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The need for more local technical capacity in Health Technology Assessment (HTA) is a leading challenge to its use in low- and middle-income countries. Zambia has been considering using HTA to support its universal health coverage initiative, which includes health benefits package design and implementation. This study assesses the local HTA capacity for the steering committee tasked with supporting the design and implementation of the national health benefits package in Zambia.
Methods
The study applied a cross-sectional web-based survey design and the consensus-based Checklist for Reporting of Survey Studies. Data were collected from the steering committee of the benefits package working group, tasked with leading the design process of the health benefits package using the Instrument for the Assessment of Skills to Conduct a Health Technology Assessment tool.
Results
The majority of respondents had not served on a selection and reimbursement committee. Clinical effectiveness skills in structuring a search strategy, handling missing data, conducting qualitative evidence synthesis, and grading the certainty of evidence were low. Skills for leadership, networking, conflict management, and project coordination, public and patient involvement were mid-level to low. Most of the respondents were aware of ethical issues with health technologies. Health economics skills in economic evaluations and decision analytic modeling, equity and health system efficiency measurement, budget impact analysis, and quality of life were identified for capacity strengthening.
Conclusion
Available technical capacities to revise and implement the national benefits package were lower in health economics, synthesis for clinical effectiveness evidence, ethics, patient and public involvement, and soft skills, in that order.
Health systems around the world share common goals, but attainment is widely variable. Universal Health Coverage (UHC) has emerged as a consolidated response to bridge the gap between what a health system should be doing and what it does. Drawing from global best evidence, this chapter explores how countries in practice could translate and achieve UHC, focusing on two central questions: What services and policies should be covered and be implemented; and second, how can health financing meet the UHC requirements? These include both health sector as well as intersectoral policies and interventions prioritized in the DCP3 package. The health sector interventions are distributed across four clusters – age-related, non-communicable disease and injury, Infectious diseases, and health services. The intersectoral interventions and policies fall under four domains – fiscal, regulatory, information and education, and built environment. The second question looks at the key challenges of country-level implementation capacity. It concludes by drawing out generalizable themes of country responses to the UHC Sustainable Development Goal targets to inform the way forward.
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