Mueller Debjani
Department of Health Care Management, Berlin University of Technology, Berlin, Germany.
Charlotte Maxeke Research Cluster, Johannesburg, South Africa.
Int J Technol Assess Health Care. 2020 Aug 13:1-6. doi: 10.1017/S0266462320000562.
South Africa's commitment to progressively achieve universal health coverage can lead to the effective and appropriate use of Health Technology Assessment (HTA) to strengthen the healthcare system. The study aimed to analyze the challenges faced in the formal implementation and utilization of HTA in the public health sector.
Review and analysis of health technology policies and legislation introduced in South Africa since 1965 serves as the backbone of this study. Walt and Gilson's health policy triangle framework and Kingdon's model were used for data analysis. In addition, a semi-structured survey was conducted among key stakeholders, including those attending HTA workshops that were held in 2016 and 2017.
The document review identified appropriate legislative and policy framework for informing healthcare decisions. Survey participants (n = 55) reported limited political support, local capacity, and awareness of HTA as barriers to implementing HTA. They noted that adequate financial resources and availability and sharing of quality data are primary drivers for HTA development. Effective governance, collaboration, and cooperation between key stakeholders of the healthcare system were suggested as possible ways forward for the institutionalization of HTA.
The South African government's goal to introduce the national health insurance program provides an excellent opportunity to formally introduce the use of HTA in decision making. Individual capacity development supported by institutional and organizational environments is urgently needed to achieve its full potential.
南非逐步实现全民健康覆盖的承诺能够推动有效且适当地运用卫生技术评估（HTA）来加强医疗体系。本研究旨在分析公共卫生部门在正式实施和利用HTA过程中所面临的挑战。
对南非自1965年以来出台的卫生技术政策和立法进行回顾与分析，以此作为本研究的核心内容。采用沃尔特和吉尔森的卫生政策三角框架以及金登模型进行数据分析。此外，还对包括参加2016年和2017年举办的HTA研讨会的人员在内的关键利益相关者开展了半结构化调查。
文件审查确定了用于为医疗决策提供依据的适当立法和政策框架。调查参与者（n = 55）报告称，政治支持有限、当地能力不足以及对HTA的认知度低是实施HTA的障碍。他们指出，充足的财政资源以及高质量数据的可得性和共享是HTA发展的主要推动因素。建议医疗体系关键利益相关者之间进行有效的治理、协作与合作，以此作为HTA制度化的可能前进方向。
南非政府引入国家医疗保险计划的目标为在决策中正式引入HTA的使用提供了绝佳机会。要充分发挥其潜力，迫切需要机构和组织环境支持下的个人能力发展。
