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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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NEWS

JLN Showcase – Sidelines of 77 World Health Assembly, Geneva

JLN Network Manager

South-South Collaboration: Harnessing Cross-Country Learning for Sustainable Health Policy Reforms, 27th May 2024 at the International Geneva, Welcome Centre On May 27th, the Joint Learning Network (JLN) took centre stage at a special showcase held on the sidelines of the 77th World Health Assembly in Geneva. Jointly hosted by JLN, UHC Delivery Lab and Amref Health Africa, with the support of UHC2030, the session was a vibrant platform for sharing impactful stories and discussing future collaborations. The event, attended by over 75 participants in person and 24 virtually, brought together policymakers, representatives from civil society organizations, pharmaceutical companies, UHC advocacy organizations, WHO, the Global Fund, Cochrane, and other stakeholders. The focus of the session was on the transformative impact of JLN in countries like Malaysia and Ghana. A representative from the Bill and Melinda Gates Foundation highlighted the critical value of investing in collaborative platforms like JLN. “South-South collaboration is a powerful tool for driving sustainable health reforms,” said Dr. Jean Kagubare, Deputy Director of PHC at the Bill and Melinda Gates Foundation. “Our investments show that cross-country learning not only accelerates innovation but also builds stronger, more resilient health systems. The real win is seeing these collaborations translate into tangible improvements in healthcare delivery and outcomes.” Dr. Anthony Ofosu, Deputy Director General of the Ghana Health Service, shared his experience: “Being part of the Joint Learning Network has been transformative for Ghana’s health system. The cross-country collaboration and knowledge sharing have significantly strengthened our policies, driving us closer to achieving universal health coverage.” Dr. Mercy Mwangangi, Senior Director of Health Systems Strengthening at Amref Health Africa, emphasized the importance of peer-to-peer learning facilitated by JLN, SPARC, and the UHC Lab. “Country pairing and coaching have been instrumental in fostering peer-to-peer learning, enabling countries to adopt best practices and tailor them to their unique contexts,” she noted. “Through our innovative learning platforms, we’ve seen firsthand how adaptive and participatory approaches can effectively address evolving health system challenges, driving sustainable reforms in LMICs.” Dinash Aravind from Malaysia’s Ministry of Health also shared insights on JLN’s impact. “JLN has been pivotal for Malaysia’s health system transformation, enhancing our policies and driving progress towards universal health coverage.” Dr. Ganda Gregory, County CEC, Health – Kisumu County noted that the Ethiopia-Kenya country pairing engagement facilitated by the UHC Delivery Lab had strengthened our Primary Care Networks, ensuring better health outcomes for our community through shared experiences and emerging lessons. The session highlighted the power of South-South collaboration in building resilient health systems and accelerating innovation, ultimately contributing to sustainable health reforms and improved healthcare delivery in low- and middle-income countries.

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NEWS July 3, 2024

JLN Knowledge Product Showcase Series – Spotlight on JLN Revision of Health Benefit Package Guide

JLN Network Manager

Authors:Vrishali Shekhar, Leon Bijlmakers, Jeanne-Marie Tucker The Joint Learning Network for Universal Health Coverage (JLN) is uniquely positioned in the global health space as an innovative community of country practitioners and policymakers from around the world actively engaged in exchanging tacit knowledge on challenges faced and co-developing pragmatic solutions to implementing universal health coverage (UHC) reforms. The co-created knowledge attempts to harnesses the in-field practitioner’s experience and expertise to develop the how-to’s of designing and refining efficient, equitable and sustainable healthcare systems, while contributing to the global knowledge resource for achieving UHC. The JLN proudly hosts a growing community of 39 member countries across the globe. Over the last 14 years, JLN has had at least 8,000 practitioners and policymakers interact on 50 technical initiatives or thematic groups resulting in over 65 knowledge products. The JLN technical offerings are used both by the member countries and non-member countries driving change in their health systems by helping address issues related to advocating for more health for money and more money for health; costing for provider payments; undertaking medical audits, designing IT systems, and how to assess primary care and integrating care, where appropriate. In this regard, the JLN is delighted to initiate the JLN Knowledge Product Showcase Series (JLN- KPSS), with the objective of providing the JLN community with greater exposure to JLN’s recently concluded and ongoing work.  The JLN KP Showcase Series provides an opportunity for the key decision and policy makers to get better acquainted with available products and approaches for development and scaling of sustainable innovations for the attainment of UHC priorities in their respective countries. It also aims to develop a thriving ecosystem by providing a platform to JLN member countries to share their experiences of documented successes and challenges in the adaptation and implementation of JLN Knowledge Products, hence fostering collaboration and knowledge sharing within the JLN community. Making explicit choices on the path to UHC – JLN Health Benefits Package (HBP) Revision Guide, the latest product of the JLN Efficiency Collaborative under the umbrella of the Health Financing Technical Initiative, was developed based on experiences from 18 countries, featured in the first event of the JLN-KP series. The event was aimed at introducing the technical aspects of the knowledge product as well as illustrating successful examples of adaptation and implementation of the Guide by highlighting country stories of Ghana, Ethiopia, South Africa and Kenya. About the Guide: The lead technical facilitator, Dr. Leon Bijlmakers highlighted the universal quest for countries to explicitly define publicly funded essential services given their fiscal constraints to create a sustainable system of UHC as the motivation behind the development of the knowledge product. The dynamic nature of the HBP is on account of the evolving nature of disease burdens and epidemiological patterns; economic cycles and their impact on fiscal budgets; availability of innovative service delivery mechanisms; and overcoming implementation challenges. Such trends compel regular revisions of the HBP to ensure efficient allocation of fiscal and human resources for the delivery of healthcare. Experiences from countries suggest that any HBP revision is reflective of local circumstances and the prioritization of services needs to be evidence based to make it a rigorous and transparent process. It goes without saying that countries face various challenges during the process of HBP revision and the Guide offers a basket of tailored methodological approaches (e.g., whole package review, partial review, incremental analysis, or a rapid review) for countries to choose from to overcome implementation concerns related to affordability and efficiency of HBP revisions.  The Guide also offers guidance on how to go about collecting and interpreting different sets of data and evidence that is crucial for achieving high quality of HBP revision related decision-making. Finally, the Guide underscores the importance of maintaining policy dialogue, establishing communication and appeal mechanisms to warrant that all stakeholders (particularly the Ministry of Finance) are aligned in the process, as well as conducting regular monitoring and evaluation of all revisions, once implemented. Customizing the HBP revision process in local country contexts is an ongoing challenge, hence it becomes imperative for countries to learn from other countries which face similar challenges and have a comparable decision-making context. In this respect, the session provided inspiration and practical guidance from the experience of four countries on how to organize the HBP process; the analytical approaches and the types of data and evidence used in the decision- making process; how to engage in effective and sustaining policy dialogue; and institutionalizing periodic HBP revisions.  Country Spotlights: The Ghanaian experience with the Guide elaborated on the process of reviewing the 5% explicitly excluded diseases conditions from the benefits package designed by the National Health Insurance Scheme. The National Health Insurance Authority (NHIA) which manages the scheme is mandated by law to review the implicit benefit package that currently covers 95% of the diseases on a periodic basis. Ghana’s story underlines the importance of documentation of the revision process for standardization, ease of reference, transparency and avoiding ad-hoc changes to the benefits packages. Additionally, the cost-effectiveness of inclusion requests is assessed to ensure the sustainability of the scheme. Going forward, NHIA is looking to implement an important recommendation of the Guide by establishing a priority setting mechanism to assess inclusions by leveraging the existing structure and outputs of the Health Technology Assessment in the Ministry of Health. Ethiopia’s illustration of the adaptation and implementation of the Guide highlighted the need to conduct a fiscal space analysis for the effective implementation of the Ethiopian Essential Health Services Package Revision. Ethiopia applied the seven principles as outlined in the JLN Guide to revise their benefits package including disease burden, cost effectiveness, equity, financial risk and protection, budget impact, public and political accountability and acceptability hence making the process participatory, inclusive, and evidence based. The process identified 1,018 health interventions from an initial list of 1,749 and ranked around 56% of them as high-priority interventions. Cost estimation of the interventions recognized a 30% budget gap in the fiscal space, rendering

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