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NEWS January 28, 2025

Webinar: Achieving Universal Health Coverage in Urban Settings: Incentives, Challenges, and Opportunities

Web Master

Cities in low- and middle-income countries are experiencing significant expansion. The World Bank estimates that India’s urban population will increase by 40% by 2036, necessitating an investment of $840 billion in infrastructure over the next five years. Given the urgent challenges related to urban health, how can low- and middle-income countries ensure access to integrated, quality, and affordable health care in line with their goal of achieving Universal Health Coverage (UHC)? This webinar, co-hosted by Management Sciences for Health and the Joint Learning Network, will focus on “Achieving Universal Health Coverage in Urban Settings: Incentives, Challenges, and Opportunities.” It will address emerging issues in urban health in India, Malaysia, and Bangladesh. The discussion will deliberate on innovative financing strategies for population health in urban areas, approaches to reducing out-of-pocket expenses, and how to leverage development finance to achieve equity and efficiency in healthcare delivery. Participants will also be able to engage in a Q&A session during the latter half of the webinar. For more information, click here. Register Now

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NEWS January 24, 2025

Understanding priority setting, resource allocation and financing trends for health: JLN Knowledge Product Showcase Series 

JLN Network Manager

Authors: Vrishali Shekhar, Dr. Daniel Darko The JLN Knowledge Product Showcase Series (JLN- KPSS) was launched to provide the JLN community with greater exposure to JLN’s recently concluded and ongoing work. This seminar series enables key decision-makers and policymakers to become better acquainted with available JLN products and approaches for development. It also demonstrates products that can be scaled in their respective countries as sustainable innovations to attain their UHC priorities. During a recent session of the JLN KPSS, members addressed the critical global challenge of strengthening health financing systems and improving health system resilience amidst evolving health priorities. The relevance of these JLN resources is underscored in the context of the global decline in public health spending post-COVID-19, and the persistence of catastrophic out of pocket health spending which poses a significant barrier to UHC thereby emphasizing the need to prioritize public financing and improve budget execution. The session spotlighted two popular JLN resources produced under the World Bank led Health Financing Technical Initiative; the Health Priority Setting and Resource Allocation (HEPRA) toolkit (produced under the Efficiency Collaborative) and the Narrative Summaries on Public Expenditures for Health (produced under the Domestic Resource Mobilization Collaborative). These tools, developed collaboratively with inputs from several JLN member countries including Bangladesh, Kenya, Indonesia, and Ghana, aim to enhance evidence-based decision-making and policy dialogue.   The session began with providing an overview of the two respective JLN resources. The HEPRA toolkit has 36 questions that comprise a structured mechanism to assess and visualize how systematic and evidence based the various existing health sector priority setting mechanisms are in a country and whether resources are allocated on the basis of the priorities that are set. When administered across multiple countries and/ or over the course of time, the tool’s output allows benchmarking across countries, monitoring progress, and identifying areas where targeted efforts can be made for improvement. Developed collaboratively with ten countries, the practical application of the toolkit included enabling more effective policy dialogue, identifying areas for capacity building, and monitoring progress in linking priority setting to resource allocation.  Complementing this, the Narrative Summaries are concise and comprehensive briefs of a country’s historical trends in health spending and domestic resource mobilization reforms that can support evidence- based decision making amongst government policymakers and help facilitate fiscal discussions, especially between Ministries of Health and Finance. These summaries leverage historical and global data to evaluate fiscal space, public health expenditures, and their alignment with national health outcomes. Each summary is customized to country needs and focused on evaluating trends in health expenditure, fiscal space, and drawing sectoral comparisons. The process of creating summaries involved collaboration with local stakeholders, enhancing capacity and promoting ownership.  The session underscored the practicality of these tools through country-specific experiences. Bangladesh emphasized the application of the HEPRA toolkit in revising its health financing strategy and aligning it with its Universal Health Coverage (UHC) roadmap. The country highlighted pilot programs transitioning donor-funded initiatives, such as tuberculosis treatment, to government-led frameworks.  Ghana presented its use of narrative summaries to evaluate the decline in health budget allocations and advocate for increased investments in health, demonstrating the resources’ role in identifying gaps and informing policy. Despite challenges such as declining budget allocations and insufficient tax revenues, Ghana has used these tools to benchmark progress and engage in policy advocacy.  Panelists from Kenya and Indonesia echoed the value of these tools, recognizing their potential to enhance transparency, improve resource allocation, and promote policy coherence. Discussions also highlighted the broader implications of budget execution on health outcomes and the importance of sustained advocacy to ensure alignment between health system priorities and resource availability.  The session demonstrated the relevance and adaptability of JLN tools in diverse country contexts. The development of the tools through co-creation by several JLN member countries ensured that they address real-world challenges faced by countries in similar scenarios in the low- and middle-income country context. Importantly, the JLN resources demonstrated their usability by helping identify areas for targeted efforts, providing actionable solutions while continuing to allow an opportunity for cross-country learning. They can also be resources for health policymakers to engage with finance ministries and other stakeholders more effectively. Finally, in the context of depleting financial resources and conflicting priorities, these knowledge products stress the need for countries to prioritize domestic resource mobilization and improve budget execution to sustain health system progress.   About the authors:  Vrishali Shekhar, Focal Point for Country Engagement and Country Core Group Activities, World Bank JLN team Naina Ahluwalia, Focal Point of JLN Efficiency Collaborative Aditi Nigam, Focal Point of JLN Domestic Resource Mobilization Collaborative Dr. Daniel Darko, Deputy Director, Financial Accounting, NHIA, Ghana  Contributors:  Naina Ahluwalia, Focal Point of JLN Efficiency Collaborative  Aditi Nigam, Focal Point of JLN Domestic Resource Mobilization Collaborative  Dr.Subrata Paul, Health Economics Unit, MoH, Bangladesh  Dr.Elizabeth Wangia, JLN Country Core Group Chair & Head, Health Financing, Ministry of Health, Kenya.   Bu Suciati Mega Wardani, Expert Staff of Director, BPJS Kesehatan/ National Social Security Agency of Indonesia 

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NEWS January 7, 2025

Shaping Resilient Health Systems: JLN’s Strategies for Tackling Health Challenges in a Changing World

JLN Network Manager

Author: Rahul S Reddy Kadarpeta, Mahlet Gizaw, Adwoa Twum, Jonty Roland Healthcare needs are rapidly evolving across the world, driven by a combination of emerging global health threats, shifting demographics, climate challenges and technological advancements. Countries must continuously adapt and prioritize the limited resources to meet the changing healthcare needs of their population.  COVID-19, and more recently, Mpox are defining moments in global public health, which have prompted investments of many nations in building resilient health systems including early warning systems, vaccine distribution networks, and pandemic preparedness. Despite the warning signs, the Global Health Security Index found that no country was fully prepared for a pandemic as of 2021.  Increasing life expectancy is also influencing a demographic shift in the population and in 2021, 727 million people were aged 65 or older globally. This estimate is projected to more than double by 2050 with 68% of the population expected to reside in an urban setting. These trends are likely to increase the risk for non-communicable diseases along with the global demand for primary healthcare and long-term care services, is expected to increase by 50% by 2030.  Further, climate change has been recognized as a major threat to global health and the Lancet Countdown Report 2023 revealed climate-sensitive diseases like malaria, dengue, and heat-related illnesses are on the rise, especially in low- and middle-income countries (LMICs).  In addition, there is an observed surge in use of technology, telemedicine and digital health tools globally, including the recent emergence of artificial intelligence (AI) for early detection of diseases like cancer, improve diagnostic accuracy, and optimize treatment plans.   As healthcare systems across the globe grapple with these ever-evolving challenges, the Joint Learning Network for Universal Health Coverage (JLN) is working with policymakers and practitioners from across 40 member countries to collectively find solutions to address some of these. JLN’s technical focus has centered on tackling key challenges in these areas including climate and health, emergency preparedness, digital health and primary healthcare. This direction aligns with the recommendations from the ‘Summit of the Future’ held in September 2024, which served as a pivotal moment to accelerate progress towards the 2030 Agenda for Sustainable Development, catalyzing focus on the “how” of global cooperation for addressing emerging opportunities and risks. Particularly for health-related goals, this has provided stakeholders valuable lessons to reimagine health systems, prioritize resilience, and invest in innovations that enable countries to work towards building more equitable, inclusive, and sustainable health systems. This journey is complex and multidimensional, and JLN supports member countries to work collectively to accelerate progress. In this blog we explore how JLN is amplifying its contributions to this discourse and supporting global efforts.  JLN’s recent technical offerings include learning collaboratives on climate and health, emergency preparedness, digital health and primary healthcare. These areas have been recognized as priority needs from member countries during the JLN’s 2022 annual Country Core Group surveys and these continue to be reflected in the recent surveys. As a part of the process for each learning collaborative, country practitioners and policymakers identify key priority areas where there are knowledge gaps or country priorities, share experiences of pragmatic solutions, and document them in knowledge products that can be adapted and implemented.   1. Climate and Health  A recent report on the cost of inaction for climate change estimates that the deaths caused by climate change in Low- and Middle-Income Countries could reach between 14.5 and 15.6 million by 2050. Nearly half of this burden is projected to be in Sub Saharan Africa with a quarter of it estimated to be in South Asia. The Climate-Smart Health Systems Collaborative  brings together mid- to senior-level government practitioners from 21 countries – Bahrain, Belize, Bhutan, Colombia, Egypt, Ethiopia, Fiji, India, Indonesia, Lao PDR, Malaysia, Mongolia, Morocco, Nigeria, Papua New Guinea, Peru, Saint Lucia, Sao Tome and Principe, Senegal, the United Arab Emirates, and Vietnam for peer-to-peer learning to address challenges related to climate and health. Facilitated by the World Bank in collaboration with Australia’s DFAT, USAID, Government of Japan and the Gates Foundation, the collaborative enables policymakers to learn from each other on building climate-smart health systems, climate change adaptation, resilience, and mitigation in the health sector, as an integral part of country efforts to achieve Universal Health Coverage (UHC). The knowledge products prioritized for co-production by the member countries for the first year of the collaborative focus on governance, financing, and data and accountability. Under governance, members are co-developing a how-to guide for implementing climate and health governance across multiple levels and within appropriate institutional structures. For financing, members are co-developing knowledge products on making the case for investment in climate and health, as well as a repository of costing, budgeting, and Public Financial Management (PFM). Regarding data and accountability, members are co-developing a toolkit to help analyze multiple data sources from various sectors and enable policy actions based on this integrated data and a repository of guides to support climate-smart health facilities. For the second year of the collaborative, member countries have expressed interest in co-developing knowledge products focusing on multisectoral action, engaging communities and service delivery models.   2. Health Emergency Preparedness  The COVID-19 pandemic has driven home the importance of health emergency preparedness. While that understanding is undisputed, countries face a myriad of challenges in turning it into reality. These challenges take many forms, ranging from the conceptual (e.g., what constitutes health emergency preparedness versus what constitutes more generalized health system strengthening) to the operational (e.g., how to build effective and well-prioritized health emergency preparedness components into broader health planning efforts and particularly into primary health care (PHC) systems). The Health Emergency Preparedness Collaborative brings together frontline practitioners and policymakers from 18 countries namely: Bhutan, Cambodia, Ethiopia, Ghana, Indonesia, Kenya, Lao PDR, Lebanon, Liberia, Malawi, Malaysia, Nigeria, Pakistan, Philippines, Solomon Islands, Tajikistan, Togo and Zambia, for peer-to-peer learning to address challenges in this space.  Facilitated by the World Bank with technical inputs from Resolve to Save Lives, the collaborative facilitates learning to improve the design and implementation

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NEWS October 1, 2024

Evaluating the Impact of Learning Networks: Insights from the JLN

JLN Network Manager

Author: Donnelly Mwachi, Amanda Folsom, Mahlet Gizaw and Rahul Kadarpeta The JLN is a country-driven network of practitioners and policymakers from 40 countries across the globe who come together to problem solve, co-develop global knowledge products, and implement solutions that help bridge the gap between theory and practice. This collective wisdom of network members is harnessed to address complex health systems challenges ultimately accelerating progress towards Universal Health Coverage (UHC). The joint learning approach evolved over a period since 2010, when JLN was launched, drawing on several global best practices in action-oriented adult learning. It emphasizes a locally led approach, where country practitioners determine priorities, set the learning agenda, and co-develop effective strategies and promising practices. Knowledge exchange among countries is organized into learning exchanges (3-6 months) and collaboratives (18-24 months). Technical facilitators play a critical role, providing organizational capacity and analytical rigour to help countries frame issues and articulate their insights in a structured manner. The JLN encourages flexible thinking, enabling practitioners to synthesize new knowledge into knowledge products – including tools, assessments, policy analysis frameworks, decision-making tools, implementation guidance, and case studies – that serve the needs of the country participants who co-created them and become global public goods for the global health community. Challenges in evaluating learning networks, such as JLN Practitioner-to-practitioner learning, managed by knowledge exchange networks or platforms, is emerging as a key pathway for building in-country capacities and contextualizing global best practices for strengthening health systems and sustainable health reforms. However, the empirical evidence on influence of these initiatives is scarce because of the challenges faced in measuring their impact. Measuring the impact of such networks can be challenging due to several factors. First, these networks often consist of a diverse range of practitioners with varying levels of expertise, and organisational backgrounds. The fluid nature of membership, with participants joining or leaving, makes it difficult to track and measure consistent outcomes over time. In addition, the ‘intangible’ benefits of developing connections with peers through the network and maintaining them, even after participating at network related activities, are difficult to measure. Further, the impact of knowledge exchange in these networks may not follow a linear path and can be diffuse, with knowledge being applied in varied contexts and at different times. This makes it hard to attribute specific outcomes directly to the network’s activities or interventions. Evaluating their effectiveness requires a comprehensive understanding of their design, functionality, and focus on purpose, membership, and knowledge-sharing mechanisms. Other challenges include the complexity, indirect and distributed nature of networks, including the long time it takes to achieve systemic changes.

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NEWS September 30, 2024

Spotlight on Bangladesh CCG

JLN Network Manager

Bangladesh has been a valuable member of the JLN since 2015 and became a Full Member in 2017. The country has made great strides in their UHC journey tapping into the JLN and also contributing immensely by sharing their experiences that have helped others in the Network. There are ongoing healthcare reforms that involve reviewing of the Health Financing Strategy that will be key in informing the health priorities of the country. The current priorities include health financing with a focus on resource mobilisation; improving the primary care service delivery; and building a telemedicine system. Bangladesh has been prompt in participating in JLN activities besides learning by responding to surveys that help shape the JLN technical priorities and also responsive to requests to share UHC information from the country to JLN. They have actively participated in the Steering Group elections and even served as a member. In forming the Country Core Group (CCG), the country strives to always ensure diversity of the team. Currently, members consist of experts and officials from various sectors and institutions in the health sector. These include the Health Services, Health Economics, Finance, Planning, Health Information, Program Management, Academia and Development Partners. The CCG meets at least 4 to 5 times a year. Due to the multifaceted roles of the members that are mostly drawn from the civil service, it necessitates efficient coordination and flexible scheduling of meetings to ensure the active and vibrant participation of CCG members in JLN initiatives amidst their busy schedules and diverse professional engagements. Bangladesh is very proactive in engaging in JLN learning opportunities. They have been members of the following collaborative- Efficiency; Domestic Resource Mobilization; Primary Health Care Financing and Payment; Negotiated Solutions for Purchasing of Expensive Medicines; Primary Health Care Measurement for Improvement; Population Targeting; and National Coordination of Pandemic Response. They have also participated in the following learning exchanges: Institutionalising Explicit Processes for Setting National Health Priorities; Primary Health Care Financing and Payment; Budget Execution; Strategic Communication; Implementing and Measuring the Performance of Primary Care Networks (PCNs); Pricing Strategies for Medical Products; and Patient Pathways and Pandemics: COVID-19 and Beyond The CCG has a process in place that ensures the dissemination of learnings that involves filling a form that provides feedback to the Minister and sharing learnings at different forums. This keeps the top senior officers (Minister and Secretary) in the loop of what is going on in the JLN. The JLN Knowledge Products resulting from the collaboratives the members participate in are sent to the relevant ministries. In the wake of COVID 19 which resulted in online engagement in JLN learnings, this posed a great challenge for members’ participation and hence are excited about the return of the in-person engagements. Bangladesh has benefitted greatly by using JLN Knowledge Products such as the Costing of Health Services for Provider Payment: A Practical Manual based on Country Costing Challenges, Trade-offs and Solutions. Most recently, they have developed the Health Benefits Package using the JLN Making Explicit Choices on The Path To UHC: The Health Benefits Package Revision Guide. The country has also piloted some Knowledge Products produced by the Efficiency Collaborative and hopes to scale up once funding is secured to measure efficiency at different levels of the health system. Going forward, the country is planning to establish a  Social Health Insurance Scheme for public servants but many citizens are in the informal sector hence a need to develop a benefit package for the informal sector. The CCG is looking to support the process using JLN Knowledge Products. Other areas of interest that JLN products are needed include:       Guidance for targeting the informal sector.       Negotiating for pharmaceuticals and essential medicines as current contracts come to an end The great work of the CCG has not been without challenges such as:   Transferred of CCG member s to other offices and ministries, this necessitates reconstitution and this disrupts the operations. However, the CCG mitigates this by sensitising new members on JLN once they come on board.   Competing responsibilities with the roles of the CCG, affects the active and effective participation of members.  Transfer of members who participate in learnings and who were members of the CCG leads to loss of knowledge.  Poor participation of members in online engagements  We applaud the great efforts of Bangladesh in the JLN and specifically recognise that all this is possible due to the efforts and commitment of the CCG members that make a vibrant CCG.

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NEWS July 9, 2024

Digital Health Collaborative First Authors’ Workshop

JLN Network Manager

The Digital Health Collaborative had its first Authors’ Workshop in Washington, D.C. from June 3-6, 2024. The workshop was attended by representatives from Collaborative member countries and special guests from digital health regional networks and organizations namely: RECAINSA, AeHIN, Africa CDC and HELINA. Representatives from Cambodia, Ghana, India, Indonesia, Malaysia, Nigeria, Pakistan, Senegal, and Tajikistan attended the workshop in person whereas representatives from Ethiopia, Kenya, and Ukraine attended parts of the workshop virtually. As a follow up to the Collaborative’s launch meeting, five workstreams were identified for co-development of knowledge products: 1) A playbook/ how-to guide on all levels of interoperability in health systems, including Health Information Exchange, 2) A how-to toolkit for digital health governance, 3) An annotated inventory of resources, 4)  A guide on private sector solutions, and 5) An orientation, evidence, and dialogue toolkit on making the case for digital health. The authors’ workshop focused on the first three workstreams. Workshop attendees participated in combined joint and parallel sessions with the objective of identifying key components and country experiences to be compiled and documented for each of the three workstreams. Specifically, they co-developed outlines for the interoperability and governance workstreams and provided feedback to a demonstration of an Artificial Intelligence (AI) companion for the inventory of resources workstream. Participants then identified the next steps for the remainder of the first year of the collaborative for each of the three workstreams. Upon completion of the workshop, members participated in offsite learning where they headed to the United States (US) Health Information Management System Society (HIMSS) National Capital Area chapter’s Health Innovation Summit, which included a digital health innovation marketplace and several talks by US digital health thought leaders. The World Bank provides technical facilitation for this Collaborative in partnership with the Digital Health Exemplars initiative, including the Center for Global Digital Health Innovation at the Johns Hopkins Bloomberg School of Public Health, eHealth Lab Ethiopia, the McKinsey Health Institute, Gates Ventures, and Exemplars in Global Health. Financial support for the Collaborative is provided by the Bill and Melinda Gates Foundation and the Government of Japan.

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