Institutionalizing Health Technology Assessment in Brazil: Challenges Ahead.

The evolving process of institutionalizing health technology assessment (HTA) in low- and middle-income countries is not yet fully understood. The present article aims to provide an analysis of some of the most recent changes in the development of HTA in Brazil, as well as the main challenges and potential barriers that may determine the process of institutionalizing HTA in the country vis-à-vis the recent approval of its federal HTA law at the end of 2011. Based on the authors' experience in HTA from an academic research perspective as well as from national and regional/local policymaking implementations, this article also proposes some measures to foster the institutionalization of HTA, for which Brazil would have to overcome three fundamental challenges for decision making: 1) Brazil has to complete an unfinished agenda regarding the implementation of its national Unified Health System (SUS), 2) the complex governance of the SUS has to be thoroughly reassessed, and 3) HTA institutionalization is to be promoted to strengthen decision making. The recent creation of a Brazilian national HTA body represents an important step not only in terms of the development of HTA in the country but also regarding the consolidation of the universal access to health care that is guaranteed by the Brazilian Federal Constitution since the creation of SUS in 1988. There is an urgent need to promote broader approaches to assess the complexity of the governance of the SUS, thus strengthening the process of HTA within the decision-making process.