Overview
Ghana has been a regional leader in institutionalising HTA. Rather than designing a new essential package from scratch, the country focused on strengthening decision-making processes for including and reimbursing medicines and services.
Through collaboration with the Ministry of Health and the National Health Insurance Authority (NHIA), we supported the development of structured HTA processes to improve transparency, consistency and the systematic use of evidence in reimbursement decisions. The Ghana experience represents a transition from implicit priority setting toward institutionalised, evidence-informed appraisal embedded within national governance structures.
Context & Objectives
Ghana’s National Health Insurance Scheme covers a large share of the population, but rising costs, increasing demand and fiscal pressure created the need for more explicit and systematic priority setting. Historically, inclusion of services and medicines in the benefits package was not consistently guided by structured economic evaluation.
The government therefore aimed to:
- Establish formal HTA processes within national decision-making
- Strengthen analytical capacity for economic evaluation
- Introduce transparent appraisal criteria for reimbursement decisions
- Improve alignment between technical evidence and policy decisions
- Institutionalise priority setting within existing governance structures
The reform process was aligned with Ghana’s broader UHC ambitions and health financing sustainability agenda.
Approach & Methods Used
- Supporting the establishment of related governance structures including the HTA Steering Committee and HTA working groups
- Development of national HTA process guidelines
- Capacity building in evidence appraisal
- Structured appraisal processes with explicit decision criteria
- Integration of multiple criteria including cost-effectiveness, budget impact, and equity.
Outcomes
Ghana successfully embedded HTA processes for evidence-informed decision-making that prioritises efficiency, equity, and sustainability in healthcare resource allocation. These guidelines enhance the transparency and accountability of health policy decisions and serve as a model for other countries seeking to institutionalise health decision-making processes in their healthcare systems
Key lessons include:
- Institutional anchoring within the Ministry of Health is critical
- HTA must be aligned with real reimbursement timelines
- Capacity building is as important as methodological development
- Clear procedural rules improve legitimacy and predictability
- Sustained political commitment is required to protect evidence-based processes from short-term pressures
Ghana demonstrates that middle-income countries can move from ad hoc priority setting toward structured, institutionalised HTA systems that support financially sustainable health coverage.
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