go to main content
Research Global health priorities

About this research group

We are active in international health systems research and in particular in health benefit package design. Our activities have led to the development of ‘evidence-informed deliberative processes’ (EDPs) which we now implement in close collaboration with Ministries of Health in a number of countries, including Ghana, Iran, Kazachstan, Moldova and Pakistan. read more

About this research group

We are active in international health systems research and in particular in health benefit package design.

Our activities have led to the development of ‘evidence-informed deliberative processes’ (EDPs) which we now implement in close collaboration with Ministries of Health in a number of countries, including Ghana, Iran, Kazachstan, Moldova and Pakistan.

Apart from our work on benefit package design we undertake studies to inform health policy decisions in HIV/AIDS programming, maternal health, and scaling-up of surgery.

Research group leader

dr. Rob Baltussen

+31 (0)24 361 31 19
contact form

Aims

We support decision-makers in countries around the world in the development and implementation of legitimate processes for health policy making, in particular for health benefit package design. read more

Aims

We support decision-makers in countries around the world in the development and implementation of legitimate processes for health policy making, in particular for health benefit package design.

Health benefit package design is an intrinsically complex and value-laden process, in which multiple criteria beyond cost-effectiveness are important, and stakeholders often justifiably disagree about the relative importance of these criteria. Yet, present theory and methods for priority setting do not reflect this, and are typically technocratic in nature. This risks to undermine the legitimacy of decisions.

We consider legitimacy, or perceived reasonableness of decisions, as the key challenge of priority setting in the coming decades. HTA-related organizations need to manoeuver between the rapid development of new technologies and ever-expanding pressures on health budgets on the one hand, and strong stakeholder voices demanding access to these technologies on the other hand. HTA organisations are increasingly scrutinized on how they make decisions, including their processes and the evidence used.

We have developed evidence-informed deliberative processes (EDPs) for HTA-related organisations to improve the legitimacy of their benefit package design.

Guidance for HTA bodies

The use of evidence-informed deliberative processes.

Our products

Practical guide

  • This is the second version of the guide. It provides support to HTA bodies to implement EDPs on the basis of 100 practical questions.

    read more

    EDPs: a practical guide for HTA bodies

    This is the second version of the guide. It provides support to HTA bodies to implement EDPs on the basis of 100 practical questions.

    EDPs are presently employed by national health authorities in Ghana, Iran, Kazakhstan, Moldova, Pakistan and Ukraine to design or revise their health their benefit packages. Its principles were used to design the health benefit package in Thailand, the Netherlands, and West Java province in Indonesia. EDPs are recommended in the guidance on HTA of the World Health Organization.
     
    The guide can be downloaded here.

    Framework

    The EDP framework has a number of particular features, which it distinguishes from other HTA frameworks:

    • EDPs consider HTA as a political and intrinsically complex undertaking, and has a strong emphasis on deliberative processes involving relevant stakeholders. We have developed approaches that stimulate debate and deepen the argumentation. This is different from many other HTA frameworks which are often limited to evidence collection and compilation.
    • The EDP framework combines different theories and best HTA practices on HTA – it is not proposing anything new. In terms of theory, EDPs are based on rational decision-making (as in multi-criteria decision analyses - MCDA) and fair decision-making (as in accountability for reasonableness – A4R). In terms of practice, it is based on a collection of best practices of HTA bodies around the world.
    • The framework provides a practical stepwise approach that covers the whole HTA process, i.e. situational analysis, installation of an appraisal committee, selecting health technologies and criteria, assessment, appraisal, and communication and appeal (see Figure below). Other HTA frameworks typically concentrate on selected steps only, e.g. evidence collection.
    • EDPs take the current decision-making context as the starting point, and offers specific advice depending on the level of HTA development. The EDP framework is also relevant for countries that have not (yet) established an HTA body.  
    • EDPs can be considered as a practical application of the WHO ‘Fair choices’ framework by Norheim et al., in terms of the stepwise approach to achieve UHC.
    • WHO EMRO recommends the use of EDPs for HTA bodies. It has been published and commented on extensively.

    See the six steps of Evidence Informed Deliberative Processes in the Figure below.

Country work

  • We provide on-going support to the Ministry of Health on the institutionalisation of HTA in the country.

    read more

    EDPs in Ghana

    In Ghana, Gavin Surgey provides on-going support (through Access and Delivery Partnership/PATH) to the Ministry of Health on the institutionalisation of HTA in the country. Recent achievements include supporting the establishment of the HTA advisory committees.

    Current work includes:

    • The development of the processes, and capacity building, for Health Technology Assessment (HTA) using Evidence-Informed Deliberative Processes (EDPs) as the guiding framework.
    • Working with the HTA committees on the assessment of the performance of selected interventions reimbursed by the National Health Insurance Agency (NHIA).
    • A review of the historical and current legislation, regulation and policy on HTA and priority setting in Ghana.

  • EDPs in Indonesia

    We have implemented EDPs to improve priority setting of HIV/AIDS health technologies at the province level and are now supporting the implementation of EDPs at the district level in Indonesia.

  • EDPs in Iran

    We are currently supporting the implementation of EDPs in Iran, in close collaboration with the High Council for Health Insurance (HCHI) Ministry of Health, to define their Health Insurane Benefit Package at the national level, targeting 30 conditions across 6 disease areas.

    The activities include:

    • Support on the implementation of evidence-informed deliberative processes in the country, i.e. remote supervision of a team of five analysts. This involves bi-weekly conference calls, webinars for capacity building, and country visits where possible / needed.
    • Identify stakeholders and develop mechanism to involve stakeholders in the decision-making process;
    • Advise HCHI on how to prepare evidence for deliberation;
    • Provide guidance on considering additional criteria in health benefit package design in Iran
    • Prepare workshops at HCHI level involving > 100 stakeholders on benefit package design;
    • Development of recommendations on the in- or exclusion of services in 20 conditions across six health domains for the HCHI.

  • EDPs in Kazakhstan

    In Kazakhstan we are working in a World bank project with the Ministry of Health on the development of HTA. The aim is developing a priority-setting tool based on evidence-informed deliberative processes (EDPs) to determine the State Guaranteed Benefit Package (SGBP) and the package of the Mandatory Social Health Insurance (MSHI), using HTA

    This involves the use of all EDPs steps: undertaking a situational analysis; formation of an advisory committee; definition of a relevant set of criteria for priority setting; assessment of performance of interventions; arrangement of a deliberative process on priorities; implementation plan of rationing decisions and M&E framework.

    Specifically, we undertake an assessment of 25 priority health technologies and develop a methodology for its appraisal using qualitative and quantitative MCDA approaches.

  • EDPs in Moldova

    The World Bank contracted Radboudumc to support the government of Moldova to plan and implement the most suitable system for Health Technology Assessment (HTA), using Evidence-Informed Deliberative Processes (EDPs) as the guiding framework.

    This study falls under the Toward Universal Health Coverage Project which is a joint project implemented by the World Bank and financed by the Swiss Agency for Development and Cooperation (SDC). Our study runs between November 2019 and December 2021 and has three main tasks: conducting a needs assessment in terms of stakeholders to involve in HTA development, identifying HTA capacity and skills, mapping HTA systems in European countries to draw lessons for Moldova, and then developing an implementation plan, including a roadmap for short- and long-term implementation.

  • EDPs in Pakistan

    In Pakistan we support the implementation process of the Disease Control Priorities 3 (DCP3) project using an evidence-informed deliberative process. DCP3 responds to the increasing need of low- and lower middle-income countries for technical guidance and support in benefit package design and in accelerating progress towards UHC.

    The EDP process was embedded in a broader institutional effort around health benefit packages in Pakistan, initiated by a joint WHO-EMRO and DCP3 secretariat mission visit to Pakistan in Jan 2019. The six steps of evidence-informed deliberative processes (EDPs) were operationalized for UHC benefit package design in Pakistan, providing EDP instructions and templates for the prioritization of health services with regard to the installation of an advisory committee; identification of decision criteria; selection of health services for scoping and assessment; assessment of health services; and appraisal of health services.

  • EDPs in Tanzania

    In Tanzania, Gavin Surgey provides on-going support (through ADP/PATH) to the Ministry of Health on the institutionalisation of HTA in the country and capacity building.

    Recent achievements include supporting the establishment of the HTA advisory committee, the development of their HTA process guidance using Evidence-Informed Deliberative Processes (EDPs) as the guiding framework and, an analysis of selected medicines reimbursed by the National Health Insurance Service.

EDP publications

Other publications

Research group members

view all team members

Connected to