Evidence-informed policy formulation: the case of the voucher scheme for maternal and child health in Myanmar.

Introduction: In 2010, with financial support from the Global Alliance for Vaccine and Immunization’s Health System Strengthening programme, the Government of Myanmar established a scheme to improve coverage of maternal and child health (MCH) services. Employing qualitative approaches, this article reviews the processes through which this scheme was devised, focusing on evidence generation and the use of such evidence to inform policy formulation. To address the problem of high mortality rates among mothers and infants, collaborative research was conducted by Myanmar’s Ministry of Health, the World Health Organization, and a research arm of Thailand’s Ministry of Public Health, between March 2010 and September 2011. In the early phase of this study, key barriers to governmentprovided MCH services were identified. Based on a comprehensive review of the literature, the introduction of a voucher scheme was raised for consideration by ministry of health decision-makers and respective stakeholders. Despite the successful experience of this financing strategy in low-income countries, a series of surveys, an economic evaluation, and focus group discussions were carried out to assess the feasibility and potential health and economic implications of this scheme in the Myanmar context. The research findings were then used to guide the design and adoption of the newly established initiative.

Policy making and roles of health technology assessment.

The processes of policy development and implementation in the public sector are complex and dynamic as several actors with different interests are involved. To pursue their benefits, these individual and organizational participants compete with each other and those with a relatively high degree of power can lead the policy decisions. Results of and recommendations derived from economic evaluation and other forms ofhealth technology assessment (HTA) are expected to have an important role in policy making and professional practice. However, it appears that on many occasions, such scientific evidence is neglected. Complex calculations, arbitrary assumptions, debatable choices of whose perspectives to pursue, difficult-to-understand methods, research designs and underlying philosophy/concepts, and time-consuming processes are claimed as key factors discouraging policy makers and practitioners from making use of HTA findings. Ethical considerations and the perception that HTA-based clinical guidelines undermine professional autonomy are also crucial.

A determination of topics for health technology assessment in Thailand: making decision makers involved.

This study is to describe experiences and findings from the topic selection process for health technology assessment (HTA) conducted by Health Intervention and Technology Assessment Program. The process comprised of 5 stages namely: (1) determining objectives, scope and involved stakeholders; (2) requesting potential topics for assessment from decision makers at the national health authorities; (3) reviewing related literature on and prioritizing the proposed HTA topics by HITAP researchers; (4) selecting the HTA topics by decisionmakers; (5) analyzing the strengths and weaknesses of the current topic selection processes by HITAP staff The strengths of the topic selection were systematic and transparent. It also required participation from stakeholders; however the limitations were topics prioritization methods and time constraints. Lessons learnt from this procedure can be useful for improving the next HTA topic selection in order to increase the usefulness of the future HTA results.