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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

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!

NEWS January 26, 2024

Enabling cross-country learning and exchange to support universal health coverage implementation

JLN Network Manager

Lauren Oliveira Hashiguchi, Maeve Conlin, Dawn Roberts, Kathleen McGee, Robert Marten, Stefan Nachuk, Ali Ghufron Mukti, Aditi Nigam, Naina Ahluwalia, Somil Nagpal Health Policy and Planning, Volume 39, Issue Supplement_1, January 2024, Pages i125–i130, https://doi.org/10.1093/heapol/czad097 Published: 23 January 2024 Abstract As countries transition from external assistance while pursuing ambitious plans to achieve universal health coverage (UHC), there is an increasing need to facilitate knowledge sharing and learning among them. Country-led and country-owned knowledge management is foundational to sustainable, more equitable external assistance for health and is a useful complement to more conventional capacity-building modalities provided under external assistance. In the context of external assistance, few initiatives use country-to-country sharing of practitioner experiences, and link learning to receiving guidance on how to adapt, apply and sustain policy changes. Dominant knowledge exchange processes are didactic, implicitly assuming static technical needs, and that practitioners in low- and middle-income countries require problem-specific, time-bound solutions. In reality, the technical challenges of achieving UHC and the group of policymakers involved continuously evolve. This paper aims to explore factors which are supportive of experience-based knowledge exchange between practitioners from diverse settings, drawing from the experience of the Joint Learning Network (JLN) for UHC—a global network of practitioners and policymakers sharing experiences about common challenges to develop and implement knowledge products supporting reforms for UHC—as an illustration of a peer-to-peer learning approach. This paper considers: (1) an analysis of JLN monitoring and evaluation data between 2020 and 2023 and (2) a qualitative inquiry to explore policymakers’ engagement with the JLN using semi-structured interviews (n = 14) with stakeholders from 10 countries. The JLN’s experience provides insights to factors that contribute to successful peer-to-peer learning approaches. JLN relies on engaging a network of practitioners with diverse experiences who organically identify and pursue a common learning agenda. Meaningful peer-to-peer learning requires dynamic, structured interactions, and alignment with windows of opportunity for implementation that enable rapid response to emerging and timely issues. Peer-to-peer learning can facilitate in-country knowledge sharing, learning and catalyse action at the institutional and health system levels. Here is the artcle: https://academic.oup.com/heapol/article/39/Supplement_1/i125/7578675?login=false

NEWS January 23, 2024

Unlocking Insights: Exploring the Pinnacle of Knowledge – JLN’s Most Accessed Gems

JLN Network Manager

James M Soki, Rahul S Reddy Kadarpeta, Vrishali Shekhar, Titus Kisangau  The Joint Learning Network for Universal Health Coverage (JLN) stands as a pioneering force, uniting practitioners and policymakers worldwide in a collaborative effort to transform health systems. Within the realms of this innovative, country-driven network, global knowledge products are meticulously co-developed, especially to cater to middle- and low-income countries. These products serve as a powerful bridge, seamlessly connecting theoretical frameworks to practical applications, with a shared vision of extending health coverage to over 3 billion individuals across the globe.   We have recently conducted an analysis of publicly available JLN’s knowledge products (KPs) to gain insights into the most frequently accessed resources.  We delved into the content management system of the JLN website, aiming to pinpoint tools, toolkits, guides, manuals, and handbooks that not only align with UHC/PHC priorities but also have attracted significant interest from our website users. This analysis focused on website data available for the year 2023. We observed that 400 unique users accessed the KPs. Below, we present a list of our most (more than 75% of users) accessed and downloaded KPs. However, it’s important to note that this compilation is not exhaustive, and all the JLN ‘s KPs can be accessed here.   UHC Primary Health Care Self-Assessment Tool: The JLN Primary Health Care (PHC) Initiative developed this tool to underscore the fundamental role of Primary Health Care (PHC) as the bedrock for implementing Universal Health Coverage (UHC) reforms in any given country. This tool serves as a valuable resource, offering countries the opportunity to conduct self-assessments of their progress towards achieving UHC and PHC goals. Featuring a comprehensive multi-stakeholder survey, the tool is designed to document and assess the intricate interactions between health insurance or financial coverage institutions and other essential PHC actors and programs. Its primary purpose is to assist countries in identifying key areas for improvement and to pinpoint opportunities for aligning health financing strategies with the PHC goals set by policymakers. Noteworthy is the successful pilot implementation of the tool in diverse settings, including India, Indonesia, Ghana, and Malaysia, which effectively demonstrated its functionality and applicability. 

NEWS January 4, 2024

Digital Health Collaborative Launch

JLN Network Manager

Participants during the in-person convening and launch of the Digital Health Collaborative in Jakarta, Indonesia The JLN’s new Digital Health Collaborative held its first in-person convening in Jakarta, Indonesia, from November 8  through 10, 2023. Member countries of the Digital Health Collaborative are Bahrain, Bangladesh, Cambodia, Ethiopia, Ghana, India, Indonesia, Kenya, Malaysia, Nigeria, Pakistan, Philippines, Tajikistan, Ukraine, and Senegal. The key objectives of this inaugural convening of the JLN Digital Health Collaborative included; launching the new Collaborative, scoping and prioritizing the learning agenda with the members of the Collaborative and initiating knowledge co-production by the Collaborative. The Collaborative launch was co-located with the Asia eHealth Information Network (AeHIN) General Meetings to allow JLN participants to join AeHIN General Meetings (from November 6-8, 2023). Twenty-nine (29) representatives from 14 out of 15 Collaborative member countries attended the meetings in person. The Digital Health Collaborative Launch meeting was kick-started by a site visit to the headquarters of Indonesia’s Social Health Insurance Agency, BPJS-Health, on November 8, followed by scoping discussions on November 9 and 10. The BPJS-Health site visit commenced with opening remarks from Dr. Ali Ghufron Mukti, President Director of BPJS-Health, followed by a presentation by Dr. Donni Hendrawan, Deputy Director of Data and Information Management. The presentation highlighted key steps in the digital transformation journey at BPJS-Health, going from a graphical user interface desktop application in the early 2000s to a more robust digital ecosystem. The presentation was followed by a visit to the command center, where Collaborative members witnessed the different analytical dashboards used by BPJS. These include live data dashboards for problematic equipment at facilities, claims, population coverage, region-level service profile, and facility and region-level ICD-10 diagnosis rates. BPJS-Health press release featured the JLN site visit, which attracted comprehensive media coverage.  The two days of the plenary meeting included sessions that covered scoping discussions and prioritization of technical priorities, a presentation on existing tools relevant to overall technical priorities, a country panel discussion of promising practices in digital health, and the next steps for knowledge products for the group. Key knowledge products that were agreed on for co-development by the group include: A playbook/ how-to guide all levels of interoperability in health systems, including Health Information Exchange A guide on private sector solutions: Public Private Partnerships An orientation, evidence, and dialogue toolkit: How to pitch better and listen more A how-to toolkit for digital health governance An AI agent (GPT) for an annotated inventory of resources Member countries will identify the next steps regarding priority knowledge products and relevant next steps in the new year 2024. 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 from the Bill and Melinda Gates Foundation, the World Bank’s Health Emergency Preparedness and Response Umbrella Program, and the Government of Japan is gratefully acknowledged.

NEWS

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

JLN Network Manager

Rahul S Reddy Kadarpeta and Mahlet Gizaw As we transition into 2024, Universal Health Coverage (UHC) stands as a formidable force in global health, catalyzing substantial progress toward the overarching goal of health for all, with an unwavering commitment to inclusivity. The COVID-19 pandemic has demonstrated the importance of building robust and resilient health systems that are 1) prepared for future pandemics, 2) able to deliver health services, including essential services that are unrelated to pandemics, and 3) ensure UHC where all have equitable access to these services. Across nations worldwide, global health stakeholders are undertaking concerted efforts to align priorities and pursue the ideals of UHC. The COVID-19 pandemic has impacted the journey to UHC for many countries. According to the WHO, while the global UHC service coverage index increased from 45 to 68 between 2000 and 2021, the increase between 2015 and 2021 was only 3 index points with no change since 2019. As of 2021, 92% of countries still report the disruption of essential services such as routine immunization; in the same year, an estimated 25 million children under five (5)years missed out on routine immunization. In times like this, a platform like the Joint Learning Network for UHC (JLN) presents a valuable opportunity for country practitioners to learn from each other with the objectives of co-developing and implementing solutions to common challenges and pain points related to UHC. Commencing with six founding nations in 2009—Ghana, India, Indonesia, Philippines, Thailand, and Vietnam—the JLN has expanded its reach to encompass 37 member countries. The JLN has evolved into a dynamic and influential entity over the past 14 years, uniting practitioners, and policymakers from diverse corners of the globe for peer-to-peer learning. The goal of this collaborative network is to co-develop global knowledge products that effectively bridge the gap between theoretical frameworks and practical implementations, propelling UHC objectives and advancements- The success of the JLN is deeply rooted in its country-led and country-driven approach.  80% of the seats on the steering group, which govern the JLN, are occupied by country representatives elected by the JLN member countries. JLN’s commitment to country ownership extends to a participatory approach, wherein representatives from participating countries define and agree upon goals, and then, impactful initiatives and learning activities are customized to align with those priorities. JLN also works closely with in-country stakeholder groups drawn from key ministries and institutions in the government (designated as country core group), the private sector, civil society, and development partners to make sure that representatives who are nominated to participate in JLN activities are a good fit (i.e. they are in an active role in making decisions and/or implementing policies related to the topics covered in the JLN activities). JLN relies on communication with these stakeholder groups to understand the country-specific technical priorities and local landscapes relevant to UHC. This strategic orientation has garnered support from key global health entities such as the Rockefeller Foundation, the Bill and Melinda Gates Foundation, the German Corporation for International Cooperation (GIZ), the World Bank, and various other collaborative partners. As the JLN continues to play a pivotal role in shaping the trajectory of global health, its collaborative endeavors stand as a testament to the enduring vision of achieving comprehensive health coverage on a global scale. Collectively, JLN members and participants have co-produced over 45 knowledge products to-date. 30 countries are known to have applied some of these knowledge products.  Applications of JLN products have contributed to meaningful changes across many of these countries. In Kenya, country representatives  customized the JLN’s manual for costing provider payments to collect data at the county referral hospital in Makueni County. The team found that the reimbursement model used in the county was not sustainable and lobbied to change the county-wide reimbursement model. This shift was adopted by the Makueni County Department of Health in the 2019/2020 fiscal year impacting the reimbursement model for all 333 health facilities with a catchment population of just under 1 million Kenyan people. In Mongolia, country representatives co-developed and applied a JLN tool on empanelment to embed a household-based empanelment approach to a WHO-sponsored mobile health technology project used for home visits. The approach resulted in new assignments of primary health care providers for 20% of residents in Arkhangai province. The team plans to scale the approach beyond the most geographically isolated target populations. In India and Ghana, the representatives used the JLN’s tool on medical audits to implement a medical audit system as part of their programs  providing financial protection to about 100 million families. The team enhanced the system in India to include standard treatment guidelines that could be decentralized and scaled by India’s states to review claims, identify fraud, and ensure the quality of health services provided to patients. Since the rollout of the medical audit system, the program team has seen positive behavior changes among providers and hospitals. The profound influence of JLN resonates at various global health conventions, as its representatives empower member countries to share their narratives and triumphs in the journey toward UHC. JLN’s knowledge products plays a transformative role in shaping the UHC agenda, by amplifying the voices of nations ardently pursuing UHC and sharing successful country-driven strategies being implemented. In the grand pursuit of UHC, JLN paints a portrait of collective ambition and accomplishment. Yet, significant gaps persist within this effort, fueled by the intricate tapestry of diverse country contexts and the evolving needs of a post-pandemic era. In the face of these challenges, the Joint Learning Network for UHC (JLN) emerges, directing its focus toward pivotal areas crucial for UHC implementation in member countries. These encompass the realms of financing and equity, digital health, health emergency preparedness, climate change, and foundational reforms for the financing and delivery of primary healthcare. As we navigate the path towards UHC by 2030, the JLN stands unwavering in its commitment to a mission that transcends challenges. It remains a steadfast provider of a platform for knowledge exchange, a catalyst for innovation, and a