Erku Daniel Asfaw, Desalegn Ararso, Mekonnen Tesfaye Mesele, Dessie Ermias, Wolde Firmaye Bogale, Ababulgu Sabit Ababor, Scuffham Paul A, Walker Damian, Sucu Rabia, Abera Samuel
Health Economics and Financing, Global Health Systems Innovation, Management Sciences for Health, Arlington, VA, USA.
Centre for Applied Health Economics, School of Medicine, Griffith University, Brisbane, QLD, Australia.
Int J Technol Assess Health Care. 2025 Apr 3;41(1):e24. doi: 10.1017/S0266462325000170.
As Ethiopia advances towards efficient resource utilization and UHC through strategic health purchasing, the institutionalization of HTA will play a critical role. This study aims to identify key stakeholders, analyze the political economy surrounding HTA and priority setting in Ethiopia, and assess existing skills and capacities for a robust and sustainable HTA system.
We employed a mixed-method approach, combining 16 key informant interviews, 24 document reviews, and a cross-sectional survey (n=65) to assess national HTA capacity. We employed the Walt and Gilson policy analysis triangle framework, alongside Campos and Reich's framework, to evaluate the context, process, content, and actors influencing HTA institutionalization, and to explore the complex interplay of institutions, positions, power, and interests among various stakeholders.
While there is a general commitment to implementing HTA across various government agencies and stakeholder groups, the institutionalization process faces several challenges, involving multiple agencies with overlapping mandates, raises bureaucratic challenges and potential conflicts, risking horizontal fragmentation as agencies compete for authority, budget, and influence. The involvement of other key stakeholders, such as professional associations, patients, and the public, is notably lacking. Challenges such as limited HTA expertise, high professional turnover, and gaps in specific HTA knowledge areas persist, with capacity-building efforts often failing to address organizational needs effectively.
The complexity of HTA institutionalization in Ethiopia underscores the necessity of managing intricate inter-agency dynamics, establishing a robust legal framework for an inclusive and transparent HTA process, building local capacity, and securing sustainable, domestically aligned funding.
随着埃塞俄比亚通过战略卫生采购朝着高效资源利用和全民健康覆盖迈进，卫生技术评估的制度化将发挥关键作用。本研究旨在确定关键利益相关者，分析埃塞俄比亚围绕卫生技术评估和优先事项设定的政治经济情况，并评估建立一个强大且可持续的卫生技术评估系统所需的现有技能和能力。
我们采用了混合方法，结合16次关键 informant访谈、24次文件审查和一项横断面调查（n = 65）来评估国家卫生技术评估能力。我们运用了沃尔特和吉尔森的政策分析三角框架以及坎波斯和赖希的框架，以评估影响卫生技术评估制度化的背景、过程、内容和行为者，并探讨各利益相关者之间机构、立场、权力和利益的复杂相互作用。
虽然各政府机构和利益相关者群体普遍承诺实施卫生技术评估，但制度化过程面临若干挑战，涉及多个职责重叠的机构，引发了官僚主义挑战和潜在冲突，随着各机构争夺权力、预算和影响力，存在横向分裂的风险。其他关键利益相关者，如专业协会、患者和公众的参与明显不足。卫生技术评估专业知识有限、专业人员更替率高以及特定卫生技术评估知识领域存在差距等挑战依然存在，能力建设努力往往未能有效满足组织需求。
埃塞俄比亚卫生技术评估制度化的复杂性凸显了管理复杂的机构间动态、为包容和透明的卫生技术评估过程建立强大法律框架、建设地方能力以及确保可持续的、符合国内情况的资金的必要性。
