Framework for a National Healthcare Technology Policy Andrei

Framework for a National Healthcare Technology Policy Andrei Issakov Coordinator Health Technology and Facilities Planning and Management Department of Health Policy, Development and Services World Health Organization, Geneva AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

Providing health care effectively and efficiently involves putting together a great variety of resource inputs, commonly described as health technology AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

Health Technology • Drugs, devices, and medical and surgical procedures used in the prevention, diagnosis, and treatment of diseases, and for their rehabilitation, including traditional medical technologies; the knowledge associated with these; and the organizational and supportive systems within which the care is provided including facilities that house both patients and products; as well as environmental, food and information technologies; and technologies used in health promotion. AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

HEALTH TECHNOLOGIES People's Health Environmental Health Individual Health Services Community Health Services Protection Technologies Prevention Technologies Clinical Technologies Support Technologies Facilities, Plant, Hospital Medical Equipment & Information & Devices Communication Clinical Technology Procedures Organization & Management Pharmaceuticals & Other Consumable Products Promotion Technologies AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

HTM problem tree Poor state of equipment Poor maintenance Insufficient training Inadequate HR Poor budgeting Absence of clear policy Poor procurement Inadequate information Insufficient interest AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

• Physical resources and equipment - often neglected domain as compared with other health system resource inputs, i. e. drugs, HR … • As policies for some constituent elements of HT are normally well established, e. g. drug policies, while others remain neglected, e. g. infrastructure and equipment, these neglected elements need to be addressed as a matter of urgency AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

Healthcare Technology Policy AFR/RC 44/R 15, 14 September 1994, urged Member States • (i) to develop a comprehensive health technology policy as an integral part of their overall national health policies and development plans; • (ii) to strengthen health care technical services at district, provincial and central levels with adequate budget and infrastructure provision in order to ensure proper planning, selection, procurement, maintenance and utilization of health technologies; • (iii) to reinforce and utilize effectively national and international training capacities to ensure the development of the whole range of required human resources, including health technology managers, engineers, technicians and craftsmen, and user training; • (iv) to include concepts and practices in health technology management in the education and training of health professionals; • (v) to define an essential health technology package, replete with costing, for various categories of health institutions in the district health system and, in due course, at provincial and central levels. AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

49 th session of the WHO AFR Regional Committee, Windhoek, September 1999 Health Technology Strategy in the African Region, AFR/RC 49/12, September 1999 Objectives - to ensure that each Member State: • Develops a healthcare technology policy supportive of the implementation of its health policy; • Acquires the capacities required for mobilizing stakeholders and implementing, monitoring and evaluating the policy implementation; • Establishes and reinforces a comprehensive HR development process to provide the health system with qualified staff in planning, management, utilization and maintenance of health technologies; • Encourages research in HTA which is a rational basis for long-term policy and strategy decisions; • Establishes and applies norms and standardsin the utilization of health technology AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

49 th session of the WHO AFR Regional Committee, Windhoek, September 1999 Health Technology Strategy in the African Region, AFR/RC 49/12, September 1999 • Expected results - by the end of 2010: • • 50% of MSs will have developed a national health technology policy; 30% of MSs will have implemented priority interventions in HTM; All MSs will have included training in HTM as an integral part of their HRH development plans; 20% of MSs will have carried out a countrywide situation analysis in HTM; 50% of MSs will have established adequate structures to cope with HTM at all levels of the health system; 40% of MSs will have included HTA research into their health system research plans; 60% of MSs will have included technology information as part of their health information systems. AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

Health Technology Policy • “Policy” - a statement of intention to do something, an orientation, a guide for action based on a set of guiding principles or values, aimed at influencing and determining long term decisions and actions • Health technology policy does not occur in a vacuum, but within the context and as integral part of the overall health and development policies AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

National Health Technology Policy • To encourage effective and efficient selection, acquisition, utilisation and management of healthcare technology • To define national objectives for improved impact of healthcare technology in service delivery • To formalise strategies for the rational introduction and utilisation of healthcare technologies • To promote HTM standards and norms - HTM code of practice AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

National Health Technology Policy • • • comprehensive and inclusive encourages the improved access to quality care addresses all aspects of physical infrastructure such as • • • installations and plant medical equipment use of energy, water supply, waste management, transport and communications and logistic systems. AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

Stakeholders of the NHTP Ministry of Health Industry and Suppliers Manufacturers Importers Vendors AHTM Workshop, Mombasa, 9 -12 August 2006 Assessment Guidelines Regulation Legislation Users and Clients HC Providers Patients Population Private Sector Insurance Department of Health Policy, Development and Services World Health Organization, Geneva

HTA (macro & micro) Healthcare Technology Management Spectrum Pre-purchase evaluation Selection & procurement Acceptance & installation Operation, service & maintenance User & service training Risk management & quality assurance AHTM Workshop, Mombasa, 9 -12 August 2006 Equity, Quality, S a f e t y Needs analysis & strategic planning CE/HE management & Department of Health Policy, Development and Services monitoring World Health Organization, Geneva

National Health Technology Policy Framework • Organizational structures • To ensure the creation, operation and sustainability of adequate and appropriate organizational structures at all levels of the health system in support of healthcare technology needs assessment, acquisition and use AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

National Health Technology Policy Framework • Needs assessment & HTA • To promote rational, informed and appropriate strategic planning, macro- and micro- assessment of healthcare technologies and their management, taking into account available resources, systemic constraints and technology transfer issues AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

National Health Technology Policy Framework • Acquisition • To promote the proper and effective selection, procurement, donation acceptance, and commissioning of healthcare technologies AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

National Health Technology Policy Framework • Utilization • To ensure maximum possible technology benefits, life cycle cost-effectiveness, quality and safety of care AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

National Health Technology Policy Framework • Capacity building and HR strategies • To develop institutional capacity and individual expertise in support of policy implementation, technology needs assessment, acquisition and use AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

National Health Technology Policy Framework • Financing • To mobilize healthcare technology resources within given economic constraints with the need to ensure adequate budgetary allocations for technology management and maintenance activities AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

National Health Technology Policy Framework • Public/private partnerships • To encourage public/private partnerships to maximize the benefit of a country's health technology resources AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

National Health Technology Policy Framework • Legislation & regulations • To consolidate existing legislation, regulations and incentives as well as formulate new instruments, where required, to ensure proper acquisition, adequate provision, appropriate distribution, and safe and effective use of healthcare technologies AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

National Health Technology Policy Framework • Research • To promote research that will lead to improved implementation, monitoring and evaluation of healthcare technology policy, support the stated outcome of healthcare technology management system and facilitate selfsufficiency in identified areas AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

National Health Technology Policy Framework • Information and knowledge sharing • To provide an integrated system for appropriate and effective data collection, storage and analysis as well as dissemination of information and knowledge in support of healthcare technology management AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

National Health Technology Policy Framework • Local production • To explore possibilities, and facilitate and promote, where feasible, local production of healthcare technology inputs (regional / intercountry possibilities) AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

National Health Technology Policy Framework • International cooperation • To promote technical cooperation among countries in order to maximize the effective use of healthcare technology resources AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

National Health Technology Policy Framework • Implementation, monitoring & evaluation • To establish mechanisms for monitoring and evaluation of performance in support of successful implementation of healthcare technology policy AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

NHTP Formulation & Implementation Phases 1. Political will 3. 2. 4. Draft NHTP Situation Analysis NHTP Formulation 5. Finalisation of NHTP document 10. Monitoring & evaluation 9. Implementation AHTM Workshop, Mombasa, 9 -12 August 2006 6. 8. Distribution Government Approval 7. Publication of NHTP Department of Health Policy, Development and Services World Health Organization, Geneva

Step 1 - Political Commitment • National healthcare equipment policy should form part of a country’s health policy and support the objectives of the national health strategy • The political commitment by government is the foundation for the formulation of NHTP • Ministry of Health launches the formulation process by establishing a task force or working group of experts AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

Step 2 - Situation Analysis • NHTP formulation preceded by a Country Situation Analysis • Study must include healthcare technology policy, management and support services and resources • Scientific Evidence is critical • WHO Guidelines on Country Situation Analysis AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

Step 3 - Preparation of draft NHTP • NHTP should include the following sections as described in the WHO Guidelines on Policy Formulation: • • Introduction Background Information Preamble General Orientation Objectives of NHTP Institutional and Operational Strategies Proposed Accompanying Measures AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

Step 4 - Preparing a Workshop for Formulation of NHTP • National workshop to develop a NHTP draft document • Stakeholder participation must be ensured • Stakeholders should include the Ministry of Health, professional groups, universities, NGOs, private sector, suppliers/vendors, bilateral and multilateral co-operation agencies • Consensus approach recommended • Ownership of policy must be ensured AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

Step 5 - Finalisation of NHTP document • Task force or working groups finalise NHTP document based on the recommendations of the National NHTP Workshop • NHTP document circulated for comment and submitted to government for appraisal and comment AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

Step 6 - Approval of NHTP document • The draft NHTP document only indicates the intentions of the government • Draft prepared under the auspices of the Ministry of Health • Draft NHTP is an official government document and therefore has to be submitted to government for approval and adoption • Following approval and adoption by government, NHTP document becomes official policy AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

Step 7 - Publication • The official NHTP document should be published, and printed in sufficient numbers to guarantee distribution to all interested parties • Workshops to disseminate information and implications of policy AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

Step 8 - Distribution and Promotion • The official NHTP document should be widely distributed and promoted through various seminars and other means • Its purpose is not to be archived in a library • A national healthcare equipment or technology policy will only become operational and implemented when supported by implementation strategy / operational plan AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

Steps 9 & 10 - Implementation, monitoring and evaluation • Implementation should be planned, and a number of prerequisites for implementation should be prepared • Mechanisms should be established for monitoring and evaluation of policy implementation • Support documentation and guidelines available through WHO • • Policy Framework Formulation and Implementation Guidelines Country Situation Analysis Wealth of documented international experience AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

INFRATECH The INFRATECH Internet-based discussion group was created in January 1999 by WHO, is hosted by PAHO and coordinated by ACCE. Purposes of INFRATECH: ØProvide a global forum for exchange of information and experience on critical issues of common concern related to health care infrastructure and technology management. ØCreate a a knowledge base for use by countries and development agencies in future projects. ØProvide Information database concerning upcoming events, publications, and educational programmes and materials. ØProvide advice on various specific problems experienced by members. üMembership is currently composed of about 400 experts from some 50 countries. üTo subscribe, send an E-mail to listserv@listserv. paho. org entering in the text portion SUBSCRIBE INFRATECH YOUR FULL NAME. üAfter you subscribe, send messages to infratech@paho. org, and they will reach all members. AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

International Centre for Healthcare Technology Management (ICHTM) Ø Ø Ø Ø Web-based ICHTM launched in May 2002 Project of IFMBE, funded by Df. ID, supported by WHO, and hosted by UCT Current and future partners – ACCE, AFTH, HTAi, IFHE, ISQua…… Goal - To establish a global knowledge and networking resource in the area of healthcare technology management (HTM) in support of health system reforms, with focus on poorly-resourced countries Purpose - To inform, link and support HTM practitioners globally, thereby empowering them to contribute to improved performance, quality and sustainability of healthcare delivery services A timely and appropriate response to the need for cost-effective capacity building and networking of HTM practitioners, especially those in poorlyresourced countries Provides value-added accessible and appropriate information; serves as a focus for multi-organisational and interdisciplinary activities at international and regional levels; facilitates networking and build communities of HTM practitioners at regional and supra-regional levels; provides a platform for stating their needs and sharing their experiences Ø http: //www. ichtm. net AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

Global Assistance in Medical Equipment (GAME) Ø A global coalition of clinical/hospital engineers, technicians, technology managers, relevant Listservs (e. g. , Biomedtalk and Infratech) and other entities to address HTM needs of health resource-limited countries. Ø Facilitated by ACCE, WHO, PAHO and other partners Ø To share very targeted HTM assistance addressing longstanding global challenges, i. e. manuals, spare parts, training, funding, and HTM technical advice and support person to person relationships. Ø To make it easy for hundreds/thousands of HTM professionals globally to do a periodic transaction, e. g. popup instant message or response to listserv question, that helps someone somewhere else with an HTM challenge on a given day. Ø GAME web site: Ø http: //global-medical-equipment. org/ AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

National Health Technology Policies • • Cameroon (starting) Ethiopia (starting) Kenya (drafted, not finalized, plans to follow up) Malawi (adopted, being implemented) Mozambique (adopted, being implemented) Namibia (adopted, being implemented) Senegal (adopted, being implemented) South Africa (framework adopted, detailed policy elements further developed, being implemented) • Swaziland (adopted, being implemented? ) • Uganda (work started, current status? ) • …… AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

1998 DRAFT !? !? ! AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

Joint Programme of Work and Funding 2006/07– 2009/10 for the Kenya Health Sector 4. 2 Infrastructure, Transport and Communication 4. 2. 1 The Challenges of Infrastructure, Transport and Communication To achieve the objectives of NHSSP II, four components of the health infrastructure (buildings, equipment, ICT, transport) must be integrated into a harmonious whole, together with other required inputs (especially human resources) to avoid mismatches in their development and ensure that health services are delivered efficiently, equitably, and effectively in a sustainable manner. This integration is embodied in the principles that need to exist for adequate planning, and management for health infrastructure. 4. 2. 2 The Strategy to Manage Challenges to Health Infrastructure, Transport and Communication The overall goal of the health sector with regard to health infrastructure will be to provide a functional, efficient and sustainable health infrastructure network to bring effective health care service delivery closer to the people. This it will do by focusing on the following specific objectives: • To support improved availability of quality of health services • To increase access of populations to physical health infrastructure 4. 2. 3 Activities for Infrastructure, Transport and Communication 4. 2. 4 Strategy Costs for Infrastructure, Transport and Communication 4. 2. 5 Financing and the Funding Gaps for Infrastructure, Transport and Communication Activities AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

Mo. H / GTZ / WHO Workshop on Maintenance Strategies in Developing Countries, Pan. Afric Hotel, Nairobi, March 1989 The Ministry of Health recognizes equipment maintenance (management) as a critical area of its development efforts. There is a vital need to conserve capital assets whether provided by the Kenyan Government or donated. … prolonging the lifetime of equipment is a priority. . . … standardization of equipment clearly must be seriously addressed by Ministry of Health … … training activities at the Kenyan polytechnics must be intensified … … To do so, Ministry of Health faces a major challenge in arranging for the necessary resources for an effective equipment management programme … Opening address by His Excellency Honourable Mwai Kibaki AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

Technology is ruled by two types of people: • those who manage what they do not understand, • and those who understand what they do not manage. (Mike Trout quotes) AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva

THANK YOU ! issakova@who. int AHTM Workshop, Mombasa, 9 -12 August 2006 Department of Health Policy, Development and Services World Health Organization, Geneva