Using Health Technology Assessment (HTA) to Evaluate and Inform Nepal’s Free Drug List

Category : In-Country Experience

HITAP team facilitated a two and a half day workshop in Kathmandu, Nepal on March 30 – April 1, 2015 at the request of the Nepalese Ministry of Health and Population (MoHP). The goal of the workshop was to explore the potential application of health and technology assessment (HTA) to evaluate and inform Nepal’s Free Drug List (FDL) as a step towards achieving sustainable Universal Health Coverage (UHC) in Nepal.  HITAP worked in collaboration with WHO and local workshop participants including representatives from the Ministry of Health and Population (MoHP), Primary Health Care and Revitalization Division (PHCRD), Health Research and Social Development Forum (HERD), Nepal Health Research Council (NHRC), Logistics Management Division (LMD) and Epidemiology and Disease Control Division (EDCD) of the Department of Health Services (DoHS), National Health Training Center (NHTC), Department of Drug Administration (DDA), and the Health Economics Unit of Bangladesh’s Ministry of Health and Family Welfare (MoHFW).

The workshop began with presentations on the current state of the FDL by members of PHCRD highlighting key challenges including the lack of a systematic process of selecting drugs for the list, uncertainty about the financial capability of procuring selected drugs, and the disconnect between the burden of disease and the drugs on the current FDL. HITAP researchers followed with presentations on the development of the National List of Essential Medicines (NLEM) in Thailand and how HTA can be used to develop an evidence-based, cost-effect methodology of reviewing and adding drugs to a sustainable pharmaceutical reimbursement list. The first day concluded with participants generating a list of conducive factors and barriers of developing an evidence-based FDL as well as developing a timeline of potential activities to be address and stakeholders to be contacted moving forward in Nepal.

When the group met again for the second day of the workshop, HITAP members gave more technical presentations about HTA tools, specifically about measuring costs, outcomes, and value for money. The local participants, with guidance from the workshop facilitators, created a model for a revitalized FDL evaluation process involving four steps, (1) nomination of medicines by the PHCRD during their quarterly review and pharmaceutical companies, (2) evidence generation lead by the NHRC, (3) decision making by a technical committee, and (4) implementation by the LMD, PHCRD, and NHEICC. This model and a list of steps moving forward were finally presented to high level decision makers from the Government of Nepal on the last day of the workshop. There was a general degree of appreciation for the impact that HTA evidence could have in a resource limited context like Nepal. The government members pledged to develop policy based on this workshop to ensure political commitment to create a concrete methodology of evaluating and further developing the FDL. Once HTA capacity is developed in Nepal, it can be used for broader health programs with an eye towards achieving UHC for the country.

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