasible when governance, costing and structured deliberation are integrated into one coherent process.

    Related Publications & Reports

  • Rwanda

    Rwanda

    Overview

    In Rwanda, we supported a comprehensive sectoral review of cancer services as part of the broader Health Benefits Package (HBP) reform under the Community-Based Health Insurance (CBHI) scheme from 2021 to 2025. Rather than reassessing the entire HBP, the government prioritised cancer as a high-burden and high-cost disease area requiring structured and evidence-informed prioritisation.

    In collaboration with the University of Rwanda, the Rwanda Social Security Board (RSSB), Ministry of Health, the London School of Hygiene and Tropical Medicine,  and other (inter)national stakeholders, we developed and applied adaptive Health Technology Assessment (aHTA) methods to assess 49 cancers, each divided into basic, core and enhanced service packages. The review generated cost-effectiveness evidence under significant time, data and capacity constraints. This represents the first large-scale assessment of multiple cancers simultaneously to inform HBP design in a low-income setting.

    Context & Objectives

    Cancer incidence in Rwanda has increased, with substantial pressure on CBHI reimbursement and national health budgets. While Rwanda has strong UHC coverage (over 80% insured through CBHI), expanding access to high-cost cancer treatments posed fiscal sustainability challenges.

    The Ministry of Health initiated a multi-stakeholder prioritisation process assessing cancers against nine criteria, including:

    • Cost-effectiveness
    • Burden of disease
    • Financial risk protection
    • Budget impact
    • Feasibility
    • Equity considerations

    The specific objectives of the cost-effectiveness component were to:

    • Select appropriate aHTA methods under local constraints
    • Identify or generate cost-effectiveness ratios (CERs) for all individual cancer services
    • Adjust for transferability across settings
    • Strengthen the methodological basis for future HBP prioritisation

    Approach & Methods Used

    • Division of each cancer into basic, core and enhanced packages using NCCN resource stratification
    • Rapid review of the Tufts CEA Registry (12,000+ CEAs) to identify transferable evidence
    • Application of structured “knock-out” transferability criteria (intervention match, geography, study quality)
    • Recalculation of Average Cost-Effectiveness Ratios (ACERs) to ensure comparability
    • Purchasing power parity (PPP) adjustment for cross-country transfer
    • Structured Expert Elicitation (SEE) with 12 national cancer experts to fill evidence gaps
    • Delphi-based consensus scoring for interventions lacking published CEAs
    • Explicit categorisation of interventions by cost-effectiveness thresholds relative to GDP per capita.

    Outcomes

    The assessment demonstrated that large-scale sectoral cost-effectiveness review is feasible within 3–4 months using adaptive HTA methods. Access to pre-extracted CEA databases significantly reduced analytical burden, while structured expert elicitation filled critical evidence gaps.

    Key findings include:

    • Strong publication bias toward common cancers (e.g. cervical, breast, lung)
    • Limited LMIC-specific CEAs for many cancer types
    • Need for better reporting standards in global CEA literature
    • Importance of clearly communicating uncertainty during appraisal

    The Rwanda experience shows how adaptive HTA can support evidence-informed benefit package design in resource-constrained settings, particularly for complex and high-cost disease areas like cancer.

    Collaborating Partners

    • Government of Rwanda
    • Rwanda Social Security Board
    • Ministry of Health
    • Rwanda Biomedical Center
    • University of Rwanda School of Public Health
    • London School of Hygiene and Tropical Medicine (LSHTM)
    • Clinton Health Access Initiative (CHAI)
    • Center for Global Development
    • Management Sciences for Health | Palladium

    Related Publications & Reports

  • Rwanda & Kenya – SHARP Consortium

    Rwanda & Kenya – SHARP Consortium

    Overview

    In Rwanda and Kenya, we co-lead the NIHR-funded SHARP (Shaping Health Packages and Researching Priorities) consortium. The programme, running from 2025-2028, supports the design, evaluation and institutionalisation of Health Benefit Packages using Evidence-Informed Priority Setting.

    The consortium combines formative and evaluative research to strengthen how benefit packages are designed, implemented and revised. Areas of research include evidence assessment, implementation constraints, and strengthening patient and community involvement in HBP processes.

    Context & Objectives

    Our focus in Rwanda is on Work Package 1.2, which addresses a critical gap in many low- and middle-income countries: how to meaningfully involve patients, communities and the public in priority setting for health benefit packages.

    Although stakeholder engagement is widely recommended, few countries have structured procedures for patient and community involvement in reimbursement or benefit design decisions. The SHARP programme therefore seeks to:

    • Map and categorise relevant stakeholders in Rwanda and Kenya
    • Analyse their interests, influence and preferences regarding HBP engagement
    • Review international and regional approaches to patient and community involvement
    • Co-design context-appropriate engagement strategies
    • Pilot and evaluate structured involvement within ongoing HBP processes

    The work distinguishes between consultation (soliciting perspectives) and participation (direct involvement in decision-making bodies), recognising that optimal strategies depend on institutional context and stakeholder readiness.

    Through stakeholder mapping, systematic review, focus group discussions and co-design workshops, the programme develops practical and implementable strategies for community engagement in HBP decision-making.

    The objective is not symbolic participation, but to strengthen legitimacy, transparency and accountability of national priority setting systems.

    Key Contribution

    SHARP positions community and patient involvement not as an add-on, but as a core component of institutionalised Evidence-Informed Priority Setting. The work generates practical guidance for African settings and contributes to regional capacity building in collaboration with Africa CDC.

    Collaborating Partners

    • London School of Hygiene and Tropical Medicine
    • KEMRI
    • University of Rwanda School of Public HealthUniversity of Nairobi.  
  • United Arab Emirates (UAE) – Abu Dhabi

    United Arab Emirates (UAE) – Abu Dhabi

    Overview

    In the Emirate of Abu Dhabi (UAE), we supported the Department of Health (DoH) in establishing a structured programme to institutionalise Health Technology Assessment (HTA) for reimbursement decisions and broader benefit package design. Guided by the Evidence-Informed Deliberative Processes (EDP) framework, we worked with DoH to develop a practical roadmap for stepwise HTA implementation.

    Rather than launching a full HTA agency immediately, the reform focused on stakeholder alignment, clear procedures and governance design. Through collaborative design and consultation, the resulting roadmap provides a multi-year plan to strengthen transparency, explicit decision criteria, stakeholder involvement, communication and local HTA capacity—aimed at improving value for money and the sustainability of health financing.

    Context & Objectives

    Abu Dhabi has compulsory health insurance with multiple schemes and benefit schedules across population groups. At the same time, healthcare spending pressures have increased due to demographic and epidemiological change and the rapid introduction of innovative (and often costly) technologies. Stakeholders recognised that HTA principles were present but not yet sufficiently embedded in a consistent, timely and transparent decision-making process.

    DoH identified key challenges: limited internal capacity for economic and HTA analysis; dependence on external expertise; and unclear coordination and mandates between units responsible for market approval versus pricing and reimbursement. These issues contributed to delays and an accumulating backlog of technologies awaiting assessment.

    The main objectives were to:

    • Build and leverage local HTA expertise over time
    • Develop a roadmap for institutionalising HTA that fits Abu Dhabi’s governance context
    • Strengthen transparency and stakeholder involvement in reimbursement decisions
    • Define and operationalise decision criteria
    • Clarify mandates, procedures and organisational roles

    Approach & Methods Used

    • Situation analysis using desk research plus semi-structured (group) interviews
    • Broad stakeholder engagement (45 stakeholders), organised across stakeholder categories
    • Two workshops to discuss findings and shape roadmap building blocks
    • Separate engagement with industry representatives via an online group interview
    • Use of the EDP framework to structure roadmap components (governance, criteria, process steps, communication, appeal, monitoring)
    • Development of a 5-year implementation roadmap, refined through meetings with senior DoH staff
    • Formal approval of the roadmap for implementation 

    Outcomes

    The process produced a DoH-approved, multi-year roadmap to establish a comprehensive HTA framework in Abu Dhabi. Key elements include setting up an HTA structure and committees embedded in the existing health sector set-up, defining scope and decision criteria, strengthening communication and transparency, and building sustainable HTA capacity.

    Key learnings:

    • Transparency and communication need explicit design, not ad hoc practice
    • Broad stakeholder consultation built urgency, ownership and legitimacy for reform
    • Clear mandates and coordination across regulatory and reimbursement functions are essential to avoid delays and backlog of HTA
    • A phased roadmap is more feasible than immediate full-scale HTA institutionalisation

    Collaborating Partners

    Our work in Abu Dhabi has been done in collaboration with Abu Dhabi Department of Health, United Arab Emirates. 

    Related Publications & Reports

  • Moldova

    Moldova

    Overview

    In Moldova, we supported the development of a national roadmap for institutionalising HTA to strengthen evidence-informed decision-making in the health system. The initiative focused on building the governance, procedural and technical foundations required to introduce HTA in a structured and sustainable way.

    Rather than immediately launching full HTA implementation, we worked with national stakeholders to design a phased reform strategy emphasising institutional design, stakeholder alignment and capacity development. The roadmap provides a sequenced approach for embedding HTA within national health financing and benefit package decision processes.

    Context & Objectives

    Moldova faces fiscal constraints, rising pharmaceutical expenditures and increasing demand for new health technologies. While technical expertise existed in parts of the system, decision-making processes for reimbursement and inclusion of services lacked formal HTA structures.

    The Ministry of Health therefore sought to:

    • Assess the readiness of the system for HTA implementation
    • Identify institutional gaps and capacity needs
    • Define governance structures for HTA appraisal
    • Develop a realistic, phased implementation strategy
    • Align HTA development with broader health system reforms

    The objective was not only technical capacity building, but institutionalisation of transparent and structured priority setting mechanisms.

    Approach & Methods Used

    • Situational analysis of existing decision-making processes
    • Stakeholder mapping across ministries, insurance bodies and academic institutions
    • Assessment of technical and institutional HTA capacity
    • Structured consultations with policymakers and experts
    • Development of a phased implementation roadmap
    • Definition of roles and responsibilities for HTA governance
    • Alignment of HTA development with benefit package revision cycles
    • The approach emphasised gradual institutional embedding rather than rapid technical rollout.

    Outcomes

    The roadmap clarified the institutional pathway for HTA development in Moldova and provided a realistic sequencing strategy. It identified governance anchoring, methodological standardisation and capacity building as key priorities.

    Key lessons include:

    • Institutional readiness assessment is essential before HTA rollout
    • Clear mandates and governance structures prevent fragmentation
    • Capacity building must accompany methodological development
    • Phased implementation increases feasibility and sustainability
    • Early stakeholder engagement strengthens ownership of reform

    Moldova’s experience illustrates how middle-income countries can move toward structured priority setting through careful institutional design and sequencing.

    As a follow-up project, we supported the School of Public Health Management in Moldova to develop an introductory course on HTA. The course targets first- and second-year master’s students, and health professionals enrolled in continuing education. In the first year (2024), 49 master’s students and 26 health professionals were trained.

    Collaborating Partners

    Our work in Moldova has been done in collaboration with the Ministry of Health, CNAM, and the School of Public Health Management in the Republic of Moldova. 

    Related Publications & Reports

  • Iran

    Iran

    Overview

    In collaboration with national stakeholders, we developed and applied an EDP to support the revision of the national health insurance benefit package, using multiple sclerosis (MS) as a test case for structured priority setting. Rising costs of MS treatments and growing budget pressure made this condition a politically and financially salient example for reform.

    Rather than redesigning the entire package, the initiative focused on introducing a transparent and evidence-informed process for revising coverage decisions within the existing health insurance system. The MS case served as a concrete entry point for institutional reform.

    Context & Objectives

    Iran’s social health insurance system covers a large share of the population, but benefit package expansion over time had not always followed explicit criteria or systematic assessment. High-cost MS medicines, increasing demand and fiscal pressure highlighted the need for clearer and more consistent decision-making.

    The objectives of the reform were to:

    • Apply structured priority setting to coverage decisions for MS treatments
    • Define explicit decision criteria for reimbursement
    • Integrate economic evaluation into appraisal processes
    • Improve transparency and legitimacy of benefit revision
    • Strengthen institutional arrangements for future technology assessments

    The MS case provided an opportunity to test structured appraisal within existing governance frameworks.

    Approach & Methods Used

    • Application of Evidence-Informed Deliberative Processes (EDPs) as overarching framework
    • Explicit definition of decision criteria (effectiveness, cost-effectiveness, budget impact, severity, equity and social values)
    • Systematic review of clinical and economic evidence for MS treatments
    • Structured stakeholder deliberation within advisory committees
    • Documentation and clarification of committee roles and decision pathways
      Integration of economic evaluation into coverage discussions

    Outcomes

    The MS appraisal process introduced greater structure and transparency into benefit package revision. Explicit criteria and documented deliberation reduced arbitrariness and improved clarity in reimbursement decisions.

    Key lessons include:

    • Disease-specific cases can catalyse broader institutional reform
    • Clear procedural rules improve predictability of coverage decisions
    • Economic evaluation can be integrated incrementally
    • Deliberative processes strengthen legitimacy in politically sensitive areas

    Iran’s experience demonstrates how EDPs can support systematic benefit package revision within established social insurance systems.

    Collaborating Partners

    • WHO Regional Office for the Eastern Mediterranean (WHO EMRO)
    • High Council for Health Insurance (HCHI)

    Related Publications & Reports