Stefan Nachuk, Amanda Folsom, and Nathaniel Otoo are members of the Joint Learning Network for Universal Health Coverage (JLN). The JLN provides a forum for countries to learn from one another and work together towards achieving UHC.
As the global movement towards UHC -as a post-2015 goal- continues to gain momentum, low and middle-income countries will need to overcome a number of design and technical challenges within their health systems to achieve UHC. Health systems strengthening and reform are very challenging– both in terms of designing policies and programs and effectively implementing them to assure the desired impact. There is often a knowledge gap between “how to” implement health systems changes and traditional research methods and technical assistance. Much knowledge about how to effectively design and implement systems change resides in practitioners who have led or are in the process of leading systems, programs, and reform processes.
Almost 5 years ago, practitioners in countries such as Ghana, India, and Thailand who were working to achieve universal health coverage (UHC) in their countries had no way to connect with each other. These practitioners tried to find answers to their implementation challenges within the myriad of articles and reports about universal coverage. They typically found that traditional technical assistance approaches tended to focus on what to implement, not how. There was a paucity of forums specifically designed for them to learn from one another and co-develop new knowledge and solutions about how to achieve UHC.
Developing practical tools to address common challenges
The Joint Learning Network for Universal Health Coverage (JLN) is charting new territory as we apply collaborative learning approaches to tackle the tough challenges and unanswered questions on how to achieve UHC.
The JLN is innovative in that it translates knowledge sharing into guides and tools that bridge theory with practical guidance on how to address challenges related to implementation of UHC in low and middle-income countries. Take for example, the Costing and Information Technology Collaboratives of the JLN, which formed to facilitate knowledge sharing amongst member countries in their respective technical areas.
The Costing Collaborative formed to address the challenge of costing of health services in information-constrained settings, which was identified as a major bottleneck for improving provider payment systems. A month ago, the Collaborative published the first-ever costing-specific resource that bridges traditional guidance on step-down accounting with practical, step-by-step guidance on what implementers can do to overcome the real life challenges. Complete with tools and templates, the Manual can easily be adapted to a variety of contexts due to the diversity of experiences reflected in each step of the Manual.
The Information Technology (IT) Collaborative utilizes a similar approach to jointly develop tools and guides aimed at improving national health information systems. Members of the IT Collaborative came together several times over the course of four years to collaboratively develop common functional requirements for the most widely needed information system building blocks (e.g, enrollment, claims processing). These common requirements have been referred to by over fifteen countries and have been tested, applied and adapted in Indonesia, the Philippines, Kenya, Ghana, and Bangladesh has begun to adapt the requirements.
In order to turn joint learning into collaborative resource development, JLN technical facilitators play a unique role by helping frame the problem, and then work with countries to “harvest” their experiences in a structured way. This is accomplished by facilitating the process of synthesizing and drawing lessons from applicable to participating countries, and ultimately helping to draft and finalize both country specific and globally adaptable solutions. Our strong culture of active learning and improvement and country ownership help to ensure that technical facilitation is of high quality, objective, and pragmatic.
Redefining who the ‘experts’ are
The principles of what needs to be done are well accepted by most countries. They are now requesting more detailed support around the ‘how to’ of implementation. In the past year, we’ve received requests from nearly 15 countries in Asia, Africa and Latin America who want to participate in joint learning activities.
Many donors appreciate tying their investments to distinct health outputs and outcomes. But like many knowledge management initiatives, it is difficult to quantify outcomes of this sort in the collaborative learning model. This kind of model requires an interest on the part of donors to invest not only in the outcomes, but also in the knowledge and learning approach itself.
The Joint Learning Network approach requires for its success an interest on the part of funders willing to invest in knowledge and learning that is critical to achieving long-term and sustainable outcomes. Though the funder community is becoming more open to country-led technical collaboration, it is still an ongoing challenge to redefine best practices in technical assistance, which will require gaining acceptance of practitioners as ‘experts’.
JLN members regularly speak of how they have drawn on experiences from other countries to redesign their payment systems or introduce new policies to expand coverage for the poor, and as the global movement towards adopting UHC as a post-2015 goal gains traction, it is imperative that for the value it provides, practitioners around the globe will need more opportunities to exchange first hand, experiential knowledge of how to implement policies and programs that will advance their countries towards UHC. With its wealth of experience, the JLN can help connect these practitioners with peers, leverage their expertise, build practical knowledge for the world and help countries move toward achieving UHC.
It has become clear that while the traditional model of donors providing technical solutions and financing them has been successful in some cases, this type of support is insufficient for catalyzing long-term change or progress. UHC is inherently a goal that requires domestic financing, leadership and technical expertise, and creates a new role and opportunity for funders to help countries implement complex reforms by supporting countries learn about the “how” of achieving UHC.