In February 2020, Thanzi La Onse (TLO) research staff from the Centre for Health Economics (CHE) and Imperial College London (ICL) visited the Health Economics and Policy Unit (HEPU) at College of Medicine, Malawi, to discuss current projects and plan future research. The aims of the research visit were twofold – to bring together UK and Malawi researchers to discuss opportunities for collaboration and capacity-building, and to share current research outputs and plans with local stakeholders and policymakers and engage them in shaping future priorities.
Key discussion topics included: a new research proposal on the use of Health Technology Assessment (HTA) in Malawi, presented by TLO Health Economics researchers Dominic Nkhoma, Isabel Kazanga and Joseph Mfutso-Bengo, from COM, and Paul Revill, Sakshi Mohan and Francesco Ramponi from CHE; and the initial results of the TLO Epidemiological Model, presented by Dr. Tara Mangal, Jonathan Roberts and Iwona Hawryluk from ICL and Wingston Ng’ambi from COM.
The first day of the visit was focused primarily on strengthening the ongoing collaboration between researchers at CHE and HEPU. Prof. Joseph Mfutso-Bengo presented his ongoing work on assessing the acceptability and feasibility of applying the VEDMAP framework to a HTA framework for Malawi. This session was joined remotely by Prof. Mark Sculpher, who is the co-lead on the research work developing a contextualised HTA framework for Malawi. Following the discussion, a plan was developed to carry out a scoping review in two stages: (i) understanding the key considerations and values used in HTA processes in low- and middle-income countries; (ii) investigating the current decision-making process followed by policy makers in Malawi, and the need and acceptability of an HTA process. This meeting was followed by some unstructured interviews with senior MOH staff at the Department of Health Technical Support Services (HTSS) to further understand the demand for HTA in Malawi. The MOH welcomed the proposal on developing a locally relevant HTA process with enthusiasm, acknowledging the dilemmas faced regularly by policymakers on health care investments.
On the second day of the visit, researchers from HEPU, CHE and ICL met with the Department of Planning and Policy Development (DPPD) and HTSS at MOH. The aim of the meeting was to identify how TLO researchers could collaborate with MOH to tackle the most pressing issues with the adoption of new health technologies, and to present the initial results of the epidemiological model.
The group considered potential platforms, existing and new, for engagement and decision-making for the effective use of HTA framework. Dr Benjamin Chilima, Director (HTSS), provided examples where the lack of a HTA framework led to suboptimal decisions in the implementation of health technologies, and highlighted the urgent need for a framework to assist MOH in allocating resources effectively. The ICL team presented results of the epidemiological modelling to the MOH team. Dr. Gerald Manthalu, Deputy Director (DPPD), recommended a workshop to familiarise key MOH and district staff with the epidemiological model, with the dual objective on improving the buy-in of the model by implementers on the ground and to create an opportunity to capture important policy questions faced by them in the model.
Later during the day, the results and data needs of the epidemiological modelling were discussed in more detail with experts from Malawi Epidemiology and Intervention Research Unit, Department of HIV and AIDS (DHA), and the Department of Preventive Services at the Community Health Sciences Unit (CHSU). Local stakeholders highlighted the extreme relevance of the work, and showed willingness to support the development of the model and use its results.
On the final day, TLO researchers had further meetings with both government and non-government stakeholders to address pending research queries and consider avenues for future collaboration.
This visit generated important outputs for both TLO streams. Interactions and consultations between TLO researchers and MOH helped to ensure the alignment of research proposals with the priorities of local decision makers, and to collaboratively explore areas of further research.
Motivated by the enthusiasm shown by stakeholders towards the development of the epidemiological model, TLO Theme 1 will look to assess the feasibility of organising a workshop to provide a comprehensive demonstration of the development and capabilities of the model. Furthermore, the protocol for the HTA Work Package under Theme 2 will be further streamlined based on the discussions and ideas that emerged during conversations with MOH staff.
By: Francesco Ramponi and Sakshi Mohan | March 2020