Factors influencing institutionalization of health technology assessment in Kenya

• Published in: BMC health services research Vol. 23; no. 1; p. 681
• Main Authors: Mbau, Rahab, Vassall, Anna, Gilson, Lucy, Barasa, Edwine
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 22.06.2023; BioMed Central; BMC
• Subjects: Delivery of Health Care; Health care reform; Health Policy; Health technology assessment; Humans; Institutionalization; Kenya; Management; Medical care; Methods; Resource Allocation; Technology Assessment, Biomedical; Kenya; Kenya; Health technology assessment; Institutionalization
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-023-09673-4

There is a global interest in institutionalizing health technology assessment (HTA) as an approach for explicit healthcare priority-setting. Institutionalization of HTA refers to the process of conducting and utilizing HTA as a normative practice for guiding resource allocation decisions within the health system. In this study, we aimed to examine the factors that were influencing institutionalization of HTA in Kenya. We conducted a qualitative case study using document reviews and in-depth interviews with 30 participants involved in the HTA institutionalization process in Kenya. We used a thematic approach to analyze the data. We found that institutionalization of HTA in Kenya was being supported by factors such as establishment of organizational structures for HTA; availability of legal frameworks and policies on HTA; increasing availability of awareness creation and capacity-building initiatives for HTA; policymakers' interests in universal health coverage and optimal allocation of resources; technocrats' interests in evidence-based processes; presence of international collaboration for HTA; and lastly, involvement of bilateral agencies. On the other hand, institutionalization of HTA was being undermined by limited availability of skilled human resources, financial resources, and information resources for HTA; lack of HTA guidelines and decision-making frameworks; limited HTA awareness among subnational stakeholders; and industries' interests in safeguarding their revenue. Kenya's Ministry of Health can facilitate institutionalization of HTA by adopting a systemic approach that involves: - (a) introducing long-term capacity-building initiatives to strengthen human and technical capacity for HTA; (b) earmarking national health budgets to ensure adequate financial resources for HTA; (c) introducing a cost database and promoting timely data collection to ensure availability of data for HTA; (d) developing context specific HTA guidelines and decision-making frameworks to facilitate HTA processes; (e) conducting deeper advocacy to strengthen HTA awareness among subnational stakeholders; and (f) managing stakeholders' interests to minimize opposition to institutionalization of HTA.