Shaping Resilient Health Systems: JLN’s Strategies for Tackling Health Challenges in a Changing World
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 of health emergency preparedness programs through cross-country engagements. Members of the collaborative prioritized the co-development of knowledge products focusing on governance, financing and surveillance. Currently, co-development of knowledge products on governance, and financing are ongoing. Related to governance, collaborative members are co-developing a practical guide on health emergency preparedness and response governance based on synthesis and assessment of country experiences. For financing, collaborative members are co-developing a guide for tracking budgeting and expenditure for preparedness and response in health emergencies, and a guide on Public Financial Management system for health emergencies. On surveillance, collaborative members have prioritized the co-development of three knowledge products: 1) Scoping and Guidance for Community-Level Digital Disease Surveillance, 2) Templates for Memorandum of Understanding for Cross-Border Surveillance, and 3) Implementation manual or guidance for setting up multi-sectoral One Health surveillance systems.
3. Accelerated Adoption of Digital Health Solutions
The COVID-19 pandemic has accelerated the adoption of digital health solutions, such as telemedicine, e-health platforms, and digital health records. These innovations have shown potential to enhance service coverage and improve access to healthcare, even in remote or underserved areas. However, recent research has found that implementing digital health programs at scale is faced by challenges related to 1) outdated governance and policy, 2) fragmented landscapes of innovation, 3) limited and uneven levels of digital literacy and access, and 4) weak infrastructure. To address these challenges, a recent report recognizes that it is essential that digital technology and data are infused into every aspect of health systems management and health service delivery for better health outcomes. The Digital Health Collaborative brings together 15 member countries – Bahrain, Bangladesh, Cambodia, Ethiopia, Ghana, India, Indonesia, Kenya, Malaysia, Nigeria, Pakistan, Philippines, Tajikistan, Ukraine, and Senegal. Facilitated by The World Bank in technical collaboration with Exemplars in Global Health (including the Center for Global Health Innovation at the Johns Hopkins Bloomberg School of Public Health, eHealth Lab Ethiopia, McKinsey Health Institute and Gates Ventures) and co-organized with the Gates Foundation and the Government of Japan, it addresses the growing need for efficient and affordable healthcare services through digital integration. The Collaborative aims to facilitate knowledge sharing among practitioners on the successful integration of digital technology and data into healthcare systems. It serves as a hub for experience-based knowledge exchange across The Collaborative is co-developing five knowledge products including a guide on interoperability, a guide on private sector solutions, a dialogue toolkit making the case for investing in digital health, a guide on digital health governance, and an Artificial Intelligence (AI) agent-enabled annotated inventory of resources.
3. Renewed Focus on Primary Healthcare (PHC)
The COVID-19 pandemic, ageing population, rapid urbanization, and increasing risk of non-communicable diseases underscore the importance of strong primary healthcare systems with an opportunity to strengthen financing and service delivery oriented towards equity, quality, efficiency and performance as a key strategy for achieving targeted outcomes. JLN has three current collaboratives related to PHC.
The Primary Healthcare Foundational Reforms for Financing and Service Delivery Collaborative, facilitated by Results for Development (R4D), brings together decision makers and PHC providers from the national and  levels from 14 countries: Botswana, Burkina Faso, Colombia, Ethiopia, Ghana, Indonesia, Kenya, Lebanon, Liberia, Malaysia, Mongolia, Nigeria, Philippines The 18-month collaborative aims to support country efforts to implement PHC reforms through practical lessons on implementing reforms and understanding how to navigate common bottlenecks.
Country members have identified three priority topics, organized into sub-groups for collaborative learning and producing solutions. Members will document lessons on the adequate level of provider autonomy/decision-making space required to influence outcomes at the facility level, the criteria that influences decisions to allocate resources to the sub-national and PHC levels and the principles for designing blended provider payment systems to incentive quality PHC services. Working through virtual webinars, working sessions and in-person convenings, the collaborative will produce several blogs summarizing the learnings from the sub-group webinars, country profiles of some member countries on approaches to resource allocation, provider payments and provider autonomy, learning and technical briefs cataloguing the experiences across the priority topics.
A subset of five countries from the collaborative (Colombia, Ghana, Indonesia, Kenya and the Philippines) at various stages of implementing Primary Care Networks (PNC), participated in an embedded 9-month learning exchange on Financing PCNs. PCNs are an emerging approach to reorganizing service delivery through networks of collaborating primary care providers working together to improve coordination, access, quality and efficiency of PHC resource use, particularly in limited resource settings. The learning exchange facilitated a four-step process to identify common PCN financing challenges and priorities across participating countries. The learning has synthesis the learnings in a learning brief, which includes the outline for a PCN Financing Manual.
The Primary Healthcare Performance Management Collaborative brings together decision makers and practitioners from13 countries: Bahrain, Egypt, Ethiopia, Fiji, Ghana, Kenya, Lebanon, Liberia, Malaysia, Mongolia, Nigeria, Philippines and South Africa. Facilitated by Aceso Global, the collaborative aims to bridge the relationship between PHC performance management practices and outcomes, emphasizing the critical role of district-level management and supervision. Having completed an initial foundational learning agenda on priority themes for immediate sharing of best practice – list – the collaborative is now focused on two workstreams of ‘implementation learning’. Liberia, Philippines and South Africa are working to develop and pilot a training course for PHC managers on supervisors to develop the hard/technical skills needed to better drive provider performance, while Mongolia and Nigeria are working to reform the digital dashboards that are used to assess performance and prioritize improvements. In both cases, a 12-month program of peer-support activities by the group is now underway to support these implementing countries while also using them as ‘living case studies’ to benefit the learning of all accompanying countries. Final knowledge products are still to be decided but are likely to include a wide range of tools and resources developed to support these two workstreams.
The Reimagining Primary Healthcare Collaborative commenced in 2022 and brings together practitioners from 14 countries: China, Ghana, Ethiopia, Kenya, Indonesia, Lebanon, Liberia, Malaysia, Morocco, Nigeria, Pakistan, Philippines, Tajikistan, and Ukraine. Facilitated by the World Bank, the collaborative was initially launched virtually with the aim to strengthen the capacity of governments to build a fit-for-purpose PHC systems through peer-to-peer learning. In consultation with the JLN Steering Group and given the creation of two new PHC-focused collaboratives in late 2023, this Collaborative was restructured in 2023 to spin off the Digital Health track as a full-fledged collaborative given the strong country demand and is now focusing its attention on innovations in service delivery and health workforce.
Shaping Resilience for a Healthier Future
In an ever-changing world, the need for resilient health systems has never been more pressing. By prioritizing primary healthcare, addressing the health impacts of climate change, and leveraging the transformative power of digital health, the Joint Learning Network (JLN) is leading the way in crafting innovative strategies to tackle complex challenges. Collaboration, shared learning, and adaptive approaches are the cornerstones of JLN’s efforts, empowering countries to build robust systems that can withstand shocks and ensure equitable access to quality care for all. As we navigate the complexities of global health, JLN’s commitment to fostering resilience and sustainability offers a blueprint for shaping a healthier, more equitable future.
About the Authors:
- Rahul Kadarpeta is the Executive Director of the JLN Network Manager, providing comprehensive oversight and actively engaged in reviewing and shaping this blog.
- Mahlet Gizaw is a JLN Health Specialist with the World Bank for reviewing the blog and sharing her valuable inputs.
- Adwoa Twum is the Senior Program Officer at Results for Development facilitating the JLN collaborative on Foundational Reforms for Primary Healthcare Financing and Service Delivery.
- Jonty Roland is the Associate Director at Aceso Global facilitating the JLN collaborative on PHC Performance Management
We acknowledge the inputs received from Somil Nagpal, Lead Health Specialist Global Practice on Health, Nutrition and Population, East Asia and Pacific Region, The World Bank.