JLN: At the Forefront of UHC in the Post-Pandemic Era

Rahul S Reddy Kadarpeta and Mahlet Gizaw

As we transition into 2024, Universal Health Coverage (UHC) stands as a formidable force in global health, catalyzing substantial progress toward the overarching goal of health for all, with an unwavering commitment to inclusivity. The COVID-19 pandemic has demonstrated the importance of building robust and resilient health systems that are 1) prepared for future pandemics, 2) able to deliver health services, including essential services that are unrelated to pandemics, and 3) ensure UHC where all have equitable access to these services. Across nations worldwide, global health stakeholders are undertaking concerted efforts to align priorities and pursue the ideals of UHC. The COVID-19 pandemic has impacted the journey to UHC for many countries. According to the WHO, while the global UHC service coverage index increased from 45 to 68 between 2000 and 2021, the increase between 2015 and 2021 was only 3 index points with no change since 2019. As of 2021, 92% of countries still report the disruption of essential services such as routine immunization; in the same year, an estimated 25 million children under five (5)years missed out on routine immunization. In times like this, a platform like the Joint Learning Network for UHC (JLN) presents a valuable opportunity for country practitioners to learn from each other with the objectives of co-developing and implementing solutions to common challenges and pain points related to UHC.

Commencing with six founding nations in 2009—Ghana, India, Indonesia, Philippines, Thailand, and Vietnam—the JLN has expanded its reach to encompass 37 member countries. The JLN has evolved into a dynamic and influential entity over the past 14 years, uniting practitioners, and policymakers from diverse corners of the globe for peer-to-peer learning. The goal of this collaborative network is to co-develop global knowledge products that effectively bridge the gap between theoretical frameworks and practical implementations, propelling UHC objectives and advancements-

The success of the JLN is deeply rooted in its country-led and country-driven approach.  80% of the seats on the steering group, which govern the JLN, are occupied by country representatives elected by the JLN member countries. JLN’s commitment to country ownership extends to a participatory approach, wherein representatives from participating countries define and agree upon goals, and then, impactful initiatives and learning activities are customized to align with those priorities. JLN also works closely with in-country stakeholder groups drawn from key ministries and institutions in the government (designated as country core group), the private sector, civil society, and development partners to make sure that representatives who are nominated to participate in JLN activities are a good fit (i.e. they are in an active role in making decisions and/or implementing policies related to the topics covered in the JLN activities). JLN relies on communication with these stakeholder groups to understand the country-specific technical priorities and local landscapes relevant to UHC. This strategic orientation has garnered support from key global health entities such as the Rockefeller Foundation, the Bill and Melinda Gates Foundation, the German Corporation for International Cooperation (GIZ), the World Bank, and various other collaborative partners. As the JLN continues to play a pivotal role in shaping the trajectory of global health, its collaborative endeavors stand as a testament to the enduring vision of achieving comprehensive health coverage on a global scale.

Collectively, JLN members and participants have co-produced over 45 knowledge products to-date. 30 countries are known to have applied some of these knowledge products.  Applications of JLN products have contributed to meaningful changes across many of these countries. In Kenya, country representatives  customized the JLN’s manual for costing provider payments to collect data at the county referral hospital in Makueni County. The team found that the reimbursement model used in the county was not sustainable and lobbied to change the county-wide reimbursement model. This shift was adopted by the Makueni County Department of Health in the 2019/2020 fiscal year impacting the reimbursement model for all 333 health facilities with a catchment population of just under 1 million Kenyan people. In Mongolia, country representatives co-developed and applied a JLN tool on empanelment to embed a household-based empanelment approach to a WHO-sponsored mobile health technology project used for home visits. The approach resulted in new assignments of primary health care providers for 20% of residents in Arkhangai province. The team plans to scale the approach beyond the most geographically isolated target populations. In India and Ghana, the representatives used the JLN’s tool on medical audits to implement a medical audit system as part of their programs  providing financial protection to about 100 million families. The team enhanced the system in India to include standard treatment guidelines that could be decentralized and scaled by India’s states to review claims, identify fraud, and ensure the quality of health services provided to patients. Since the rollout of the medical audit system, the program team has seen positive behavior changes among providers and hospitals.

The profound influence of JLN resonates at various global health conventions, as its representatives empower member countries to share their narratives and triumphs in the journey toward UHC. JLN’s knowledge products plays a transformative role in shaping the UHC agenda, by amplifying the voices of nations ardently pursuing UHC and sharing successful country-driven strategies being implemented.

In the grand pursuit of UHC, JLN paints a portrait of collective ambition and accomplishment. Yet, significant gaps persist within this effort, fueled by the intricate tapestry of diverse country contexts and the evolving needs of a post-pandemic era. In the face of these challenges, the Joint Learning Network for UHC (JLN) emerges, directing its focus toward pivotal areas crucial for UHC implementation in member countries. These encompass the realms of financing and equity, digital health, health emergency preparedness, climate change, and foundational reforms for the financing and delivery of primary healthcare.

As we navigate the path towards UHC by 2030, the JLN stands unwavering in its commitment to a mission that transcends challenges. It remains a steadfast provider of a platform for knowledge exchange, a catalyst for innovation, and a staunch advocate for policies championing equity and ensuring access to high-quality healthcare for all. The JLN’s journey is not merely a response to the complexities of our time; it is an inspirational narrative of resilience, determination, and a collective country-led vision for a healthier, more equitable world. With each stride forward, the JLN becomes a driving force in the transformation of global health, reminding us that our shared pursuit of UHC is not just an aspiration but an achievable reality with the right blend of inter-country collaboration, innovation, and unwavering commitment to the policymakers that constitute the JLN’s life force. As the JLN continues to shape the international dialogue on health, it sparks a collective enthusiasm that transcends borders, uniting nations in the pursuit of Universal Health Coverage.

Reference: World Health Organisation, 5 October 2023, Universal Health Coverage, Key Facts, World Health Organisation website accessed on 3 January 2024. (Link)

Authors: Rahul is the Executive Director, Joint Learning Network for UHC (JLN). Mahlet is a Joint Learning Network Health Specialist at the World Bank. Authors acknowledge input from Somil Nagpal, Lead Health Specialist, the World Bank and the JLN Network Management team.