Situation analysis of evidence-informed health decision-making in Lao PDR: the case of health technology assessment.

Background: There is increasing interest in using evidence to inform policy in Lao PDR, which is in the process of establishing a unit for Health Technology Assessment (HTA). This situation analysis aims to explore the current landscape of evidence generation and translation into policy decisions in Lao PDR using the case of HTA. Methods: A mixed methods approach was applied. Self-administered questionnaires and semi-structured interviews were conducted with different stakeholder groups. Data were analysed thematically and summarised in tabular form. Findings: There were 212 responses to the survey and 38 stakeholders were interviewed between March and September 2021. The health policy decision process in Lao PDR is based on consultation meetings, influenced by external experts and/or companies, without consistent use of evidence. There remains a lack of human resource and infrastructure for health evidence to inform policy. Two-thirds of the respondents to the survey strongly agreed that HTA helps in efficient allocation of health resources and improving quality of healthcare. Half of the respondents perceived that HTA can impact the government budget and transparency, which was consistent with findings from the qualitative data. Use of economic considerations was limited in Lao PDR. HTA was seen to apply to policy areas, notably for reimbursement. Only a few organisations can supply health evidence and HTA output, and more training and multi-disciplinary collaboration is needed to conduct and produce HTA and other health evidence to inform policy in Lao PDR. Funding for HTA remains a concern. Interpretation: Improvement of the health policy decision process is urgently needed in Lao PDR. Limited capacity to conduct HTA as well as institutional considerations need to be addressed. Recent efforts towards this end through the establishment of a unit focused on HTA, capacity building activities and international collaborations are promising to establish evidence-informed priority setting for health policy and can also benefit from regional efforts in this direction. This type of approach to assess the situation for evidence use will be beneficial for other countries embarking on this path. Funding: Wellcome Trust, the United Kingdom Department of Health and Social Care (DHSC), and the Ministry of Public Health, Thailand.