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NEWS July 1, 2024

JLN Champion -Spotlighting Stefan Nachuck, Universal Health Coverage Champion

JLN Network Manager

Over the last twenty years, since I entered the public health space at the Rockefeller Foundation, the JLN has been a big part of my life. The first round of learning collaboratives, which stretched from 18 to 24 months, taught us a lot collectively about what worked, and what didn’t, and why. In the best cases it was “magic”, and you could feel the positive energy in the air and see the results in terms of quality collective technical outputs combined with application to national reform efforts. Some of our basic takeaways regarding “how to do this right” after the first round of learning collaboratives, included: Approaches can vary, but objectives matter. Everybody in the room needs to have a north star in terms of ultimate outputs and how these might be used. Community matters in the sense that the long-term payoff is in creating a lateral community of technocrats and academics who can and will continue to collaborate, formally or informally. Facilitators matter a lot. Good facilitation means being a good combination of Einstein (technically strong) and Mother Theresa (strong social and community-building skills). Some have it, and some don’t. Co-production matters. If facilitators do all the work, then there is no sweat equity and thus little real learning happening. Collaborative membership matters. This means that one needs consistent engagement from the same people over the life of a learning effort. If individual members are bouncing in and out of a collaborative, the value of the work declines precipitously. Donors matter, to the extent that many funding streams tend to focus on discrete project-focused efforts, and not on building robust, results-oriented south-south communities. Since then, the JLN has grown massively, taking on many more members than the original six countries that participated in the very first collaboratives. And the range of topics and approaches undertaken to date is quite breathtaking. In retrospect, the smartest thing we probably did was simply to engage in active listening with country members who wanted something like this to exist. Instead of starting with “priors” in terms of “how development should work”—we asked people what would be most suitable for them, and then did our best to experiment and optimize around those basic demands. It’s been an honour to be associated with JLN all these years, and I look forward to an exciting future—this story is far from complete. Stefan Nachuck now works with Morris Brothers LLC, USA. He was with Rockefeller Foundation in 2008/2009 when he spearheaded the launch of JLN along with R4D, the World Bank, GIZ, Access Health International and country representatives from Ghana, Thailand, Vietnam, and India.

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NEWS

South-South Collaboration: Harnessing Cross-Country Learning for Sustainable Health System Policy Reforms

JLN Network Manager

Authors: Titus Kisangau, Rahul S Reddy Kadarpeta, Cynthia Waliaula, Rispah Walumbe  Enhancing capacities in health systems strengthening is critical to achieve sustainable health systems reforms towards Universal health coverage (UHC). Traditional methods for capacity building and knowledge exchange often adopt didactic approaches. They assume that technical requirements are static and the need for tailored solutions is for specified timeframes for policymakers and practitioners. However, the ever-evolving technical obstacles in achieving reform objectives and the diverse spectrum of policymakers engaged in this process challenge such conventional approaches.i   A participatory knowledge production process provides stakeholders with dynamic insights, enhancing their capacity for effective problem-solving and addressing future challenges. Cross-country learning, as a method for knowledge sharing and learning aims to build sustainable capacities among policymakers and practitioners involved in health policy reforms within the low- and middle- income country context. This approach recognizes various trajectories associated with achieving sustainable reform, acknowledging the contextual variations and shared elements across countries.  This blog delves into the practical insights from countries into the application of diverse cross- country learning approaches for countries from the global south. This presents a synthesis of the discussions held during the 77th World Health Assembly 2024 – Side session “South-South Collaboration – Harnessing Cross-Country Learning for Sustainable Health System Policy Reform” organized by Joint Learning network for Universal Health Coverage (JLN) and UHC Delivery lab anchored by Amref Health Africa on 27 May 2024, Geneva. The session attracted attendance of 100 global health leaders and public policy practitioners drawn from Ministers of health, policymakers, global health experts drawn from various development partners/ organizations  exploring novel ideas for investments, NGOs, Civil society organizations, researchers and academia convened to examine south-south partnerships as an enabler of enduring reforms in national systems. 

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NEWS June 27, 2024

Advancing Universal Health Coverage in Malaysia: Harmonizing Country Priorities with Collaborative Learning

JLN Network Manager

Authors:Dinash Aravind, Premila Devi Jeganathan, Khor Shu Lin, Mohamad Azim Mohd Azmi, Isha Sharma, Jane Nyambura, Rahul S Reddy Kadarpeta As countries progress towards UHC, it’s crucial to understand that the goalposts are dynamic. UHC represents not just a destination, but a continuous journey aimed at enhancing health system performance to achieve equitable population health and ensure financial risk protection¹ . It is essential to contextualize global learnings on UHC and make them relevant to enhance the capabilities of in-country stakeholders, especially policymakers, technical leaders, and practitioners. This enables them to appreciate the diversity of their country’s local health systems, identify problems, and address them with context-specific solutions. It is crucial to tailor reforms as health systems evolve dynamically. JLN operates on this premise, and in this blog, we share JLN’s contributions towards strengthening Malaysia’s capacities to progress towards UHC. JLN adopts a country-driven and joint learning approach that engages practitioners in learning from each other to address challenges as well as co-produce practical solutions for implementing UHC reforms. In this process, JLN prioritizes the specific needs of each country articulated in member countries’ policies and initiatives, when planning its technical offerings. Additionally, they are voiced in the JLN’s annual Country Core Group Survey, administered to each member country. These standardized and consistent institutional practices have enabled JLN to expand its membership from 6 countries in 2009 to 39 in 2024, remaining relevant in addressing emerging challenges through technical initiatives such as health emergency preparedness, digital health, contracting of health services, and primary healthcare performance management. Malaysia has been consistent on its pathway towards UHC. Health has always remained an important agenda of the government with it being an essential and integral part of Malaysia’s government policies. Over the years to address the need of the population, Malaysia has embarked on many initiatives to improve UHC through sharing of resources within an integrated network of hospitals, bringing healthcare closer to the community such as mobile clinics, ambulatory services, domiciliary care, rural low risk birthing centres, innovative value-added medicine supply services and various other initiatives². Among the Western Pacific region countries, Malaysia has improved its UHC service coverage index from 52 in 2000 to 76 in 2021. Malaysia is unique in the sense that while Out-of-Pocket (OOP) expenditure averages around 35%, the incidence of catastrophic health expenditures remains relatively low at 1.5%³.

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NEWS June 12, 2024

Press Release : JLN Steering Group Co-Convener Elected 

JLN Network Manager

The Joint Learning Network for Universal Health Coverage (JLN) is pleased to announce the election of Prof. Ali Ghufron Mukti, M.Sc., PhD, as the new Co-Convener of the JLN Steering Group. Prof. Mukti, who currently serves as the President and Director of Indonesia’s Social Security Administering Body for Health (BPJS Kesehatan), brings a wealth of experience and proven leadership to this vital role.  In his acceptance message, Prof. Mukti expressed his gratitude to the Steering Group members Country Core Group members, Amref Health Africa and various organizations, supporting JLN, including the World Bank, Bill & Melinda Gates Foundation (BMGF), and all other parties involved. He emphasized the collaborative spirit and shared commitment that has been pivotal to his election.  Prof. Mukti’s extensive experience in health administration and his successful implementation of Indonesia’s National Health Insurance Program are expected to significantly benefit JLN. Under his leadership, BPJS Kesehatan has achieved remarkable milestones, including:  Universal Health Coverage: Extending health insurance to 97% of Indonesia’s population, totaling 271.05 million members.  Financial Stability: Transitioning the national health insurance program from a deficit to a surplus.  Service Quality Improvement: Enhancing health service delivery by providing down payments to hospitals, increasing health service tariffs, and boosting patient satisfaction.  Reduction in Out-of-Pocket Expenses: Lowering out-of-pocket health expenditures from 49.7% to 25%.   Prof. Mukti is also recognized as a distinguished lecturer at several world-renowned institutions, including Oxford University, Harvard Medical School, and Johns Hopkins University.   “I hope I can bring this success story to JLN,” Prof. Mukti said. “I will certainly continue to establish good cooperation and communication ahead. I hope that JLN News and the Country Core Group Newsletter, as well as any type of meeting both online or offline, can always be used to communicate among us, to build new knowledge products, to consult, to assist, and to share practical experiences among JLN member institutions. I’m sure that JLN can be more advanced in the future.”  The JLN community welcomes Prof. Mukti’s vision and leadership and looks forward to advancing universal health coverage goals globally under his guidance, Ebrahim Al Nawakhtha Secretary General, Supreme Council of Health, Bahrain is the Convener of JLN Steering Group, and the other co-convener is Mr. Dinash Aravind, Senior Principal Assistant Director, National Health Financing, Planning Division; Ministry of Health, Malaysia   The JLN Steering Group guides the strategic direction of the network and ensures it is country-led and country-driven. 80% of the seats on the steering group are occupied by country representatives elected by the JLN member countries.   In 2024, representatives from Ethiopia, Ghana, India, Indonesia, Nigeria, Philippines, South Korea, Vietnam, Bahrain, Kenya, Malaysia, and Senegal are part of the Steering Group. This leadership structure is designed to foster a collaborative environment where countries can share their experiences and strategies for achieving universal health coverage and set the agenda according to identified 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.  Commenting on the election, Dr. Rahul Sankrutyayan Reddy Kadarpeta, Executive Director, JLN stated, “We are thrilled to have Prof. Ali Ghufron Mukti step into the role of Co-Convener of the JLN Steering Group. His impressive track record in advancing health coverage in Indonesia through innovative and effective strategies makes him an invaluable asset to our network. We look forward to his leadership in guiding JLN’s mission to achieve universal health coverage worldwide.    About JLN:    The Joint Learning Network for Universal Health Coverage (JLN) is an innovative community of policy- makers and practitioners from around the world engaged in practitioner-to-practitioner learning to address challenges and co-produce practical solutions to implementing reforms toward universal health coverage. Learn more   For More Information Contact:   Dr. Rahul Sankrutyayan Reddy Kadarpeta, Executive Director, JLN. [email protected]  

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NEWS June 10, 2024

JLN Champion -Spotlighting Adolfo Martinez Valle, Universal Health Coverage Champion

JLN Network Manager

Throughout my nearly 25-year professional career in public health, I have faced achievements and challenges as a champion of Universal Health Coverage (UHC). In my own country, Mexico, I oversaw planning and evaluation agencies for designing and implementing national health and social protection policies, including the 16-year-old insurance scheme targeted to the population not covered by social security -Seguro Popular and the 22-year-old conditional cash transfer program – Progresa/Oportunidades/Prospera. These programs, despite being recently cancelled, were instrumental in significantly reducing out-of-pocket and catastrophic expenditures, a testament to my expertise in financial management. They also played a crucial role in diminishing child and maternal mortality, improving access to health services and nutrition, and reducing extreme poverty. The most recent change in government in Mexico also left me needing a policymaker or implementer space to pursue further UHC in my own country. I overcame this challenge by continuing my academic career, which I began nearly twenty years earlier when I earned my doctoral degree at the Johns Hopkins University School of Public Health. I have been a professor and researcher at the National University of Mexico for the past five years, where I have published evidence on improving health systems’ performance. On the global stage, I have been an active and dedicated member of the Joint Learning Network for Universal Health Coverage (JLN) since 2015. This platform, which I am deeply committed to, has provided me with the opportunity to share my health policy experiences with a diverse range of members. I am particularly proud of my service on its Steering Committee, where I had the privilege of chairing it as the Convener from 2018 to 2021. One of my most memorable experiences was participating in a 2016 Kosovo workshop funded by the World Bank, where I collaborated with colleagues from Ghana and the Philippines. Back then, we were able to offer valuable insights on our experiences implementing national insurance schemes in our respective countries, which proved to be highly relevant to the health care reform efforts in Kosovo. Affordable quality care for everyone still needs to be achieved in my country, Latin America, and many other countries, including the JLN members. Mexico needs to rebuild its health system after suffering significant setbacks caused by the COVID-19 pandemic and a negligent federal government. Out-of-pocket expenditures are still high, public financing needs to be more efficient, and the Ministry of Health needs to be stronger. Fortunately, windows of opportunity still exist in the academic setting and through the JLN, where I can help set the path toward UHC both in my country and abroad. Adolfo Martinez Valle is a JLN Country Core Group (CCG) Member, Director General, Performance Evaluation, Ministry of Health, Mexico

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NEWS April 15, 2024

Bridging Knowledge Frontiers: The Role of JLN’s Strategic Communication for UHC Planning Tool

JLN Network Manager

Authors:Oswald Essuah-Mensah, Rahul S Reddy Kadarpeta , James Soki, Isha Sharma JLN’s technical initiatives are meticulously crafted to foster knowledge exchanges that adeptly address the priorities and needs of the member countries. These engagements embody practitioner-to-practitioner and cross-country learning, skillfully facilitated by technical experts and revered thought leaders. The focus is on delving into specific thematic issues, culminating in collective problem-solving endeavours. The result is a global knowledge product, curated from innovative ideas and best practices from tacit knowledge of the policymakers and practitioners transcending geographical boundaries. This transformative process empowers participating leaders to navigate the intricacies of healthcare challenges with a comprehensive global perspective. It not only fosters a profound sense of solidarity but also cultivates a shared commitment to the discourse on Universal Health Coverage (UHC). JLN has so far produced 45 plus knowledge products in over a decade, and in more than 30 instances these have been adapted and implemented to address health systems issues in countries. Strategic Communication for Universal Health Coverage: Planning Tool is one such knowledge product. This tool was an output of a JLN Learning Exchange “Institutionalizing Explicit National Priority Setting Learning Processes” developed by the JLN member countries in collaboration with the Health Finance and Governance (HFG) Project, with funding from the USAID. It was developed drawing lessons and experiences from eight-member countries including Ghana to help UHC policy champions and communicators in the design of comprehensive strategic communication plans. It guides communicators through a structured plan, outlining process and includes guiding questions specifically related to strategic communication for UHC. The tool was adapted and implemented by the Ghana National Health Insurance Authority (NHIA) in the country for the design of comprehensive strategic communication plans for the digitalization of member registration for expanding population coverage. NHIA was established under the National Health Insurance Act 2003, Act 650, later revised to ACT 2012, Act 852 with a mission to ensure basic healthcare services for all residents. It has the function of securing the implementation of a national health insurance policy that ensures access to basic healthcare services to all residents to attain universal health insurance coverage. Enrollment or registration of eligible households is an integral and crucial part of expanding coverage. This requires simplifying enrollment procedures, information campaigns, subsidies, user-friendly registration processes, and community engagement. Tailoring these strategies to Ghana country context and fostering collaboration between the NHIA with various stakeholders was vital for success. Learnings from several countries suggest that digital technological innovations could bridge access gaps and streamline the registration or enrollment process. As part of expanding population coverage, in December of 2022, the NHIA embarked on a digitalization of member registration. The MyNHIS App was developed to align with the government’s digitalization agenda. This underscores a commitment to leveraging technology to enhance healthcare delivery and accessibility, aiming to boost membership and advance towards UHC. Research had proven that some barriers to enrolment included the distance of registration points to members, and long queues that had to be navigated to enable new registrations or renewals. The cornerstone of this digitalization drive was the seamless integration of mobile and app-based platforms for member registration and renewal. With the implementation of the project planned from September 2021 to December 2021, it was important to ensure proper communication to the different stakeholders not limited to citizens, residents, healthcare providers and civil society organizations.   “Ghana being a member of the JLN since 2010, tapped into the JLN Knowledge products database and identified the Strategic Communication for Universal Health Coverage: Planning Tool. This tool provided a comprehensive framework for crafting strategic communication plans, tailored to promote digital products and services crucial for achieving UHC.” The communication strategy centered on convenience, speed, and empowerment of individuals through cell phones (for mobile renewals) and smartphones for the APP users. The communication was designed to fortify and amplify the policy, and digital innovations designed to attain UHC in Ghana. The intervention was presented as a new product to ensure convenience to members for efficient, convenient, and faster registration. The tool was modified and tailored towards marketing digital products and services offered by the scheme. Some of these were – the mobile renewal of membership (*929#) and the mobile app (MyNHIS App) for new registration, renewals, and linkage with the national Ghana Card) and for use with third parties as well. A major part of the tool was used especially with the illustrative communication channels where key messages were passed on to both primary and secondary audiences using traditional electronic media and the new media (social media channel) NHIA’s strategy unfolded in several well-orchestrated steps, from identifying the technological gaps to setting up a dedicated project team, and from developing culturally resonant key messages to piloting and large-scale rollout. A significant aspect of this strategy was the local translation of key messages, ensuring inclusivity and understanding across Ghana’s diverse linguistic landscape. The identification of key messengers, such as the corporate affairs directorate and regional and district Public Relation Officers, was crucial in conveying these messages effectively. As shown in figure 1.Fig 1: NHIA Strategy Implementation Journey: Steps and Key Components. The tool was detailed and easy to adopt at the country level. It highlights the importance of sustaining effective communication and government support in driving UHC. The mobile renewal service in Ghana has since won three prestigious awards and serves as the most convenient means to actively stay on the NHIS for about 80% of the members. The Mobile App has over 77,000 people signing up for themselves and third parties since its launch in December 2022. NHIA plans to use the tool as a communication guide to the NHIS as the scheme continues to develop new digital inventions to drive its membership. JLN’s exemplary support to member country-driven knowledge exchange including adapting and implementing knowledge products advance the mission towards UHC. The transformative journey of Ghana’s National Health Insurance Authority (NHIA) exemplifies the power of knowledge exchange and strategic communication in driving policy initiatives towards Universal Health Coverage (UHC).

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