Universal health coverage (UHC) is currently the priority of most health systems throughout the world. It entails all individuals having access to required health services, of sufficient quality, without suffering financial hardship. While many health systems in Africa are striving to achieve UHC in the near future, most are still facing the perils of lack of access to essential life saving medicines, malnutrition, high levels of child and maternal mortality and the growing double burden of infectious and chronic diseases. These challenges call for a close examination of the progress toward UHC and formulation of lessons to learn from success stories. As such the ISPOR Africa Network hosted a forum on 3 December 2021 as part of Virtual ISPOR Europe 2021. The forum brought together experts to discuss case studies from different parts of Africa in the areas of accessibility of essential medicines and the situation of health technology assessment as a basis for resource allocations for UHC.
This event summary summarizes a couple of reflections from these experts.
Towards UHC in Africa: Case studies on access to Essential Medicines and Health Technology Assessment – The Situation in Ghana
Dr Peter Agyei-Baffour who is an associate professor in the Department o Health Policy Management and Economics at the Kwame Nkrumah University of Sciences and Technology, Ghana and President of ISPOR Ghana Chapter, discussed the Ghanaian context. He introduced the place of the essential medicines concept in the Ghanaian health system. Dr Agyei-Baffour discussed the Ghanaian experience in the introduction of the social health insurance and implementation of medicine reimbursement policies. The presence of a strategy for health technology assessment (HTA) and HTA Institutionalization in Ghana were also discussed. A detailed presentation on HTA governance structure, legislations and strategies were also made.
Access to Essential Anticancer Medicines in Africa: Case study from Ethiopia
Dr Eskinder Eshetu Ali, the Principal Investigator of the ISPOR Africa Research Network started by mentioning that access to essential medicines is the cornerstone of UHC. He stated that it is an unfortunate reality that ensuring access to medicines remains a major challenge for the health systems of many African countries. According to Dr Ali, the overall level of expenditure and per capita expenditures for medicines are low in many African countries when compared with global standards. In contrast, the share of out-of-pocket expenditure on drugs is very high. It was with this background that the ISPOR Africa Research Network embarked on evaluation of the status of access to essential anticancer medicines in selected African countries and Dr Ali’s presentation was focusing on the segment done in Ethiopia. It was mentioned that the study done based on the WHO/HAI survey recommendations revealed that overall availability of medicines is still a major challenge despite an apparent increase in availability the past four years. It was also found that the public sector had better pricing and affordability of anticancer medicines. For example, a one cycle (21 days) treatment of cervical cancer using the cisplatin and fluorouracil based regimen required four days of work for the lowest paid government employee based on public sector prices while it took 21.2 days of work for the same person based on private sector prices. Dr Ali concluded by mentioning that a lot still needs to be done to improve access to essential anticancer medicines in Ethiopia and the study will be done in other parts of Africa such as Algeria, Egypt, Nigeria, Kenya, South Africa and Uganda.
HTA and priority setting for UHC in Ethiopia: Progress, setbacks, and prospects
The Ethiopian experience on HTA was presented by Dr Daniel Erku, President of the ISPOR Ethiopia Chapter and Chair of the Centre for Research and Engagement in Assessment of Health Technology (CREATE). Dr Erku stated that the Ethiopian government recently introduced equity-driven health insurance schemes focusing the economically disadvantaged segments of the society including the agricultural and informal sectors. The application of Multi Criteria Decision Analysis (MCDA) in the revision Ethiopia’s Essential Health Service Package (EHSP) was identified as an indication of the government’s growing interest in and use of (economic) evidence to inform health policies. However, most of such activities were said to be largely donor dependent and lack sustainability. Despite the government’s commitment to introduce HTA as one of the eight main implementation strategies of the five-year Health Sector Transformation Plan (HSTP II) (2020/1-2024/25) several challenges for HTA institutionalisation in Ethiopia were also discussed. These included limitations financial and human resources and absence of country specific datasets to inform economic evaluation activities. Moreover, the fragmentation of efforts to institutionalise HTA was mentioned as a major shortcoming. Dr Erku ended by introducing the establishment of CREATE to respond to the issue of sustainability of HTA in Ethiopia and listing the major activities that CREATE was engaged in since its inception.
The forum then ended with a brief period of discussions and responses to questions raised by the audience. The future of HTA in Africa, the Ghanaian experiences in medicines pricing and the issue of ensuring sustainable access to essential medicines in African countries were the concluding points of discussion.