Building Health Transformation Assessment (HTA) Capacity in Low- and Middle-Income Countries (LMICs): Linking Business & Operational Transformation to Health Impact

Health Technology Assessment (HTA) is no longer just a technical exercise, it is a strategic tool for reshaping how health systems in low- and middle-income countries (LMICs) make decisions. Through evaluating the value, cost-effectiveness, and equity impact of health interventions, HTA provides governments and institutions with the evidence needed to allocate scarce resources more effectively.

But building HTA capacity requires more than technical training, it demands institutional strengthening and operational transformation. LMICs must embed HTA within existing governance and financing structures, invest in data systems, drawing lessons from business and operational transformations in sectors such as banking, telecommunications, and energy, to create clear pathways for evidence uptake in policy.

Why HTA Is a Business and Operational Transformation Issue

Too often, HTA is seen narrowly as a technical tool for academics or policymakers. In reality, it represents a business and operational transformation agenda for entire health systems.

Consider this:

• Ministries of Health must shift from ad hoc procurement to strategic purchasing based on HTA evidence.

• Regulators must evolve from being passive approval bodies to active decision-makers informed by cost-effectiveness and equity.

• Donor-funded programs must transition from project-driven interventions to institutionalized national priorities, ensuring sustainability.

In short, HTA reshapes the way systems plan, finance, and deliver health services. Like any transformation effort in business, success depends not just on having the right data, but on having the right structures, leadership, and processes to act on that data.

The Case for Institutional Strengthening

Building HTA capacity should not just be about creating isolated technical units, it requires embedding HTA into the institutional DNA of health systems. This means:

1. Dedicated HTA Structures: Establishing national HTA agencies or units with clear legal mandates, governance frameworks, and accountability mechanisms.

   
   

2. Integration with Policy Cycles: Ensuring HTA outputs directly inform annual budgeting, procurement cycles, and reimbursement decisions, turning analysis into action.

   
   

3. Human Capital Development: Training not just economists and clinicians, but also policy officers, procurement managers, and administrators in the use and value of HTA.

   
   

4. Sustainable Financing: Moving beyond donor dependency by embedding HTA in national health financing strategies, with line-item budgets to sustain operations.

   
   

5. Cross-Sector Partnerships: Leveraging academia, think tanks, and private sector expertise to supplement government capacity while building national ownership.

From Capacity to Transformation

When HTA is institutionalized, LMICs can achieve business-like efficiency in health spending and operational resilience in service delivery.

For example:

• Procurement shifts from bulk purchasing to value-based decisions.

• Health budgets become more transparent and defendable in parliamentary debates.

• Patients gain faster and fairer access to essential medicines and technologies.

• Governments build credibility with both citizens and partners by showing that limited resources are used wisely.

This is not a quick win however, it is a long-term transformation journey. But the payoff is significant: health systems that are not only better financed but also smarter, more equitable, and more sustainable.

The Call to Action

For LMICs, the opportunity is clear. HTA must be seen as a strategic investment in sustainable health systems. Donors, governments, academia, and the private sector all have a role to play in building this capacity, but the most important step is institutionalizing HTA as a permanent function of governance.

Only then can LMICs transform business as usual into a model where every decision is guided by evidence, every dollar delivers maximum impact, and every citizen has access to interventions that truly improve lives.