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NEWS April 8, 2024

Introducing a learning collaborative on how to establish government-led contracting for TB- and other health-related services

JLN Network Manager

Authors: William Wells; Jacob Hughes, Denise Silfverberg, Sara Wilhelmsen, James Soki, Rahul S Reddy Kadarpeta Accelerating progress towards the health-related Sustainable Development Goals (SDGs) requires concerted efforts by all health systems stakeholders. Country governments anchor these efforts, playing a stewardship role. Still, as part of this stewardship, they need to explore ways of leveraging non-state actors to increase health system efficiency, effectiveness, and accountability. In the context of declining donor funding for many of these non-state actors, identifying government-led sustainable health financing solutions becomes more important. Government-led contracting for health services is where the government contracts with nongovernmental organizations (NGOs)/civil society organizations and the for-profit private sector using the country’s procurement system and domestic funds. This mechanism allows the use of complementary skill sets from the public and private sectors. It can support the optimization of available resources, especially in mixed health systems in low- and middle-income countries where health systems can be under-resourced or fragmented. However, governments in some low- and low-middle-income countries are focused almost exclusively on the direct implementation of health activities by public sector staffing. For such countries, contracting is a new way of conceptualizing the role of government in health sector stewardship and understanding these possibilities is challenging without exposure to other health systems that are already implementing such approaches. In addition, governments (and other key stakeholders) that are considering contracting often do not have a complete understanding of the essential legal, regulatory, policy and procedural requirements. Decision makers may be unaware of lessons learned elsewhere, and of contracting tools already developed by other countries. This can lead to lost time and unnecessary expenditure of effort and resources and can be a deterrent to moving forward with contracting. On the heels of World TB Day, the JLN is partnering with USAID’s Health Systems for TB (HS4TB) project to offer a Collaborative on Contracting Organizations for Health-Related Services for practical learning on this topic. HS4TB’s analysis of available literature found abundant guidance on the ongoing implementation of health contracting, but little available consideration on the qualitative aspects of establishing contracting such as the decision-making, obstacles, opportunities, and processes. This finding provides the rationale for focusing the collaborative on the early stages of contracting: navigating the political, legal and regulatory barriers to make concrete steps towards establishing contracting for TB- and other health-related services; and the initial establishment of systems to manage the contract management cycle. The offering will be conducted with TB as an example. However, the knowledge and tools it produces would be applicable and valuable to any health system leader interested in sustainable health financing options within mixed health systems. Strong political will is necessary for sustainable health contracting in any country. In Bangladesh, the National TB Program and the Health Economics Unit of the Ministry of Health and Family Welfare worked together to outline the potential benefits of health services contracting to key stakeholders in the country through meetings and workshops, resulting in a remarkable change in attitudes. This engagement resulted in the inclusion of contracting for TB services in critical policy documents and helped secure a budget for TB contracting in the National TB Program’s Operational Plan. This HS4TB-JLN collaborative will enable participants to share country experiences on what is needed to initiate the country conversation on health contracting, why challenges and constraints to contracting exist and how to overcome them, and how systems and capacities can be introduced and optimized for the implementation of TB- and health-related contracting. Countries participating in the collaborative will benefit from practitioner-to-practioner learning exchange and sharing of country experiences, which can be used for inspiration as they tackle their unique contracting challenges. Read more about the collaborative here. Please form a country team and join in this joint learning journey by submitting your EoI by April 15. About the Authors: William Wells is a Senior TB Technical Advisor, USAID;  Jacob Hughes is a Senior Technical Director, MSH, Denise Silfverberg is a Principal Technical Advisor, MSH and Sara Wilhelmsen, is a Principal Technical Advisor, MSH  while James Soki, is Program Manager, JLN and Rahul S Reddy Kadarpeta is the Executive Director, JLN.

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NEWS April 5, 2024

Celebrating Women Leaders Inspiring Contribution Towards Advancing Universal Health Coverage

JLN Network Manager

Authors: Isha Sharma, Rahul S Reddy Kadarpeta and Jane Nyambura  Leadership by women at all levels of the health system has played a pivotal role in advancing universal health coverage worldwide. Women leaders have pioneered the art of embracing collaboration and empathy, pivotal to bringing together various stakeholders to work on common goals. Joint Learning Network for Universal Health Coverage (JLN) nurtures these values and benefits from collective thinking and problem solving to co-produce several knowledge products that support the design of innovative policies and implement strategic initiatives across the world. JLN has ensured that the contributions of women policymakers and practitioners within the network are always respected and celebrated. On 8 March 2024, International Women’s Day, we held a webinar to share the remarkable contributions of women leaders at JLN in advocating for UHC around the globe. As a collective acknowledgement of the resilience, leadership, and passion of women in healthcare, this blog highlights the learnings from the webinar which featured Dr Nguyen Khanh Phuong, Director, Health Strategy & Policy Institute, Ministry of Health, Vietnam, Mrs Vivian Addo-Cobbiah, Former, Deputy Chief Executive, Operations, National Health Insurance Authority (NHIA), Ghana, Dr. Elizabeth Wangia, Ag. Director, Health Financing, Ministry of Health Kenya. Vivian and her colleagues at the National Health Insurance Authority (NHIA) and the Ministry of Health in Ghana have been an integral part of the JLN since 2010. At NHIA, her contributions have been instrumental in establishing an accreditation system for health facilities, ensuring adherence to specific healthcare quality standards at credentialed facilities and Clinical and Compliance Audits for NHIA. Additionally, as one of the authors of the JLN knowledge product on Medical Audits, she witnessed the transformative impact of refining medical audit targets, processes and outcomes through successful adaptation and implementation of the JLN Tool on developing and Strengthen Medical Audit Systems. Vivian emphasizes that her JLN experience not only inspired her to intensify her efforts but also reinforced her dedication to advancing Universal Health Coverage (UHC) in Ghana. Dr Phuong has been affiliated with JLN since 2010. Her involvement in the JLN Provider Payment Collaborative, along with support from the member countries of the network, facilitated strategic recommendations for nationwide provider payment system reform in Vietnam. The reform coupled with the adoption of the Health Insurance Law, marked a significant milestone in the nation’s health systems strengthening journey. She expressed, “The JLN has been a source of inspiration and empowerment for me, providing a platform for learning, knowledge-sharing, and accessing resources from across the globe. By leveraging the expertise and experiences of other member countries, we were able to tailor solutions to address Vietnam’s specific healthcare challenges effectively.” Dr Liz, utilizing her leadership expertise within clinical practice and policy units in Kenya, began her involvement with JLN during the COVID-19 pandemic. Engaging in various learning exchange activities, she supported Kenya’s efforts in combating the pandemic, drawing upon the collective wisdom of JLN member countries. This experience fueled her interest and strengthened her dedication to leveraging global insights for local impact, particularly evident in her ongoing engagement with the JLN Digital Health Collaborative to advance primary healthcare services through technology. She remarked, “By harnessing the collective wisdom and experiences of stakeholders at national and subnational levels, we can accelerate progress towards our shared goal of achieving equitable, accessible, and quality healthcare for every individual in Kenya.” All three women leaders acknowledged that their contributions are inspired by other women leaders, who have played pivotal roles in driving transformative change in improving health systems, paving the way for them to continue this path. Liz mentions being motivated by Ms Susan Nakhumicha, Minister of Health, Kenya, whose leadership led to the enactment of UHC legislation, including the Social Health Insurance Act and the Innovative Primary Health Act. The women governors of the 7 counties (of a total of 47 counties in Kenya) have prioritized health within their jurisdictions and provided perspectives aligning with the diverse needs of local contexts. She adds “When women occupy leadership roles at national and subnational levels, they transcend individual roles to work collectively and this ability to navigate between different levels of government facilitates unity and cooperation, for the common good and benefit of all.” Vivian shares her admiration for Dr.   Lydia Dsane-Selby, (distinguished medical doctor and former CEO, NHIA), Dr. Martha Ghansa-Lutterodt, (Chief Pharmacist and former Director, Technical Coordination at the Ministry of Health), and Dr. Cynthia Bannerman (Public health specialist and former Director Quality Assurance, Ghana Health Service), women leaders in Health from Ghana who have shaped her health systems thinking and career. They ensured that there was space for all women to grow. She adds “We collaborated cohesively to achieve substantial progress within Ghana’s health sector institutions, a practice we should uphold. Rather than regarding ourselves as rivals vying for space, we should prioritize working in harmony and peace. By maintaining this approach, I am confident that women will continue to make remarkable advancements.” Dr. Phuong draws inspiration from visionary leaders like Nguyễn Thị Kim Tiến, former Minister of Health with great enthusiasm for health reform such as hospital fee policy, hospital quality improvement and Madame Đào Hồng Lan, the current Minister of Health, whose leadership brought together the Ministry and other government sectors to prioritize healthcare needs and find solutions in the post-pandemic period amidst resource shortages. These JLN leaders also advocated for women to embrace change and perceive challenges as opportunities for personal and professional growth. They stressed the importance of utilizing available support and resources to continuously enhance skills and demonstrate capabilities. Mentorship plays a crucial role in guiding young women through their careers and fostering personal development. “A proactive approach not only helps women gain recognition but also opens doors to new opportunities, allowing us to become even stronger versions of ourselves,” – Phoung “By seeking out mentorship opportunities, women can benefit from the wisdom, guidance, and experience of other women who have already paved the way. Women in positions to provide guidance have a responsibility to

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NEWS March 18, 2024

Empowering Policy Reform through Shared Wisdom Beyond Borders: Kenya’s JLN Experience

JLN Network Manager

Authors: Isabella Maina, Rahul S Reddy Kadarpeta, and James Soki Joint Learning Network for Universal Health Coverage – JLN’s 14-year odyssey stands as a remarkable testament, fueled by the compelling narratives exchanged among fervent policymakers and practitioners steering health systems transformation in their respective nations, all in the relentless pursuit of universal health coverage (UHC). These narratives encapsulated the tacit knowledge acquired within their unique contexts, as they grappled with practical challenges that transcended the support of any ‘consultant’ or ‘technical assistance’. When these stories were shared among peers, a collective recognition of shared problems and challenges emerged, motivating them to collaboratively seek solutions. These stories, a potent force in themselves, became the driving impetus behind these leaders as they passionately championed the cause of UHC and achieved significant milestones along the way. In the case of Kenya, its association with JLN since 2009, proved to be transformative. Actively engaging with the JLN community, Kenyan policymakers/ practitioners gained invaluable insights from their counterparts in different countries. Participation in various JLN learning collaboratives enriched our knowledge base and co-produced innovative solutions in health financing, service delivery, and system efficiency. These shared efforts became a catalyst for innovation and informed decision-making significantly contributing to strengthening Kenya’s healthcare system. Kenya’s journey towards UHC began with the constitutional recognition of health as a fundamental human right in 2010. This guided the formulation of the Kenya Health Policy 2012-2030 and subsequent Health Sector Strategic Plans (HSSPs). The policy aimed at enhancing health outcomes and reducing disparities is supported by increased budgetary allocations to the health sector, reflecting a commitment to improve health infrastructure and explore innovative financing mechanisms. The establishment of the Social Health Insurance Fund (SHIF) replaced the National Health Insurance Fund (NHIF). Steps were taken to strengthen strategic purchasing alongside community-based primary healthcare underscoring Kenya’s comprehensive approach to achieving UHC. Responsive monitoring and continual adjustment of strategies through evaluation are ensuring the evolving health needs of its population are met. The lessons learned and solutions adapted from the network’s collective knowledge became instrumental in shaping some of these policies. We present here four highlights drawing from Isabel Maina’s learning experiences with JLN where Kenya was able to tailor and implement strategies that resonated with its specific context, resulting in advancements in UHC goals – improving healthcare delivery, and ultimately enhancing the well-being of the population. JLN PHC financing collaborative and country pairing with Ghana to advance Primary Healthcare Reforms in Kenya The UHC agenda in Kenya is premised on Primary Health Care – an approach that is considered from existing evidence as more efficient and cost-effective in the long run. The Government policy commits to PHC reforms through the establishment of Primary care Networks (PCNs) across all counties in Kenya. PCN is a network of primary care facilities (health centres and dispensaries) that are linked to a county primary hospital and the community units in their area of jurisdiction in the form of a hub and spoke model. The PCN aims to strengthen service delivery and create a seamless connection between PHC level and hospitals. For this ambitious reform agenda to be translated into implementation, the main question in the policy circles was “How to go about it? Where do we start?”  Actively engaged with the JLN, there was an awareness that Ghana – a JLN member country was experienced in the formation and use of preferred primary care provider (PPP) networks as an innovative approach to catalyze providers with enhanced capacity to deliver essential primary health care (PHC) services and to use resources more efficiently. The JLN PHC financing and payment collaborative in which Kenya and Ghana policy makers/ practitioners were participating created an opportunity for more learning between the two countries.  This collaborative, practitioner-to-practitioner learning and exchange was organized through virtual meetings in June 2020 between the Kenya team (Ministry of Health PHC team, health financing team, NHIF and selected County teams) and the Ghana PHC team. The Kenyan team learnt the nuances of how PCNs could be operationalized – the process of setting up functional PCNs, governance structures, the referral networks within and outside the PCN, the purchasing arrangements, management/ supervision, monitoring and evaluation of quality service delivery. Armed with this information, Kenyan policymakers developed guidelines for National implementation of the PCNs. Additionally, the best practices learnt from Ghana and other key learnings from the JLN PHC financing collaborative informed the PCNs implementation then in 12 counties – a journey that has currently culminated in the establishment of close to 120 networks across 39 counties. Kenya National Benefits Package design and Co-developing the JLN Benefits Package Revision Guide The moral question in Kenya, just like in many other countries on the UHC journey was ‘what to pay for’ in Kenya’s health system and how to arrive at the decision. Hence the journey towards the benefit package reforms was born, with the need to design an affordable, equitable, good-quality package of care for Kenyans in line with the Kenya constitutional guarantee of the right to health care services, and the right to the highest attainable standard of health. In 2018, the Ministry of Health, Kenya established a Health Benefits Package Advisory Panel with the mandate of defining a unified comprehensive and costed benefit package for Kenyans. The panel of experts included JLN practitioners from Kenya and practitioners with expertise from JLN member countries. Further, the Kenyan technical staff used this experience to inform the development of the JLN Health Benefits Package Revision Guide in 2022 (Making explicit choices on the path to UHC – the JLN Health Benefits Package Revision Guide). During this, Kenyan practitioners participated alongside those of   Ethiopia, Ghana, Nigeria, South Africa, Sudan, Bangladesh, and India in contributing to the product that would hence guide nations in the revision of the benefits package, demonstrating the symbiotic relationship between JLN and Kenya. JLN Knowledge Products Adaptation and Implementation Kenya adopted and implemented JLN knowledge products to support its UHC journey. In 2018, the UHC-PHC Self-assessment Tool, Costing of Health

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NEWS February 15, 2024

Navigating the Labyrinth: Unlocking Effective PHC Performance Management in Low-Resource Settings

JLN Network Manager

Authors: Jerry La Forgia[1], Jonty Roland[2], Anuska Kalita[3], James Soki[4], Rahul S Reddy Kadarpeta[5] Investing in Primary Healthcare (PHC) is more than just a financial commitment. Leaving no one behind is a central promise of the 2030 Agenda for Sustainable Development. A well-designed PHC system can act as a platform to integrate last-mile service delivery to provide comprehensive health services for the realization of Universal Health Coverage (UHC). It also addresses determinants of health, enhances health security, and ultimately leads to better health outcomes for all. Countries that build and maintain robust PHC systems position themselves as resilient entities capable of weathering future health shocks and effectively detecting and preventing epidemics while addressing the growing incidence of chronic diseases. Despite the evident benefits, the unfortunate reality persists in many countries where PHC systems remain unreliable, under-resourced, of poor quality, and lack accountability to users. Issues such as stockout and absenteeism plague these systems, undermining their potential impact. The disparity in healthcare infrastructure further widens the gap in health outcomes, disproportionately affecting vulnerable populations. The Tracking Universal Health Coverage 2023 Global Monitoring Report highlights that, as of 2021, approximately half of the world’s population – 4.5 billion people – were not covered by essential health services. Furthermore, in 2019, about two billion people experienced financial hardship due to out-of-pocket spending on health, including 344 million people living in extreme poverty. To fully harness the potential of PHC and elevate healthcare outcomes, country case studies from the PHC Performance Initiative (PHCPI) as well as other research, indicate a key role for effective performance management to ensure the delivery of sustainable and high-quality PHC services. PHC performance management consists of a set of formalized organizational processes supported by individual managerial skills that enable subnational health managers and leaders to continuously and routinely implement and adapt improvement efforts in PHC units and services.  More specifically, effective performance management entails monitoring inputs, processes and outcomes while engaging and providing actionable feedback to PHC providers to foster practical solutions aimed at continuous improvement. At the heart of creating an enabling environment for PHC, performance management is strengthening sub-national and district-level leadership through enhanced management, supervision and engagement with front-line providers as well as communities. These leaders act as architects of performance improvement in orchestrating the intricate changes in healthcare delivery at the local level. They are instrumental in ensuring that healthcare facilities are adequately equipped, services are provided promptly and of acceptable quality, healthcare professionals are motivated and engaged, and the community’s needs are met effectively. By championing evidence-based decision-making through implementing and acting upon performance metrics, district leaders can catalyze significant improvements in PHC services. Additionally, fostering collaboration between district leaders, healthcare professionals, and communities can create a synergy that enhances continuous improvement. Enabling these district leaders involves providing adequate training, resources, and support to empower them to make informed decisions that positively impact PHC performance. There are various improvement building blocks that countries have taken to strengthen PHC performance management and, ultimately, their PHC systems, depending on their context. These experiences have shed light on key organizational and managerial pathways essential for elevating PHC in low-resource settings.The three interlocking pathways are mentioned below: Formalized Processes and Tools for Data Management: The application of formalized processes and tools lays the foundation for robust data measurement and collection. Key processes include setting and tracking targets, implementing supervisory systems, conducting performance reviews, providing constructive feedback, promoting effective follow-up on agreed actions and engaging stakeholders effectively. By embracing structured methodologies reinforced by practical tools, healthcare organizations can enhance their capacity to gather meaningful data, monitor progress, and engage stakeholders collaboratively, fostering a culture of transparency and accountability. Strengthening Managerial “Hard Skill” Capacities: Managerial “hard skill” capacities address core competencies crucial for effective performance management in PHC. This includes bolstering skills in data measurement, analysis, and interpretation, and planning and organizing work processes. Additionally, they also entail developing supervisory arrangements and embracing digital monitoring and visualization tools, thereby enabling healthcare leaders to develop and implement the aforementioned management processes with analytical precision and strategic foresight. Cultivating Managerial “Soft Skill” Capacities: Managerial “soft skill” capacities embrace the human element as pivotal in driving performance improvement. These involve fostering trust and teamwork among PHC staff, facilitating transparent communication on plans and targets, and engaging in collective problem-solving. More broadly, soft skills development emphasizes cultivating change management and leadership competencies, empowering leaders to coach, motivate, and guide health workers in addressing challenges and achieving their targets, thereby creating a learning organization based on a performance-oriented organizational culture. JLN’s Primary Health Care Performance Management Learning Collaborative intends to draw together national and sub-national leaders of primary care services to examine and implement more effective PHC performance management using a combination of three interlocking pathways. Learn more about this initiative here [1] Chief Technical Officer and Founding Director, Aceso Global [2] Associate Director, Aceso Global [3] Health Systems Specialist, Harvard School of Public Health/Consultant WHO on Primary Healthcare-Implementation Solutions [4] Program Manager JLN for UHC [5] Executive Director JLN for UHC

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NEWS

JLN’s Collaborative Learning Approach Highlighted: Health Systems Strengthening Practice Spotlight

JLN Network Manager

Authors: Folsom, A. and Ewald, L. JLN’s collaborative learning approach highlighted in this Health Strengthning Systems Practice Spotlight. Over the past 15 years, multiple collaborative learning networks have launched to support health systems strengthening. This brief introduces collaborative learning as an effective approach to support sustainable health system strengthening. Collaborative learning brings together local leaders and experts to learn from one another, problem-solve, co-create new knowledge, and adapt and apply their learning. Collaborative learning can be incorporated within HSS programs as an alternative or complementary model of technical assistance. With strong participant engagement and effective facilitation, it has the potential to strengthen health systems and accelerate progress towards improved health outcomes in low- and middle-income countries. Reference: Read Full Brief Here!

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