Organizational Formation for Priority Setting: Historical Perspectives and Thematic Analysis of India’s Health Technology Assessment Agency

Figures & data

Table 1. List of critical events that created momentum for the creation of the MTAB and HTAIn and HTA policy development in India.

1. 2012–13: a. Twelfth Five-Year Plan 2012-2017^Citation10 b. Parliamentary Standing Committee: DHR will set up Technology Assessment Board^Citation11 2. 2013: a. India-UK NICE International (iDSI) Memorandum of Understanding^Citation12 b. The UK DFID grant to the National Institute for Health and Care Excellence 3. 2014: a. Publication of the NHSRC HTA study projects b. Joint DHR-NICE International (iDSI)-World Bank workshop^Citation13 c. NHSRC report on HTA landscape and need^Citation14 4. 2015: a. DHR-NICE International (iDSI) Joint Steering Committee 5. 2016: a. PMAC conference attended by Swaminathan^Citation15 b. DHR-ICMR-iDSI workshop held to plan the institutionalization of HTA c. Parliamentary Standing Committee: DHR three-year goal to have a fully functional Health Technology Assessment Board 6. 2017: a. National Health Policy of 2017 emphasized importance of HTA evidence and organization b. Cabinet note submitted by DHR secretary for approval and funding of MTAB and HTAIn to the Ministry of Finance

Figure 1. MOHFW organizational charts before and after HTAIn formation: 2013 and 2019.

Notes: Boxes highlighted in red reflect the network development. PM-JAY refers to Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, the national health insurance program. JIPMER refers to Jawaharlal Institute of Postgraduate Medical Education and Research. PGIMER refers to Postgraduate Institute of Medical Education and Research. CMC Vellore refers to Christian Medical College Vellore. Regional resource hubs and technical partners were established and expanded after the creation of the MTAB and HTAIn.

Table

Date	Title or Reference	Event Description
2012-2013	Twelfth Five-Yea r Plan^Citation10	“On the lines of the UK’s NICE, DHR would develop expertise to assess available therapies and technologies for their cost-effectiveness and essentiality, and formulate and update, on a regular basis, the Standard Treatment Guidelines, and suggest inclusion of new drugs and vaccines into the public health system,” Para 20.194.
2013	India-UK NICE International (iDSI) Memorandum of Understanding^Citation12	MOU between the government of India and UK was signed, specifically between MOHFW DHR and UK NICE International for activities pertaining to HTA.
2013	Parliamentary Standing Committee^Citation11	“DHR will set up Technology Assessment Board consisting of economists, social scientists, public health professionals and other specialists (similar to the Offices of Health/Medical Technology Assessment systems in some countries) whereby new technologies can be scientifically assessed for cost efficacy before introduction / procurement for affordable health care.” p.36, Para 6.8.
2014	DHR/ICMR Study Visit to UK NICE^Citation17	Study visit to UK NICE made by DHR, ICMR, and NHSRC to understand the governing structure, the remit, the role and management of committees, what is HTA, how is cost effectiveness evidence generated, and so on, building upon the MOU and actioning upon areas of joint interest at that time.
2014	Joint DHR-NICE International (iDSI)-World Bank workshop^Citation13	Awareness building conference/workshop cohosted by the MOHFW DHR and World Bank with attendance by high-level leadership including the Secretary of Health, the Secretary for the Department of Health Research (Dr. Katoch), the High Commissioner for the UK to India, as well as the advisor to the health minister.
2014	MoHFW STG Taskforce	NICE International (iDSI) invited to the Ministry of Health and Family Welfare taskforce on Standard Treatment Guidelines
2014	NHSRC HTA Certificate Course	The course was led by the technology division in NHSRC which also led a WHO Collaborating Center for Medical Technologies, which led to the publication of a compendium of early HTA studies, essentially a compilation of the study projects from the students who had participated in their two courses.
2014	ITAD Evaluation Report of iDSI	Independent evaluation of IDSI and UK NICE International Activities up to 2014 including workshop in Kerala.
2014	NHSRC report on HTA landscape^Citation14	Developed by the NHRSC and WHO India, the report highlights the essential health technologies needed to respond to India’s disease burden.
2015	PMAC - Prince Mahidol Award Conference 2015	iDSI invited Mr. Jhalani to PMAC along with side meetings for regional countries organized by HITAP, resulting in greater support of HTA.
2015	Dr. Soumya Swaminathan joins as the Secretary, Department of Health Research	Dr Soumya Swaminathan joins as Secretary of the MOHFW DHR who becomes a key champion and supporter of HTA in India with much needed political authority.
2015	The Current Status of Priority-setting and Health Technology Assessment for Universal Health Coverage in India^Citation16	Report with discussion of the HTA landscape in India including the early work led by NHSRC as an early HTA champion.
2015	DHR-NICE International (iDSI) Joint Steering Committee Formed^Citation18,Citation19	–
2016	PMAC - Prince Mahidol Award Conference 2016^Citation20,Citation15,Citation21	The 2016 PMAC theme was HTA and priority setting, with UK NICE International and HITAP central in the organization. Dr Soumya Swaminathan attended and spoke, and other senior policy makers from India also attended.
2016	DHR-ICMR-iDSI* workshop held to plan the institutionalization of HTA^Citation22,Citation23,Citation24	“Universal Health Coverage is the need of the hour for India and HTA can be a potent solution for this. The Government is very keen and has already started a journey towards achieving this…the Government is committed towards HTA …HTA will help to shift towards evidence-based policy-making.” Smt. Anupriya Patel, Minister of State, Health & Family Welfare.
2016	Parliamentary Standing Committee^Citation15	“Three Year Goals - have a fully functional Health Technology Assessment board.”
2016	Recruitment of HTAIn Secretariat begins	–
2016	Identify HTAIn technical partners^Citation25,Citation26	iDSI sends a questionnaire to organizations to map out HTA technical partners used as the basis to identify the regional resource centers.
2016	ITAD Evaluation of iDSI Report	Evaluation of iDSI activities with UK NICE International in India over 2014-16 period, before HTAIn was established.
2017	HTAIn Established (including HTAIn Secretariat, technical appraisal committee, and board)^Citation27	Established in the Department of Health Research with a network of 18 Regional Resource centers across India.
2017	National Health Policy^Citation28	“Important capacity with respect to introduction of new technologies and their uptake into public health programmes is health technology assessment (HTA)… is required to ensure that technology choice is participatory and is guided by considerations of scientific evidence, safety, cost effectiveness considerations and social values… The National Health Policy commits to the development of capacity in this areas and the use of this approach for making technology choices that impact on public,” Para 8.10.
2017	2017-2020 BMGF ICO grant	Grant to support the HTAIn secretariat, including creating credible and institutionalized structures and processes and championing the routine consideration of evidence for policy.
2017	3-year iDSI-DHR HTA Capacity Building program	–

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