Strengthening Health Technology Assessment Capacity in Indonesia
Indonesia’s Universal Health Coverage initiative, known as Jaminan Kesehatan Nasional (JKN), has benefited 94.64 percent of the population since it was established in 2014. JKN aims to provide affordable health care to all individuals, covering a wide range of medical needs from basic flu treatments to costly cancer therapies. However, the program has faced challenges such as overspending and financial strain, highlighting the need for improvement.
To address the challenges, the Ministry of Health (MOH) created the Indonesian Health Technology Assessment Committee (InaHTAC) comprising experts and academic representatives, and tasked it with conducting research to evaluate JKN’s services and providing input to improve and optimize public health spending.
Evaluating Health-Related Products
InaHTAC conducts extensive evaluations of drugs, medical devices, and procedures covered by JKN to examine new and existing treatment options that may prove more effective or cost-efficient. Due to resource limitations, the committee must prioritize which research topics or technologies to evaluate to maximize the impact of JKN’s services—a process called topic selection. InaHTAC reviews suggestions from doctors’ associations, hospitals, universities, industries, and other stakeholders about new products for JKN coverage.
“Topic selection is an important part of the entire HTA process. It is often overlooked and tends to exhaust our resources. We need to untangle the complex process into something that is efficient, manageable, and even understood by our partners.”
– Armansyah, Center for Health Financing and Decentralization Policy, Ministry of Health
Streamlining the Process
The USAID MTaPS Program collaborated with InaHTAC and the Center for Health Financing and Decentralization Policy at the MOH to streamline the topic selection process through a series of workshops between USAID and stakeholders. These workshops:
- Simplified topic submission to make it easier for stakeholders to submit their topics, doubling completed document submissions from stakeholders from 19 topics in 2021 to 41 topics in 2022
- Reduced the selection criteria from eight to six, with simpler indicators—allowing stakeholders to better understand the expectations and align their submissions
- Enhanced information management by developing an operational manual to better manage the influx of suggestions from stakeholders and ensure proper documentation and organization of information
- Improved submission feedback from InaHTAC to foster continuous improvement of submissions and collaboration between InaHTAC and stakeholders.
In addition to the streamlined topic selection process, the USAID MTaPS advised monitoring and evaluation for continuous improvement of the process. In the future, the topic selection process will be more inclusive, and InaHTAC and the MOH can receive more input to improve the JKN, including from patients.
Strengthening HTA Capacity
Improving HTA capacity for rational and systematic decision making has increased the impact of InaHTAC’s policy recommendations to cover the most cost-effective medicines, devices, vaccines, and procedures. It also streamlines the JKN benefits package.
Moving forward, USAID MTaPS is supporting development of a manual on HTA topic selection to guide daily operations of the process. The manual will be used as the main reference for InaHTAC and the Center for Health Financing and Decentralization Policy when they call for HTA topics in upcoming cycles. USAID MTaPS will also use advanced study methods to strengthen the HTA appraisal process for the Center for Health Financing and Decentralization Policy and HTA agencies.