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In November 2013, NICE International launched the international Decision Support Initiative (iDSI) to support low and middle income governments in making resource allocation decisions for healthcare. The aim of the iDSI is to identify practical ways to scale peer-to-peer process and technical support for more systematic, fair and evidence informed priority setting in healthcare.

The innovative partnership model brings together NICE InternationalHealth Intervention and Technology Assessment Program , the Center for Global DevelopmentImperial College London and the University of York as well as the Office of Health Economics and Meteos

For a more detailed introduction to the aims and objectives of the iDSI, read the strategic overview.

Project activity:

International Decision Support Initiative awarded US$12.8 million grant from the Gates Foundation

January 2016

In January 2016, the international Decision Support Initiative (iDSI, launches Phase 2 with an award of US$12.8 million (£8.9 million) from the Bill & Melinda Gates Foundation. This represents a major single investment by the Foundation dedicated to making better decisions for better health, and a significant commitment by the Foundation and iDSI partners worldwide to enacting the Bangkok Statement on Priority-Setting for Universal Health Coverage.

iDSI’s mission is to guide decision makers to effective, efficient and ethical healthcare resource allocation strategies for improving people’s health. Since 2014 it has significantly strengthened local capacities for setting health priorities across Indonesia, India, Vietnam, China and South Africa

With the funding boost in Phase 2, iDSI will scale up its practical support to countries aspiring to universal health coverage (UHC), both in terms of intensifying and sustaining the institutional impact in the five flagship countries, and broadening its geographic reach particularly into sub-Saharan Africa. iDSI also continues to receive funding support from the UK Department for International Development and the Rockefeller Foundation.

Damian Walker, Deputy Director (Data & Analytics, Global Development) , Bill & Melinda Gates Foundation, said: “Countries worldwide face life-or-death choices in deciding whom receives what kinds of healthcare at what cost. iDSI will work with national and global decision-makers to help them make better choices, to save as many lives as they can afford and allow as many people as possible to lead healthy and productive lives.”

iDSI is a global network of public bodies, think-tanks, and academics in priority-setting, and comprises core partners NICE International (UK), HITAP (Health Interventions and Technology Assessment Program, Thailand), CGD (Center for Global Development, USA), and PRICELESS SA (Priority Cost Effective Lessons for System Strengthening at the University of Witwatersrand School of Public Health, South Africa), who join as the iDSI regional hub for sub-Saharan Africa. iDSI builds on its core partners’ track records over the past decade in delivering demand-driven practical support to low- and middle-income country governments, and puts into action recommendations from the 2012 CGD Priority-Setting in Health Working Group, which articulated the need for systematic, fair and evidence-informed priority-setting mechanisms in healthcare

Prof. Karen Hofman, Director of PRICELESS SA, said: “The iDSI grant will enable us to continue supporting the Ministry of Health, Treasury and other health policy makers in South Africa on setting evidence-based priorities as the country moves towards National Health Insurance. But more than this, building on successful initiatives in South East Asia we aim to go beyond our borders to share successes and lessons with policymakers in sub-Saharan Africa, as they too move towards UHC.”

“Our ambition for iDSI is that evidence-informed decision making becomes the norm in countries that we work with,” agreed Dr Yot Teerawattananon, Leader of HITAP, “and that these countries begin to contribute to the efforts in developing the capacity of other countries.”

In the era of Sustainable Development Goals and countries transitioning from aid, country policymakers will increasingly be making their own healthcare spending decisions with the goal of UHC. iDSI will provide much needed support for countries, and respond to growing demand for knowledge sharing and capacity building for priority-setting.

“iDSI has the potential to be a major contributor to improved health outcomes and health equity on the African continent,” added Prof Hofman.

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Supporting India’s efforts towards Universal Health Coverage: NI achievements since 2009 and next steps for iDSI in India

January 2016 

In a blog post for the iDSI website, Francoise Cluzeau, Associate Director at NICE International has summarised the organisation’s key achievements in India since 2009. She also outlined plans for activity in the country from 2016 onwards, which will be incorporated within iDSI following recently secured funding from the Bill and Melinda Gates Foundation and DFID for the next phase of the programme. 

NICE International through iDSI will continue to support India in its efforts towards Universal Health Coverage by strengthening quality mechanisms and priority setting processes and by building capacity for HTA. 

Adviser Thomas Wilkinson takes part in a workshop on costing methodology for vaccines

October 2015

Thomas Wilkinson took part in a 2-day workshop in Seattle, USA, focussed on costing methodology for economic evaluation in the field of vaccine delivery. The workshop was part of a larger initiative led by the University of Washington to develop a standardised, high quality costing method for vaccine evaluation, and has the potential to make a significant impact on local, national and global decision making around vaccine introduction and scale up.

The workshop was relevant to the work of iDSI, and in particular the continued work on the iDSI Reference Case, which is an economic evaluation methodological workstream led by NICE International. The workshop was coordinated by the University of Washington.

Read about the background to the iDSI (previously Gates) Reference Case.

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Bridging policymakers and researchers: iDSI Workshop on Supporting Evidence-Informed Policymaking

October 2015

On 5-7 October 2015, NICE International hosted the international Decision Support Initiative (iDSI) workshop on Supporting Evidence-Informed Policymaking, at the Bill & Melinda Gates Foundation (BMGF), Seattle. The workshop was led by Prof John Lavis (McMaster Health Forum) and Dr Jessica Shearer (PATH), and aimed to share learning and spur reflection about how development initiatives, funders and governments can together support evidence-informed priority-setting in health.

Key messages from the workshop included the importance of strengthening the capacity of ‘knowledge brokers’ to facilitate knowledge transfer and exchange between researchers and policymakers; and of building country-relevant success metrics around evidence-informed policymaking into development initiatives’ monitoring and evaluation frameworks.

The workshop brought together policymaker and technical representatives from Thailand, Indonesia, India, Tanzania and Ethiopia alongside organisations working globally in priority-setting, including iDSI and its partners, BMGF, PATH, Disease Control Priorities Network, Institute for Health Metrics Evaluation, Joint Learning Network for UHC and Priorities 2020.

View the presentations from the workshop

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NICE hosts senior delegation from Indonesia

September 2015

From 28 - 30 September 2015, NICE hosted a delegation of senior health policy makers and academics from Indonesia on a 3-day study visit. The delegation was led by Dr Untung Suseno Sutarjo, Secretary General, Ministry of Health of Indonesia. The aim of the study visit was for the delegates to learn about the UK’s approach to using evidence and social values to inform healthcare decision making and to explore how NICE can work in partnership with Indonesia as they continue their progress towards universal health coverage.

The visit was supported by USAID and iDSI, working in partnership with the Indonesian Ministry of Health and the WHO country office. It was part of a continued series of engagements between Indonesia, NICE and iDSI partners, including HITAP, which is working with the Indonesian Ministry of Health to develop HTA to support health policy decision making.

The agenda included presentations on the National Health Service, its organisation and key guiding principles.  The delegation also learnt about the history and background of NICE during discussions with Sir Andrew Dillon and Professor David Haslam, and how NICE has managed to remain a useful institution within the National Health Service over the years.

NICE staff introduced the delegation to key NICE outputs including Technology Appraisal recommendations, Clinical Guidelines, Public Health Guidance and Quality standards.  The delegation also visited the NIHR Evaluation, Trials and Studies Coordinating Centre, University of Southampton to learn about the key role of health research in informing health decision making in the UK. On the final day of the visit, Professor John Cairns chaired a session at NICE offices to discuss the proposed roadmap for HTA institutionalisation in Indonesia and how NICE and partners can support this initiative.

The visit was highly successful and has laid the groundwork for continued partnership between NICE and the Ministry of Health in Indonesia over 2016-2018. 

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NICE International supporting the development of HTA processes in Indonesia

September 2015

NICE International joined the HITAP team, senior officials from the Ministry of Health (MOH), the National Health Security Office (NHSO) and Mahidol University in Jakarta for two days of meetings on the strategy around establishing and sustaining a HTA process in support of Universal Health Coverage (UHC) in Indonesia.

The events were coordinated by the WHO country office and major funding and delivery partners including PATH, USAID and DFAT also joined, as did different stakeholders from government, including the recently set up HTA Committee; representatives from Badan Penyelenggara Jaminan Sosial (BPJS), the health insurance agency; different MOH departments including P2JK which is serving as the Secretariat for the HTA committee; managers from major hospitals and community involvement leaders.  

In parallel, Carleigh Crubiner, who is leading on the ethics stream for iDSI, conducted a series of interviews with key stakeholders in preparation of applying for a Wellcome Trust grant to support this work-stream going forward. 

The Secretary General of the MOH joined the discussions and reiterated the government's commitment to high quality services and the relevance of accountable HTA processes to achieving the objectives of UHC. During their presentations, the HTA Committee chair and Committee members raised issues of capacity, data and institutional coordination across major players such as the Indonesian FDA and the MOH, as potential challenges. Strengths included the existing legal framework setting out HTA as a requirement in the decision making process for technology adoption decisions, and the HTA committee with dedicated, though part-time support staff and a broad and supportive international network. A HTA roadmap is being drafted with a mission and vision already well-articulated (see slide 1 of PowerPoint presentation below) and setting the authorities achieving a clear HTA process and structure with over 100 staff in place by 2026. The vision also sets out that 0.05% of the Jaminan Kesehatan Nasional (JKN) budget should be used to support HTA activities.

One of the major take home messages was the need to connect HTA results with the way the health benefits package is designed and updated and in particular aligning payment mechanisms with HTA decisions through for example introducing national level value-based prices for individual drugs and devices especially those paid for through Fee For Service and adjusting the bundle price for care episodes to reflect the cost of cost effective technologies.

During the second day, a comprehensive list of activities was presented by the MOH leadership (see slides 2 and 3) and a donor coordination meeting was held to agree on priority areas and responsibilities. iDSI will coordinate with existing players both local and international to make sure our activities contribute towards the government's vision. The leadership of the MOH and BPJS will also be hosted at NICE the week of 28 September 2015, as part of our ongoing collaboration with the Indonesian authorities. 

View the slides from the event

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NICE International visits HITAP 

August 2015

In August 2015, Laura Morris visited the Health Intervention and Technology Assessment Program (HITAP) for two weeks as part of the partnership between NICE and HITAP. The purpose of the visit was to better understand HITAP’s role in providing evidence in the Thai health system and delivering practical support to other countries in the region.

Laura shadowed HITAP researchers leading on an economic evaluation of the Package of Essential Non-Communicable Disease Interventions (PEN), conducted as part of iDSI practical support in Indonesia. This study aimed to examine the value-for-money and budget impact of different options for implementing the PEN. It was completed in collaboration with the Indonesian Ministry of Health and WHO country and regional offices.

The study demonstrated that screening for diabetes and hypertension is highly cost-effective and leads to greater health gains at population-level (versus no screening). The current programme was estimated to:

  • Reduce healthcare costs by 14.22 million IDR (around £675 or $1031) for every disability adjusted life year (DALY) averted
  • Yield 7.10 more DALYs averted than no screening

 Analysis also showed that cost-effectiveness could be improved (and coverage of the intervention increased) by targeting the screening at high-risk groups (Rattanavipapong et al., in press). This targeted option has the potential for significant savings, which can be reā€allocated to other programs to improve overall treatment.

During her time in Bangkok, Laura also participated in a study visit to HITAP by a delegation from Vietnam. The delegates will be responsible for forming a Council for the Basic Health Service Package (BHSP), due to be submitted in 2017. They visited HITAP to present their progress so far and discuss the appropriate role and membership of the council. As part of the study visit, HITAP presented on the Thai Sub-committee for Benefit Package and Laura presented on the role of NICE’s Technology Appraisals Committees, providing the Vietnamese colleagues with an overview of the experiences from Thailand and the UK in this area. 

NICE International at the 11th iHEA World Congrees

July 2015

NICE International staff attended the congress of the International Health Economics Association (iHEA) from 12th-15th July 2015 at Bocconi University, Milan, Italy. The iHEA congress is held bi-annually and is a key forum to showcase work and keep up to date with important global developments in health economics.  

NICE International staff were involved in three panels at the 2015 iHEA congress.

  • The first presented work of the iDSI economic evaluation methods work streams, and included colleagues from University of York, LSHTM, University of Glasgow, and Erasmus University.
  • The second discussed sub-Saharan institutional networking initiatives and included colleagues from University of Witwatersrand, South Africa, HITAP, Thailand, and the Ethiopian Public Health Institute.
  • The third panel was led by LSHTM and presented experiences of international support for priority setting, where NICE International staff described key learnings from work in Myanmar, Kerala, the Philippines, Vietnam, and Colombia. 

Attendance at the iHEA congress by NICE International staff was central to the continued engagement and dissemination activities of NICE International, and also provided opportunities for continued representation of NICE at international forum. 

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NICE International  mapping priority-setting activities in Malawi

June 2015

Laura Morris travelled to Malawi as part of initial iDSI activities in Sub-Saharan Africa. The purpose of the trip was to learn about current priority-setting activities in Malawi and identify any gaps, through meetings with representatives from the Ministry of Health and their major technical partners. This follows earlier communication as part of a mapping exercise conducted by iDSI in 2014.

During the meetings, Laura identified the articulated needs of the Ministry of Health in relation to planning and costing policy, coordination of the health sector across numerous funding and delivery partners, and the government’s ability to commission and use local research. Discussions explored potential areas for involvement by NICE International and other iDSI partners over the next 12 months. Contacts in Malawi continue to be engaged in wider iDSI activities in Sub-Saharan Africa, including participation in a Rockefeller Foundation-funded meeting on pragmatic research

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NICE International presents the Reference Case for Economic Evaluation at the HTAi conference

June 2015

NICE International staff attended the annual conference of  Health Technology Assessment International (HTAi) in Oslo, Norway from 14th to 17th June 2015.

The theme for the conference was “global efforts in knowledge transfer: HTA to health policy and practice”, and was highly relevant to the growing methodological and knowledge translation work of NICE International. NICE International staff participated in two panels, both of which attracted high levels of interest.

The first panel presented  work commissioned through iDSI conducing pilot assessments using the recently developed Reference Case for Economic Evaluation, and involved colleagues from Imperial College, London School of Hygiene and Tropical Medicine (LSHTM), and the Ministry of Health in the Philippines. The second panel presented comparative experiences of NICE’s Technology Appraisal programme with colleagues from the United States and Uruguay. 

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May 2015

On 13-15 May 2015, Ryan Li (adviser) represented NICE International and the international Decision Support Initiative (iDSI) at the 4th HTAsiaLink Annual Conference in Taipei.

Ryan participated in two plenary sessions: presenting the iDSI approach to supporting evidence-informed priority-setting; and moderating a panel discussion on the experiences and challenges in developing health technology assessment (HTA).

During the panel, leaders of HTA agencies in Thailand, Malaysia, South Korea, and Taiwan candidly shared their perspectives on issues of great relevance to decision-makers and HTA practitioners alike, such as recruitment and retention of skilled staff, and striking the seemingly fine balance between independence and sustainability of funding.

NICE International is a founding associate member of HTAsiaLink, and look forward to closer collaboration with HTAsiaLink in the coming years under iDSI, to support capacity development for priority-setting and HTA across Asia and sub-Saharan Africa.

Further information on the 4th HTAsiaLink Annual Conference 

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HTA workshop in Indonesia

April 2015

Francis Ruiz joined colleagues from HITAP at a stakeholder workshop in Jakarta to highlight the role of HTA and priority-setting in supporting UHC .

In support of ongoing iDSI activities in Indonesia, at the end of April 2015, Francis Ruiz, Senior Adviser, NICE International participated in a stakeholder workshop organised by the WHO on HTA, held in Jakarta.

Attendees at the workshop included representatives from multiple stakeholder groups including local academics and clinicians, the MOH (Centre for Health Insurance, Pusat Pembiayaan dan Jaminan Kesehatan or PPJK) and the social health insurer Badan Penyelenggara Jaminan Sosial (BPJS). The workshop began with presentations from Francis Ruiz and Dr Yot Teerawattananon on the role of explicit priority setting and HTA in support of UHC, drawing examples from the UK and Thai experience. There was also a presentation from Prof Dr Sudigdo Sastroasmoro, Chair of the recently established HTA committee, on the current status of HTA in Indonesia and the work of the committee.

The second half of the workshop focussed on the HITAP supported economic evaluation of an MOH adapted version of the WHO PEN programme. (PEN stands for “Package of Essential Non-Communicable disease”). HITAP presented preliminary results of an analysis of alternative screening policies that could be adopted.

Francis Ruiz also participated in training workshops for the technical secretariat supporting the HTA committee and selected topic experts, as part of capacity building work by HITAP to enable an evaluation of two future topics: treatments for pulmonary arterial hypertension, and a comparison of peritoneal and renal dialysis.

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Supporting Health Technology Assessment development in Indonesia

November 2014

Francis Ruiz visited Jakarta in the context of iDSI and the ongoing work with our partners in the Health Intervention and Technology Assessment Program (HITAP) in supporting HTA development in Indonesia. The aim of the three-day visit was to obtain selected stakeholder perceptions on the role of HTA in Indonesia, and information on recent progress in that area. He met with Prof. Dr. Sudigdo Sastroasmoro, Chair of the recently created HTA committee and members of the supporting secretariat at the Ministry of Health, the PPJK. There were also meetings with the Australia Indonesia Partnership for Health Systems Strengthening (AIPHSS) and colleagues from the Development Cooperation unit (Health) of the Australian Department of Foreign Affairs and Trade (DFAT).
During these meetings, not only were the technical aspects of HTA discussed, including the capacity gaps that currently exist In Indonesia, but also the critical importance of developing an effective policy framework and set of multi-stakeholder processes to support the consistent use of HTA in actual decision making.

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Third Global Symposium on Health Systems Research in Cape Town

September/October 2014

Francis Ruiz attended the Third Global Symposium on Health Systems Research in Cape Town at the end of September 2014.

The Symposium focussed on health systems strengthening and adopted a multi-disciplinary approach to considerations of access to health services, quality and people “centredness”. Attendees at the workshop included major donors and international health and development agencies such as the Bill and Melinda Gates Foundation, Rockefeller, WHO and the World Bank. At the Symposium NICE International exhibited a poster presentation on its work in supporting better decisions for better health, and the role of the International Decision Support Initiative (iDSI). Francis Ruiz also met with representatives from the South African Department of Health and the Finance ministry to discuss ongoing work in developing HTA in South Africa.

During the same visit to South Africa, Francis Ruiz met with Karen Hofman, Associate Professor in the School of Public Health, University of Witwatersrand in Johannesburg. Discussions were held on the role of the School and PRICELESS (Priority Cost Effective Lessons for System Strengthening South Africa) in particular in supporting the work of iDSI and the development of HTA in sub-Saharan Africa. Francis Ruiz also delivered a talk at the School on “NICE UK – How it came to be, its role in the NHS, present and future challenges.”

The visit to South Africa concluded by attending a Gates-funded conference organised by Overseas Development Institute fellows based in health ministries in Burundi, Liberia, Mozambique, Zanzibar and Malawi. Francis Ruiz was joined by Paul Revill of the University of York, and former ODI fellow, in discussions that covered the day-to-day work of the fellows in relation to among other things, working with donors, preparing health system accounts, and the costing of national health strategies. The ODI fellows also provided information on existing health economics capacity in the countries they work in, important data to inform the work of iDSI.

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A global health vision for the International Decision Support Initiative: Rockefeller Bellagio Center, Italy

What would the world look like if the international Decision Support Initiative (iDSI), were successful? Decision makers around the world would be making the right choices for better health.

Meeting of the IDSI in Italy

This is the mission for the iDSI - to guide decision makers to effective and efficient resource allocation strategies for improving people’s health.

This new vision and mission was an important outcome of a meeting convened by NICE International at the Rockefeller Bellagio Center, involving current and new partners of iDSI. From the discussions, iDSI also developed a new conceptual framework.

This framework will be used to evaluate the impact the IDSI has on institutional strengthening - leading to better decisions for better health across the world.

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iDSI Steering Group meeting

June 2014

On 5th June 2014, NICE International convened a meeting in London for the iDSI Steering Group and delivery partners, with 2 aims: Firstly, to report on progress made during the first 5 months of the project; and secondly, to begin the process, in conjunction with partner countries, of selecting a country in which iDSI will carry out an 18 month, hand-on demonstration project pilot.This was the first meeting bringing together the iDSI Steering Group, which includes our donors, delivery partners and other key global stakeholders.

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NICE International launches the International Decision Support Initiative

November 2013

In November 2013, NICE International launched the international Decision Support Initiative (iDSI) to support low and middle income governments in making resource allocation decisions for healthcare.

Dr Kalipso Chalkidou, Director, NICE international said, "We are delighted to be part of the iDSI, a unique platform for engaging with and responding to the growing demand for evidence-informed decision-making processes. Drawing on our UK and global experience, and leveraging funds from additional sources, such as the Rockefeller Foundation, we look forward to working together with our UK and international partners and colleagues from overseas governments to realise the objective of equitable access to good quality affordable care for all those who need it. In doing so, we hope to demonstrate a workable and sustainable model for scaling up technical cooperation and two-way learning across healthcare policy makers and practitioners committed to Universal Healthcare Coverage."

In the context of the Universal Coverage movement, iDSI aims to strengthen priority-setting institutions as a means of improving the quality and efficiency of health care. Functioning institutions and processes will make it possible for low and middle income governments to apply international and local evidence, and utilize local technical capacity in order to improve the efficiency and distributional impact of resource allocation decisions.

iDSI builds on the international work of NICE and HITAP and follows on from the 2012 CGD Priority Setting working group which articulated the need for systematic, fair and evidence informed priority setting mechanisms in healthcare and called for a series of actions iDSI aims to implement.

“People who decide how to spend health budgets hold the lives of many others in their hands,” says Amanda Glassman, director of the CGD global health program and co-author of the report. “With hope, the iDSI will better equip these decisions makers with fair, evidence-based recommendations on how to help as many people as possible with the resources available.”

We will be posting updates on the project in the CGD, NICE and HITAP and York websites as the project progresses.

View the iDSI strategic overview (PDF)

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