Priority Setting in Health Technology Assessment in South Africa

South African Values & Ethics for Universal Health Coverage

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Why a framework?

South Africa’s population has multiple diverse health needs. There are many challenging decisions about what health services and health interventions will or will not be covered by the National Health Insurance with a limited budget. This priority-setting for health raises many ethical questions about how to use scarce resources. Decision-makers must balance the needs of individuals with the broader health needs of the population, accounting for equity considerations and the many ways that health interventions impact other aspects of wellbeing.

An ethics framework can help navigate these challenging decisions and trade-offs, providing a method and structure for exploring morally relevant ethics considerations associated with a decision, not just focusing on cost effectiveness.

Where

Where

A diverse stakeholder working group developed this Framework in South Africa, supported by an international and in-country research team. The Framework was then tested in 3 provinces in South Africa

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What

What

An Ethical Framework with 12 domains. Each domain has an explanation several questions to guide the decision-making process. The Framework was designed to apply after a health intervention is proposed for inclusion or prioritisation and selected for review.

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How

How

The SAVE-UHC approach consisted of two phases. In Phase I, the research team convened and facilitated a national multi-stakeholder working group to develop a provisional ethics framework through a collaborative, engagement-driven process. Phase II, the research team tested the Framework with simulated Health Technology Assessor Groups in 3 provinces.

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The development of the SAVE-UHC Framework

The ethics framework was developed by a multi-stakeholder working group across five meetings.

The research supporting the development of this Framework was done by the SAVE-UHC Research Team.

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