OBJECTIVES:  Informing about decisions taken is crucial in order to reduce variability in practice and inequities in the access to health care services in the same country. In many countries and regions, hospitals are autonomous in their decisions around the incorporation of health technologies, and different decisions could be taken about the same technology. Tunisia recently implemented a HTA agency (INASanté) to inform decisions around health technologies and it should have an impact in obtaining information around what has been implemented in real world practice and why METHODS: An analysis of how decisions were taken for different technologies (drugs, procedures and medical devices) and which were the key elements of this decision-making process was performed. This comprised a SWOT analysis and direct contact with stakeholders for “in depth” interviews according to best practices in qualitative research. Based on this analysis, a flow chart of decisions was built and the main pitfalls were identified in order to make proposals to bridge the gap and structure the information around innovations uptake in hospitals. RESULTS: Weaknesses were: the inexistence of standardized forms for the inclusion of health technologies in the hospital formularies, the inexistence of explicit grids with criteria and the lack of information among hospitals around the decisions. The stakeholders identified INASanté as an opportunity to structure the process of technology uptake in hospitals, to standardize the processes and to centralize information around decisions. CONCLUSIONS:Hospitals in Tunisia require a structured and informed process of health technologies uptake. This process should include: a standardized form for proposals submission, criteria for prioritization, a defined timetable for resolutions, a grid that includes criteria for decision-making and a centralized database of proposals and final decisions. Without compromising hospitals’ independency, INASanté could propose a manual and centralize the information in order to avoid duplicates and reduce inefficiencies.