Integrating ethics and equity into priority-setting for universal health coverage: a proof-of-concept study in South Africa


  • Dr Kalipso Chalkidou

    Imperial College London

  • Dr Carleigh Krubiner

    Center for Global Development

  • Dr Nicola Barsdorf

    Stellenbosch University

  • Prof Karen Hofman

    University of the Witwatersrand

  • Prof Ruth Faden

    Johns Hopkins University

  • Lord Ara Darzi

    Imperial College London

Project summary

Priority-setting in healthcare is morally complex and involves unavoidable trade-offs. Policy makers face ethical dilemmas when making decisions about healthcare coverage. With many countries pursuing universal health coverage, health technology assessment (HTA) has become a popular approach to decision-making in healthcare. HTA evaluates the value for money of different health interventions while enabling 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 the effects of systematic ethics analysis in HTA.

This proof-of-concept study will generate evidence on how a context-specified ethics framework used to set health priorities can be developed, and the influence its application may have on HTA recommendations in South Africa. This has the potential to affect decisions about the extension of national health insurance and longer-term approaches to HTA in South Africa and elsewhere.

We will co-produce an ethics framework to guide NHI decision-making and evaluate how the framework can influence HTA recommendations. Findings will be widely disseminated, presenting the effect on coverage recommendations, resources required to develop and apply the framework, and implementation considerations for systematic ethics analysis in HTA.