1. Resource Creation: Health Technologies in Support of System Development Adham R Ismail, MS, MBA, PhD Biomedical Engineer Department of Health Systems & Services Development Capacity Development Workshop on Health System Development Alexandria 20– 24 May 2007

2. Health Technology & Pharmaceuticals DHS, EMRO 2 Presentation Outline Definition of Health Technologies Health Technology as part of Health System Resources. Health Technology Assessment and Management. Essential Health Technologies. WHO and Health Technologies. Conclusions.

3. Health Technology & Pharmaceuticals DHS, EMRO 3 Definition of Health Technologies

4. Health Technology & Pharmaceuticals DHS, EMRO 4 What is a Health Technology ? WHO experts define HT as; “ The application of organized knowledge and skills in the form of devices, medicines, vaccines, procedures and systems developed to solve a health problem and improve quality of lives”. This broad definition also encompasses traditional medicine, health promotion & prevention activities and information systems.

5. Health Technology & Pharmaceuticals DHS, EMRO 5 Scope of Health Technologies

6. Health Technology & Pharmaceuticals DHS, EMRO 6 Main Thrust The main thrust is to assist Member States in establishing and optimizing the use of health technologies with multiple applications for service delivery.

7. Health Technology & Pharmaceuticals DHS, EMRO 7 Health Technologies and Health Systems

8. Health Technology & Pharmaceuticals DHS, EMRO 8 Health Technologies in Contemporary Health Systems They form the foundation for prevention, diagnosis and treatment of illness and disease. Thousands of new technologies are introduced into practice each year. Rapid changes in technology & complex systems for financing and care delivery resulted in growth in spending. Technologies and Health Systems are interdependent –Sustainable supply of technologies require functional health systems and vice-versa.

9. Health Technology & Pharmaceuticals DHS, EMRO 9 Health Technology Assessment and Management

10. Health Technology & Pharmaceuticals DHS, EMRO 10 What is HT Assessment (HTA)? HTA is a multi-disciplinary activity that examines the effect of technologies on: –Available Resources, –Cost & Cost-effectiveness, –Technical Aspects (ex. safety & efficacy) –Other Aspects (ex. legal & ethical issues) HTA goal is to –Provide input to decision-making in policy and practice. –Ensure value for money.

11. Health Technology & Pharmaceuticals DHS, EMRO 11 How to assess HT Needs? A tool (e.g. a questionnaire) is needed for proper assessment of needs. The questionnaire provides Structural, Process and Management indicators of all HT aspects in each country. Using this common approach allow comparisons between MS, and suggest regional strategies.

12. Health Technology & Pharmaceuticals DHS, EMRO 12 HTA & Utilization of resources: Medical Equipment Study Prior to use After use Source: Swiss Center for International Health, Basel, 2005

13. Health Technology & Pharmaceuticals DHS, EMRO 13 HTA & Cost-Effectiveness: Medicine Prices Study A WHO and Health Action International initiative. Sample survey of the retail prices of 30 “core” medicines in at least 4 districts, minimum of 10 pharmacies per area (including public, NGO and private facilities) Compares local to international reference prices Identifies price components from manufacturers to retailer Assesses affordability for 10 courses of treatment

14. Health Technology & Pharmaceuticals DHS, EMRO 14 HTA of Technical Aspects: Procurement of MRI

15. Health Technology & Pharmaceuticals DHS, EMRO 15 Management Support Organization Financing Information Management Human Resources Selection Distribution Use Procurement Health Technology Management (HTM) Components

16. Health Technology & Pharmaceuticals DHS, EMRO 16 HTM: Rational Use of Technologies Irrational use of technologies is a complex problem. Solution requires collaborative efforts and different types of interventions (Educational, Managerial, Economic & Regulatory). Experience shows that attention to one aspect of the problem does not work.

17. Health Technology & Pharmaceuticals DHS, EMRO 17 HTM Case Study: Irrational Use Medicines Over 50% of all medicines are prescribed, dispensed or sold inappropriately, and up to 50% of all patients fail to take them correctly. Irrational use of antimicrobials (for ex.) contributes to antimicrobial resistance: –TB (up to 17 % primary multi-drug resistance) –HIV/AIDS (up to 25 % primary resistance to at least 1 anti-retroviral) A successful strategy rely on sufficient government investments on medicines and staff.

18. Health Technology & Pharmaceuticals DHS, EMRO 18 Essential Health Technologies

19. Health Technology & Pharmaceuticals DHS, EMRO 19 Essential Medicines List Medicines are “essential” when they are safe, efficacious, of high quality, affordable and meet needs of majority of population WHO Model List of Essential Medicines –1 st list in 1977 & latest 14 th version in 2005. –315 active ingredients & ~15 fixed-dose combinations. –almost 99% are patent free. –156 countries have national essential lists. In poor countries, ~ 50% of population do not have regular access to needed medicines

20. Health Technology & Pharmaceuticals DHS, EMRO 20 Priority Vaccines WHO provides a model list as a guideline. This list (based on BOD analysis) includes BCG, diphtheria, hepatitis B, measles, oral poliomyelitis, and tetanus, etc. Quality must be assured for 100% of vaccines. Quality can be assured by a National Regulatory Authority (NRA) working independently from manufacturers.

21. Health Technology & Pharmaceuticals DHS, EMRO 21 Essential Medical Devices and Clinical Procedures Introduce simple technologies that address health problems, especially in under- resourced areas. WHO should provide guidance on minimum set of devices & procedures that are critical for HS. With the support of EMRO, a methodology for development of the list was established. The methodology relies on BOD, existing list of devices and financial resources.

22. Health Technology & Pharmaceuticals DHS, EMRO 22 WHO and Health Technologies

23. Health Technology & Pharmaceuticals DHS, EMRO 23 Medicines

24. Health Technology & Pharmaceuticals DHS, EMRO 24 WHO Medicines Strategy 2004 – 2007: 4 objectives, 7 components, 44 expected outcomes Objectives  Policy  Access  Quality & safety  Rational use Components 1.Implementation and monitoring of medicines policies 2.Traditional and complementary medicine 3.Fair financing and affordability 4.Medicines supply systems 5.Norms and standards 6.Regulations and quality assurance systems 7.Rational use by health professionals and consumers

25. Health Technology & Pharmaceuticals DHS, EMRO 25 Vaccines

26. Health Technology & Pharmaceuticals DHS, EMRO 26 WHO strategy to improve vaccine quality Strengthening National Regulatory Authority (NRA) in each country –Priority 1: vaccine producing countries –Priority 2: vaccine self-procuring countries –Priority 3: countries procured through UN agencies Improving the vaccine production to reach the prequalification status of the vaccines Ensuring a vaccine self-sufficiency in the EM region

27. Health Technology & Pharmaceuticals DHS, EMRO 27 Prequalification Process Strengthening NRA through joint assessment and institutional development using 6 core functions. Reassessment evaluation at regular intervals Continuous monitoring

28. Health Technology & Pharmaceuticals DHS, EMRO 28 Other Health Technologies

29. Health Technology & Pharmaceuticals DHS, EMRO 29 Blood Transfusion Safety Gaps in availability of blood. Promotion of voluntary donation. Focus is on blood safety through capacity development and technical expertise. Use of WHO collaborating centers. Rational use of blood products Safe injections & infection prevention/control Rehabilitation of blood transfusion services

30. Health Technology & Pharmaceuticals DHS, EMRO 30 Diagnostics and Lab Technology Rehabilitation of lab networks to support service delivery at different levels. Focus is on capacity development. Improvement of quality using external/internal assurance schemes and SOPs. Reducing antimicrobial resistance & containment and control hospital infections. Improving bio-safety and bio-security Improving access through linkages with surveillance and epidemiology departments.

31. Health Technology & Pharmaceuticals DHS, EMRO 31 Diagnostic Imaging, Medical Devices and Clinical Procedures Accessible, safe and reliable diagnostic imaging. Increased patient safety by ensuring access to safe and effective medical devices. Strengthened capacity at PHC facilities to provide emergency/essential surgical care. Improved access to ethical, safe and suitable transplantations. Strengthened services through e-Health.

32. Health Technology & Pharmaceuticals DHS, EMRO 32 Conclusions HT is an important HS building block. They contribute to increasing access but also to an escalation in healthcare delivery costs. Main focus is on effective management of HT: –Proper assessment of country-specific needs. –Appropriate selection, adequate procurement and rational use of HT. –Unimpeded transfer of technology between countries. –Rational health technology investments. –Development of norms and standards. –Monitoring and Evaluation.

33. Health Technology & Pharmaceuticals DHS, EMRO 33 Thank You