In November 1993, the International Development Research Centre (IDRC) and several partner organizations sponsored an international conference entitled Needs-Based Technology Assessment: Exploring Global Interfaces, in Ottawa, Canada. The conference was attended by 103 delegates, including government representatives from 15 developing countries, international non-governmental organizations, donor agencies and several universities. The major recommendation of this conference addressed the urgent need for the international technology assessment community to develop a means by which developing countries could acquire the expertise to implement a needs-based technology approach, linking the needs and priorities of the population to policy development and implementation.
The favoured approach to meet this need was the development of a toolkit which would contain a variety of tools and methods appropriate for conducting needs-based health technology assessments at different levels of sophistication, as well as case studies which would test applications. The development of a toolkit for needs-based technology assessment was considered to have a number of important points. Ideally, it should:
In response to this recommendation, the World Health Organization (WHO) Collaborating Centre for Health Technology Assessment at the University of Ottawa brought together a team of international experts in health technology assessment to develop such a toolkit. A draft conceptual framework was prepared and presented to a small group of international experts at a half-day workshop held in Ottawa. The draft concept and overall framework with draft sub-components was presented at the International Society for Technology Assessment in Health Care (ISTAHC) conference in June 1995. This forum afforded the researchers leading this initiative, the opportunity to debate and receive comments on the overall direction and approach for the toolkit from a range of experts in the field. Provisional consensus was reached on the framework and a project proposal was submitted to IDRC who then provided core funding.
The Equity-Oriented Toolkit has 4 major steps:
The steps of the toolkit are applicable to individuals as well as populations. It is based on clinical and population health status and considers gender equity, social justice and community participation.
1. Burden of illness
Measures the burden of illness in a population and incorporates societal and individual determinants of health (e.g. cultural, genetic, political, psychosocial, environmental, biological). It applies concepts of needs assessment and priority setting.
2. Community Effectiveness
Describes the actual effectiveness of an intervention when applied in the community. It considers interactions between: 1) efficacy, 2) screening/diagnostic accuracy, 3) health provider compliance, 4) patient adherence, and 5) coverage.
Read more about community effectiveness.
3. Economic Evaluation
Describes the efficiency of an intervention: the relationship between the health benefits and the costs.
4. Knowledge Translation/Implementation
The process that includes synthesis, dissemination, exchange and application of knowledge to improve health.
Read more about applying the equity-oriented toolkit for health technology assessment and knowledge translation here.
Ueffing E, Tugwell P, Hatcher Roberts J, Walker P, Hamel N, Welch V. Equity-oriented toolkit for health technology assessment and knowledge translation: application to scaling up of training and education for health workers. Human Resources for Health. 2009;7(67).
In the two situations below, a decision is required on which technology should be purchased. When the question is phrased in such a manner, it is difficult to decide because the choices are limited to the technologies being considered, and the needs are vaguely described (i.e. a "worried" district doctor, "recommended" by a newly trained radiologist). To avoid being placed in such a difficult situation, one should pro-actively and regularly do a needs assessment. These needs can be prioritised based on burden of disease, availability of cost-effective technology and values or preferences of the community. A rational and responsive technology acquisition and implementation program can then be subsequently drafted.
A hospital is considering buying a helical CT scan, based on the recommendations of a radiologist, newly returned from training in a foreign country. However, within the same department, it takes five days before an ultrasound examination can be performed from the time of scheduling.
It is now rainy season. The district doctor is worried about diseases like hepatitis, diarrhoea and even mosquito-borne diseases like dengue fever. His choices are:
Learn more about Burden of Illness by clicking the links below
Policymakers, payers, and health care providers are responsible for deciding which health services should be provided to whom to help reduce the burden of disease, disability and death. To achieve this goal, evidence-based information is required to make the precise decisions. Since health service resources need to be spent efficiently, steps in health information inquiries have been proposed. These steps are shown as the Technology Assessment Iterative Loop (TAIL) as discussed in the Introduction. In this chapter, we will focus on the community effectiveness, which is the third step in the TAIL.
The rationale of community effectiveness is to determine how well an intervention with the potential for reducing burden will work when applied in the community. Community effectiveness may be considered as the 'real world' efficacy of an intervention since it is affected by certain external elements. Community effectiveness is determined by five factors: efficacy, screening and diagnostic accuracy, health provider compliance, patient compliance, and coverage.
Learn more about Community Effectiveness by clicking the links below
In all societies, resources are scarce in the sense that there will never be a sufficient number to produce all the goods and services that people value. This is not just a problem of the public sector, but is common to all types of activities regardless of whether they are public or private. For example, time can be considered the ultimate scarce resource from an individual perspective. There is never enough time to do all the things that we would like to do, so we have to choose between the myriad of competing ways of spending time. It is the same with any resource - land, capital, labour etc. A resource could be used in many ways that would produce benefits for people and choices between alternative uses.
Learn more about Economic Evaluation by clicking the links below
There are several levels of policies relevant to the discussion. These include the public policy, the system policy, the facility policy, the practice policy and the empowerment of the public and other stakeholders to balance technology development, optimisation, dissemination and utilization with the expectations and values of the stakeholders.
There are two key requirements for promoting technology policy, strategies and management. The first requirement is to develop strategies through partnerships of stakeholders to make sure that needs-based cost-effective technologies within the constraints of health systems are available and adopted for appropriate use in all levels of health care (public, system, facility, practice). Secondly, in a democratic system, we need to empower the public to make rational choices of the technologies and to ensure the accountability of the distribution and use of technologies according to the objectives of the different types of health policy.
Learn more about Knowledge Translation & Implementation by clicking the links below
This section gives an overview of the basic steps in the technology assessment process based on a health needs perspective as described with this toolkit. It also incorporates the method of technology assessment as developed at the Canadian Coordinating Office for Health Technology Assessment (CCOHTA).
Technology Assessment Process
Needs Assessment and Priority Setting
CCOHTA Standardized Report Format
IDRC provided core funding and in-kind support has been given by the University of Ottawa Faculty of Medicine and School of Nursing, the University of British Columbia, Queen's University, Harvard University School of Public Health, University of the Philippines, Chulalongkorn University (Thailand), Health Systems Research Institutes in Thailand, and the World Health Organization.
The team is led by Dr. Peter Tugwell and Janet Hatcher Roberts, Co-Directors of the WHO Collaborating Center for Knowledge Translation and Health Technology Assessment in Health Equity and Dr. David Banta advised the process.
The chapter leaders were: Dr. Chitr Sitthi-Amorn (Chulalongkorn University, Thailand), Dr. Somsak Chunharas, Dr. Manathip Osiri and Dr. Tessa Tan Torres (University of the Philippines), Dr. David Evans(WHO), Dr. Arminee Kazanjian (University of British Columbia), Dr. Michael Reich (Harvard University), Dr. Yvo Nuyens (COHRED, United Nations Development Programme (UNDP), Dr. Raisa Deber (University of Toronto). Janet Hatcher Roberts, Co-Director of the Collaborating Centre, supervised the process in Ottawa. Barbara Laperrière provided research support, and Marie-Josée Dion, Dr. Sharmila Mhatre, Jeea Saraswati and Dr. Sharen Madden in turn coordinated the project through the Collaborating Centre. The Coordinating Office for Health Technology Assessment (CCOHTA, Ottawa) provided editing and formatting services.
List of authors and Afilliations:
Dr. Chitr Sitthi-Amorn
Director,Clinical Epidemiology Unit, Faculty of Medicine, Chulalongkorn University
Phya Thai Road, Bangkok, Thailand
Dr. David Banta
Retired from TNO
67 Rue de la Roquette,
75011 Paris, France
Dr. Somsak Chunharas
National Health Foundation
1168 Paholyothin 22
Bangkok 10900, Thailand
Dr. Raisa B. Deber
Department of Health Policy, Management and Evaluation
University of Toronto
McMurrich Building, 2nd Floor
12 Queen's Park Crescent West
Toronto, Ontario M5S 1A8
Dr. David Evans
Department of Health System Financing, Expenditure and Resource Allocation (FER)
World Health Organization
Arminée Kazanjian, Dr. Soc.
Health Care & Epidemiology
Faculty of Medicine
The University of British Columbia
5804 Fairview Ave
Vancouver, B.C. V6T 1Z3
Dr. Yvo Nuyens
211 Rue des Fontanettes,
01220 Divonne, France
Dr. Manathip Osiri
Dept of Medicine
Phya Thai Road
Dr. Michael R. Reich
Harvard Center for Population and Development Studies
9 Bow Street
Fax: 617 495-5418
Dr. Tessa Tan Torres
World Health Organization