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Thimphu, Bhutan – In a groundbreaking move to strengthen its healthcare system, Bhutan’s Ministry of Health has partnered with Thailand’s Health Intervention and Technology Assessment Program (HITAP) and received support from the UNDP-led Access and Delivery Partnership (ADP) to introduce a revamped Health Technology Assessment (HTA) framework. This strategic initiative aims to enhance evidence-based healthcare decision-making as Bhutan strives towards achieving Universal Health Coverage (UHC). The updated framework reflects the nation’s commitment to aligning with global best practices while addressing its unique healthcare challenges.
The new framework is the result of extensive consultations with stakeholders, international guideline reviews, and iterative revisions. It promises to optimize resource allocation and improve healthcare delivery nationwide, offering a more efficient and effective approach to managing health technologies.
Tackling Longstanding Challenges in Health Technology Assessment
Bhutan’s journey toward institutionalizing HTA began with the establishment of the Essential Medicines and Technology Division in 2008, which was later renamed the Health Intervention and Technology Assessment Division (HITAD). In 2013, Bhutan introduced its first HTA guidelines, which were revised in 2018, leading to significant decisions like the inclusion of pneumococcal conjugate and rotavirus vaccines in the national immunization program.
However, Bhutan’s progress was often hindered by persistent challenges such as limited technical expertise, insufficient funding, and a disconnect between HTA findings and procurement processes. The small market size further reduced the country’s bargaining power in health technology procurement, while the lack of a streamlined process between evidence generation and purchasing decisions compounded the difficulties.
In response to these barriers, Bhutan’s Ministry of Health undertook significant reforms to overhaul the HTA framework. The new structure integrates lessons from past experiences and introduces innovative strategies to address these persistent issues, including aligning HTA processes with national fiscal cycles and creating more robust prioritization mechanisms.
Innovations in the Updated HTA Framework
One of the defining features of the new HTA framework is its alignment with Bhutan’s budgetary and procurement cycles. This synchronization ensures the timely allocation of resources and enables health technology prioritization to be finalized early in the fiscal year, streamlining the budgeting process. The framework employs a three-point scoring system to prioritize health technologies based on their potential cost savings, impact on reducing international referrals, and alignment with national health strategies. Technologies that address high-priority health system challenges, such as reducing the financial burden of cross-border referrals, receive particular attention.
Additionally, the introduction of the Price Threshold Determination Group (PTDG) aims to bridge the gap between HTA findings and procurement decisions. The PTDG, which includes representatives from Bhutan’s Health Trust Fund, the Health Financing Division, and other relevant bodies, will negotiate prices for non-cost-effective technologies based on thresholds derived from HTA evaluations. This will ensure that procurement aligns with HTA recommendations, maximizing value for money and enhancing Bhutan’s bargaining position.
Another key innovation is the emphasis on collaboration for evidence generation. HITAD will now be able to commission research from local institutions such as the Khesar Gyalpo University of Medical Sciences of Bhutan and the Royal University of Bhutan, as well as international research agencies. This approach will help ensure the timely availability of high-quality evidence while addressing gaps in technical capacity. Capacity-building efforts include workshops, structured HTA courses at universities, and international internships to promote sustainable HTA practices in Bhutan.
Stakeholder Engagement and International Best Practices
The development of the updated HTA framework has been characterized by a participatory approach, with extensive consultations in 2022 and 2023 involving policymakers, healthcare professionals, patient representatives, and pharmaceutical companies. These consultations helped identify the strengths and weaknesses of previous HTA processes, clarify stakeholder roles, and outline strategies to overcome challenges. Bhutan’s framework draws on successful HTA models from countries such as Thailand, the Philippines, Singapore, and the UK, tailoring them to Bhutan’s context.
Moreover, the framework includes rapid assessment protocols for public health emergencies, allowing for timely, evidence-based decision-making during crises. This feature highlights Bhutan’s commitment to building a resilient healthcare system that can adapt to evolving challenges.
Transforming Healthcare Decision-Making in Bhutan
The updated HTA framework is expected to have a profound impact on Bhutan’s healthcare system. By aligning resource allocation with national priorities and fiscal cycles, it ensures that healthcare interventions are both cost-effective and equitable. The framework’s strategic price negotiations, along with improved evidence generation capacity, will allow Bhutan to make more informed and impactful healthcare decisions. Monitoring and evaluation mechanisms will also be integrated into the framework, ensuring that health technologies meet their intended outcomes.
International collaboration has played a crucial role in Bhutan’s HTA journey. Partnerships with HITAP and networks such as HTAsiaLink have provided technical expertise, training, and co-research opportunities. Financial support from ADP has been instrumental in institutionalizing HTA and ensuring that external support aligns with Bhutan’s domestic priorities. Moving forward, Bhutan plans to continue building internal capacity through local universities and dedicated funding, securing the long-term sustainability of evidence-informed policymaking.
A Model for Evidence-Based Policymaking in Low-Resource Settings
Bhutan’s HTA journey provides valuable insights for other countries facing similar challenges in institutionalizing evidence-based healthcare decision-making. The framework’s development process underscores the importance of engaging diverse stakeholders, aligning HTA initiatives with political and fiscal cycles, and leveraging international partnerships. While challenges remain, Bhutan’s approach highlights the potential for tailored solutions to address local needs effectively. By fostering collaboration, investing in capacity-building, and capitalizing on political opportunities, Bhutan has laid a strong foundation for achieving sustainable and equitable healthcare outcomes.
The new framework not only strengthens Bhutan’s health system but also serves as a model for other low- and middle-income countries aiming to optimize their healthcare resources. With this comprehensive and innovative approach, Bhutan is well on its way to enhancing its healthcare system and contributing to the global conversation on evidence-based healthcare policymaking.
