OBJECTIVES : Lebanon is a middle-income country characterised by a fragmented healthcare system and an unregulated market. The country has committed to establish an HTA agency, yet to date no policy was implemented in this regard. This research aims at exploring the mechanisms that can secure effective governance of the HTA process in the country and generating policy recommendations.

METHODS : A framework to conceptualise HTA governance was developed based on an extensive literature review. Semi structured interviews were conducted with key experts and potential stakeholders in the HTA process in Lebanon to explore themes identified in the conceptual framework. Data collected was analysed thematically using the framework method.

RESULTS : Participants highlighted sociopolitical challenges to decision making, fragmented healthcare system and complex stakeholder dynamics as the main threats to governance and implementation of HTA in the country. They offered two operational scenarios for instituting an HTA unit in Lebanon. The first is a mandatory unit under the governance of the Ministry of Public Health (MOPH) with decisions reinforced through ministerial decrees. The second is an advisory unit with a mediator role, supported by academic bodies and MOPH yet outside the governance of the latter. Features of HTA governance include a centralised independent unit supported by legal framework, public communication of assessment and appraisal processes, structured involvement of patients, industry and academic institutions in the HTA process and a monitoring system to evaluate HTA impact.

CONCLUSIONS : A converging approach that leverages on network governance maybe an alternative to the top down approach for implementation of HTA policy in Lebanon. Further efforts to refine policy formulation around HTA must focus on the evaluation of local capacity for conducting HTA in the country.