What do we need to know? Data sources to support evidence-based decisions using health technology assessment in Ghana

Samantha A Hollingworth,Martha Gyansa-Lutterodt,Lydia Dsane-Selby,Francis J Ruiz,Justice Nonvignon,Emmanuel Odame,Laura Downey,Kalipso Chalkidou

doi:10.1186/s12961-020-00550-8

Abstract

BackgroundEvidence-based decision-making for prioritising health is assisted by health technology assessment (HTA) to integrate data on effectiveness, costs and equity to support transparent decisions. Ghana is moving towards universal health coverage, facilitated mainly by the National Health Insurance Scheme (NHIS) established in 2003. The Government of Ghana is committed to institutionalising HTA for priority-setting. We aimed to identify and describe the sources of accessible data to support HTA in Ghana.MethodsWe identified and described data sources encompassing six main domains using an existing framework. The domains were epidemiology, clinical efficacy, costs, health service use and consumption, quality of life, and equity. We used existing knowledge, views of stakeholders, and searches of the literature and internet.ResultsThe data sources for each of the six domains vary in extent and quality. Ghana has several large data sources to support HTA (e.g. Demographic Health Surveys) that have rigorous quality assurance processes. Few accessible data sources were available for costs and resource utilisation. The NHIS is a potentially rich source of data on resource use and costs but there are some limits on access. There are some data on equity but data on quality of life are limited.ConclusionsA small number of quality data sources are available in Ghana but there are some gaps with respect to HTA based on greater use of local and contextualised information. Although more data are becoming available for monitoring, challenges remain in terms of their usefulness for HTA, and some information may not be available in disaggregated form to enable specific analyses. We support recent initiatives for the routine collection of comprehensive and reliable data that is easily accessible for HTA users. A commitment to HTA will require concerted efforts to leverage existing data sources, for example, from the NHIS, and develop and maintain new data (e.g. local health utility estimates). It will be critical that an overarching strategic and mandatory approach to the collection and use of health information is developed for Ghana in parallel to, and informed by, the development of HTA approaches to support resource allocation decisions. The key to HTA is to use the best available data while being open about its limitations and the impact on uncertainty.

Highlights

Evidence-based decision-making for prioritising health is assisted by health technology assessment (HTA) to integrate data on effectiveness, costs and equity to support transparent decisions
These six data source domains encompass many of the key elements needed for a well-conducted economic evaluation, with context-relevant details specified ex ante based on a suitable reference case [21]. international Decision Support Initiative (iDSI) developed a reference case for adaptation to local situations [22] and it provides a systematic way to inform the conduct and reporting of economic evaluations
We have summarised the main data sources available in Ghana (Table 1) and those used for the Ghana hypertension economic evaluation (Table 2) [14]

Summary

Introduction

Evidence-based decision-making for prioritising health is assisted by health technology assessment (HTA) to integrate data on effectiveness, costs and equity to support transparent decisions. Decisions can be better informed through the use of credible and fit-for-purpose evidence on where and how money is being spent in the health system, outcomes of interaction with the health service, and the general ‘healthiness’ of the population Such information can be synthesised in order to understand value-formoney of current and future investments in the health system and the impact on health through increasing efficiency. Health technology assessment (HTA) represents a commonly used approach to synthesising evidence on the effectiveness and costs of an intervention, which aims to consider social value judgements as part of a process to inform efficient and equitable resource allocation [1, 2]. The World Health Assembly Resolution of 2014 on Health Intervention and Technology Assessment recognizes the importance of this approach as a key element of any strategy for achieving universal health coverage (UHC) [2, 10]

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