The Urgent Need for National Health Technology Assessment to Transform Lebanon’s Healthcare

A WHO-commissioned study by Lebanese and international research institutions mapped the state of health technology assessment (HTA) in Lebanon, identifying critical barriers like lack of collaboration and resources, and recommending the creation of an autonomous national HTA body to strengthen evidence-based healthcare policymaking. The study underscores that institutionalizing HTA is vital for improving efficiency, equity, and quality in Lebanon’s fragmented healthcare system.

In a time of rapid medical innovation, Lebanon is facing growing pressure to manage the introduction of new health technologies while upholding the principles of universal health coverage (UHC) and health equity. Recognizing these challenges, a major study was commissioned by the World Health Organization (WHO) Lebanon Country Office and carried out by the Higher Institute of Public Health (ISSP) at Saint Joseph University (USJ), alongside the Center for Clinical, Health Economics and Outcome Research (CCHO-MA), the WHO Lebanon office, the Montreal University Hospital Centre in Canada, and the Institut Supérieur de Santé Publique. The initiative aimed to map Lebanon’s health technology assessment (HTA) landscape, identify obstacles, and outline a strategy to embed HTA firmly within national health policymaking.

HTA is increasingly viewed worldwide as a vital, multidisciplinary tool that evaluates the social, economic, organizational, and ethical dimensions of health technologies. Designed to generate evidence that supports more effective and equitable decision-making, HTA has been well-integrated across healthcare systems in Europe, North America, and Australia. However, in many developing countries, including Lebanon, it remains at an early stage, heavily influenced by local healthcare system dynamics and political realities. The Lebanese study, undertaken in response to World Health Assembly Resolution 67.23, intended to assess the current situation and recommend a path for national HTA adoption, critical for achieving sustainable UHC.

A Mixed Approach to Capturing Lebanon’s Health System Challenges

The research adopted a two-phased approach: a survey questionnaire was sent to 88 selected stakeholders, and a series of focus group discussions were held in Beirut. These participants came from diverse backgrounds, including private hospitals, public health funds, pharmaceutical companies, academia, and healthcare professionals. Although only 20 participants completed the survey, primarily due to limited time or familiarity with HTA, the project benefited from the engagement of 34 individuals in full-day focus group discussions, significantly enriching the qualitative analysis.

Survey and focus group participants agreed on Lebanon’s top priorities for applying HTA. Leading the list were decisions related to the pricing, coverage, and reimbursement of health technologies, as well as the development of clinical guidelines and disease management pathways. Additional areas identified included redesigning health service delivery models and revising provider payment schemes. This prioritization signals a strong appetite among Lebanese stakeholders for evidence-based policymaking that can better regulate both access to and the quality of health services.

The study also provided a nuanced understanding of the barriers preventing HTA institutionalization in Lebanon. Lack of collaboration and consensus among national stakeholders emerged as the most pressing obstacle, a theme echoed across both survey responses and focus group discussions. Additional challenges included bureaucratic inertia, limited financial resources, the absence of reliable local databases, and a shortage of professionals trained in HTA methodologies. One participant summed up the frustration succinctly: “No database, no collaboration between stakeholders, and no political interest [in HTA].”

Building Momentum: Opportunities for HTA Success in Lebanon

Despite these serious hurdles, the research team identified several enabling factors that could help Lebanon build a functional HTA system. Both survey and focus group participants highlighted the urgent need to invest in developing local human capital, training skilled health economists, statisticians, and public health professionals to drive the process. Many pointed to the importance of leveraging international HTA networks and collaborations as immediate accelerators of progress.

Government support, while seen as essential, was framed with caution. Participants stressed that any HTA entity must be shielded from political influence to maintain its credibility and ensure that decisions are based purely on evidence. “It should not be influenced by the minister, and its decisions should be applied to all stakeholders,” one participant emphasized, encapsulating the need for operational independence. Furthermore, participants agreed that the establishment of a multidisciplinary national HTA committee, initially under the Ministry of Public Health’s umbrella but progressively transitioning to a fully independent agency, would offer the best structural model for Lebanon.

Priority-setting parameters for HTA evaluations were also agreed upon: safety and effectiveness of technologies were identified as the most critical factors, followed closely by their impact on patient quality of life and burden of disease. These criteria are particularly pertinent for Lebanon’s fragmented healthcare landscape, where rationalizing scarce resources has become an urgent national imperative.

Lessons from Global Experiences and Relevance to Lebanon

The study drew useful comparisons to international experiences, noting that countries such as Malaysia, Hungary, and several Latin American nations have successfully built centralized HTA bodies to guide their healthcare decision-making. In resource-constrained environments, centralization was found to facilitate capacity building, foster stakeholder buy-in, and enhance policy coherence. Lebanon, with its fractured financing system and varied healthcare delivery structures, could clearly benefit from a similar centralized HTA approach.

Moreover, the study found that HTA integration with the development of clinical guidelines and disease management pathways could significantly bridge the persistent gap between research evidence and clinical practice. This would not only ensure better quality care for patients but also enable a more efficient allocation of resources across the healthcare system.

Charting a Realistic Roadmap for Lebanon’s HTA Future

In its final analysis, the study makes an urgent call for Lebanon to embed HTA into its national health policy framework. The recommended roadmap begins with establishing a multidisciplinary HTA committee with formal but non-interfering ties to the Ministry of Public Health, evolving over time into an autonomous, politically insulated agency. Immediate actions include building technical capacity, developing health information infrastructure, strengthening stakeholder collaboration, and launching pilot projects aligned with national health priorities.

While the barriers are significant, the study emphasizes that the rewards of institutionalizing HTA, higher quality healthcare, more efficient use of limited resources, and enhanced policy legitimacy, are too important to ignore. For Lebanon, HTA represents not just a technical exercise but a transformative opportunity to modernize its health system and move closer to the ideals of universal, equitable healthcare for all its citizens.