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SAMJ: South African Medical Journal

versão On-line ISSN 2078-5135
versão impressa ISSN 0256-9574

SAMJ, S. Afr. med. j. vol.101 no.5 Pretoria Mai. 2011




Health technology assessment in South Africa - future promise



To the Editor: The scope of technologies for health extends from technologies that provide a direct benefit to health (such as molecular genetics, biological technologies, pharmaceuticals and medical devices) to those that support health system functions (such as telecommunications, information technologies, devices for environmental protection and food technologies).1 Appropriate technology in a health setting should be scientifically sound, adapted to local needs, acceptable to the community, maintained as far as possible by the people themselves in keeping with the principle of self-reliance, and capable of being applied with resources that the community and the country can afford. This requires development of well-defined policies and programmes delivered through a countrywide system incorporating the above concepts and based on a decentralised model such as the district health system in South Africa.2 Over the past two decades, the health technology (HT) situation in South Africa has been changing rapidly.3 However, the fragmented policy environment relating to these changes has led to unco-ordinated development of policies and guidelines. Against this background we assessed the current state of implementation of HT in South Africa and attempted to identify future challenges.

A qualitative study design involved interviewing a convenient sample of practitioners and experts from public hospitals, provincial departments of health and academic institutions (N=32). We found that not every province in South Africa has developed its own HT policies, although development, procurement and use of health technology fall within provincial jurisdiction in terms of the National Health Act.2

Participants from provinces without HT policies believed that lack of clear policies and guidelines often resulted in haphazard procurement affecting service delivery in their health facilities. Challenges include inappropriate equipment, unavailability of consumables and spare parts, high maintenance costs and short lifespan. All suggested that establishment of dedicated agencies for HT at provincial and district levels would improve the current situation, provided their membership is made up of experts in the field. Consolidation of existing good practices and their relevance and effectiveness, particularly in a local setting, would be important enablers, whereas unavailability of trained manpower and lack of understanding of HT processes and their usefulness and impact on improvement of health care would be major barriers for future activities.4 They felt the need for health professionals, health managers from departments of health and academic institutions to work together for development of an enabling environment for use of efficient, effective and relevant HT in South Africa to make a greater impact.

We conclude that progress has been made in the past two decades in this area, but there is still a need for more co-ordinated effort to improve health outcomes. This requires a concerted effort from the departments of health and academic institutions.


Debjani B Mueller
Centre for Research on Health Economics, Social and Health Care Management (CREMS)
University Carlo Cattaneo (LIUC), and
Clinical Epidemiology Research and Training Centre (CERTC)
University of the Witwatersrand

Moreshnee Govender
CERTC and School of Public Health
University of the Witwatersrand

Debashis Basu
CERTC and Department of Community Health
Charlotte Maxeke Johannesburg Academic Hospital and
University of the Witwatersrand


1. World Health Organization. The World Health Report 1998 - Life in the 21st Century: A Vision for All. Geneva: WHO, 1998.         [ Links ]

2. South African Government. National Health Act (Act 61 of 2003). Pretoria: Government Printer, 2004.         [ Links ]

3. Govender M, Letshokgohla ME, Basu D. Health technology assessment - a new initiative in South Africa. S Afr Med J 2010;100(6):334.         [ Links ]

4. Rajan A, Gutierrez-Ibarluzea I, Moharra M. Addressing issues in health technology assessment promotion: Motives, enablers, and barriers. Int J Technol Assess Health Care 2011;27(1):55-63.         [ Links ]

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