Assessing the potential of HTA to inform resource allocation decisions in low-income settings: The case of Malawi

Francesco Ramponi*, Pakwanja Twea, Benson Chilima, Dominic Nkhoma, Isabel Kazanga Chiumia, Gerald Manthalu, Joseph Mfutso-Bengo, Paul Revill, Michael Drummond, Mark Sculpher

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Health technology assessment (HTA) offers a set of analytical tools to support health systems' decisions about resource allocation. Although there is increasing interest in these tools across the world, including in some middle-income countries, they remain rarely used in low-income countries (LICs). In general, the focus of HTA is narrow, mostly limited to assessments of efficacy and cost-effectiveness. However, the principles of HTA can be used to support a broader series of decisions regarding new health technologies. We examine the potential for this broad use of HTA in LICs, with a focus on Malawi. We develop a framework to classify the main decisions on health technologies within health systems. The framework covers decisions on identifying and prioritizing technologies for detailed assessment, deciding whether to adopt an intervention, assessing alternative investments for implementation and scale-up, and undertaking further research activities. We consider the relevance of the framework to policymakers in Malawi and we use two health technologies as examples to investigate the main barriers and enablers to the use of HTA methods. Although the scarcity of local data, expertise, and other resources could risk limiting the operationalisation of HTA in LICs, we argue that even in highly resource constrained health systems, such as in Malawi, the use of HTA to support a broad range of decisions is feasible and desirable.

Original languageEnglish
Article number1010702
Number of pages12
JournalFrontiers in public health
Publication statusPublished - 28 Oct 2022

Bibliographical note

Funding Information:
The authors wish to thank Charles Mwansambo (MOH), Kate Langwe (MOH), Godfrey Kadewere (MOH), Marlen Chawani (HEPU), Faless Jeremiah (HEPU), Nthanda Nkungula (HEPU), and Mercy Juma (HEPU).

Funding Information:
The Malawian MOH does not have a specific systematic process to determine the types of research that are most needed. Research is conducted in an ad hoc manner, and the National Health Research Agenda does not necessarily reflect what research has the greatest potential to improve population health in the country. When conducted, additional research is typically supported by external sources of funding. The MOH does not have a national budget for health care research on the costs and benefits of new technologies (), but there is a recommendation to allocate 2% of the health budget toward research (). However, because there has not been a process in place to assess and prioritize research needs, this funding has remained uncommitted. The Health Services Joint Fund (), co-financed by the governments of the UK, Norway and Germany, could act as a catalyst to attract resources and funding for research. However, weak institutional mechanisms to support research decisions in the health care sector could partly explain the low funding for research.

Publisher Copyright:
Copyright © 2022 Ramponi, Twea, Chilima, Nkhoma, Kazanga Chiumia, Manthalu, Mfutso-Bengo, Revill, Drummond and Sculpher.


  • health technology assessment (HTA)
  • healthcare decision making
  • low- and middle-income countries
  • Malawi
  • resource allocation in health care

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