Integrating Ethics and Equity into Priority Setting for Universal Health Coverage: A Proof-of-Concept Study in South Africa (360G-Wellcome-208045_Z_17_Z)

Priority-setting for health is morally complex with unavoidable trade-offs. Policymakers face ethical dilemmas in healthcare coverage decisions. With many countries pursuing Universal Health Coverage, health technology assessment (HTA) has become a popular approach to health decision-making. HTA evaluates the value-for-money of different health interventions while providing a mechanism to facilitate transparent and inclusive decision-making. Although ethics is stated as a core component of HTA, and theoretical HTA ethics frameworks exist, the uptake of ethics analysis in HTA is limited. Few studies have explored practical implementation and impacts of systematic ethics analysis in HTA. This "proof-of concept" study in South Africa will generate evidence on how a context-specified ethics framework for health priority-setting can be developed and the influence its application may have on HTA recommendations – with the potential to impact near-term decisions for the National Health Insurance (NHI) policy rollout and longer-term approaches to HTA in South Africa and beyond. With key stakeholders, we will co-produce an ethics framework to guide NHI decision-making, then evaluate how applying the framework influences HTA recommendations. Findings will be widely disseminated, presenting impacts on coverage recommendations, resources required to develop and apply the framework, and implementation considerations for systematic ethics analysis in HTA.