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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 April 15, 2024

Digital Health Innovations at BPJS-K: Beacon of Lessons for JLN countries

JLN Network Manager

Authors: Vrishali Shekhar, Dr. Anthony Adofo Ofosu, Mouhamed Mahi SY In response to popular country demands, Joint Learning Network (JLN) launched a new collaborative on Digital Health, between November 8-10, 2023, in Jakarta, Indonesia. The Digital Health Collaborative convened key decision makers from 15 countries including Bahrain, Bangladesh, Cambodia, Ethiopia, Ghana, India, Indonesia, Kenya, Malaysia, Nigeria, Pakistan, Philippines, Tajikistan, Senegal, and Ukraine to brainstorm on the scoping activities of the collaborative and initiate associated knowledge products. Technical facilitation support for the collaborative is provided by the World Bank along 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. One of the highlights of the in-person Collaborative launch meeting in Jakarta was the field visit to the BPJS Health or the Health Social Security Organizing Agency’s office premises. The field visit included warm welcoming remarks by Dr. Ali Ghufron Mukti, President Director of BPJS-Health followed by a technical presentation by Dr. Donni Hendrawan, Deputy Director of Data and Information Management. President Ghufron Mukti, fondly called Pak Ghufron, gave the audience an insight into Indonesia’s health reform process with the implementation of the national health insurance program- Jaminan Kesehetan Nasional or JKN. Indonesia’s journey with JKN which successfully covers over 95% of the country’s population, or over 250 million people, is not only remarkable but also aspirational to other low-middle income countries that are looking to achieve universal health coverage in their countries. In its ten years of existence, Pak Ghufron underscored the importance of digital health transformation as a crucial factor in the success of a relatively young JKN program. He acknowledged the significance of digital health innovations to secure equitable and universal access to high-quality affordable health services; improve health system efficiencies; promote health-seeking behavior; disease prevention and diagnosis management; amongst others very early on in its health reform process. He also highlighted the criticality of building a sustainable e-health ecosystem in alignment of the national vision promoting evidence-based decision-making in the health system. One such initiative supporting the transformation of health service quality is the launch of the i-Care JKN. I-Care JKN, an innovative application is focused on improving the accessibility of the medical history of JLN participants over the past year to the health facilities, hence allowing them to provide faster and more precise care to its beneficiaries. By facilitating communication and collaboration between doctors and health facilities, i-Care JKN allows doctors to plan appropriate treatment based on more real-time, actual, and factual data. By adhering to the rules in Law Number 27 of 2022 concerning Personal Data Protection (PDP Law) and ISO/IEC 27001 standards as well as cooperating with the National Cyber and Encryption Agency (BSSN) and the Ministry of Communication and Information Technology, BPJS-K has maintained security and protection of the BPJS Health participants’ data. Edwin Aristiawan, Director of Information Technology BPJS Kesehatan, proudly noted that endeavors to ensure the strengthening of data security and protection were high priority and that the encryption process and passwords minimize data leakages. President Director of BPJS Kesehatan Ghufron Mukti explained the operational system of BPJS Kesehatan to delegates from 15 countries participating in the Joint Learning Network (JLN) at BPJS Kesehatan Head Office, Jakarta, Wednesday (8/11/2023). The field visit included a real-time demonstration of the command center that displayed the magnitude and relevance of the data that is visualized by the BPJS analytics teams. This gold mine of data, which comprises 112 million data transactions per day in the JKN Program or 1,296 data transactions per second, plays a pivotal role in the data-driven implementation and optimization process of the JKN program. The 397.8 billion raw data are visualized as live dashboards on a range of areas such as problematic equipment at facilities; contributions; claims; population coverage; access to health services and region-level service profile; and facility and region-level ICD-10 diagnosis rates etc. The BPJS IT team also substantiated creating a standalone sample of their data, representative of the BPJS Kesehatan system, that allows for analytical work by researchers, academics, practitioners, and other related parties. The digital health strategy of BPJS-K recognizes its influential role in changing health outcomes in Indonesia. As a result, BPJS-K has been making concerted investments in governance and capacity building of its workforce to allow for maximum utilization of the modernized benefits in the health sector. However, it is equally important to acknowledge that the implementation of appropriate digital health interventions may not be an easy task for low and middle-income countries that face financial and infrastructural constraints. In this context, Indonesia’s e-health journey offers potential lessons and solutions to JLN member countries that are looking to incorporate the vision for the digitalization of the health sector aimed at improving health system efficiencies in their respective country contexts. About the Authors: Dr. Anthony Adofo Ofosu, Deputy Director-General of the Ghana Health Service. He is also the CCG Chair from Ghana. Mouhamed Mahi SY, Director of UHC digitalization, ANACMU Senegal Vrishali Shekhar, Focal point for Country Core Groups and Country Engagement,Joint Learning Network for UHC

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NEWS April 8, 2024

Introducing a learning collaborative on how to establish government-led contracting for TB- and other health-related services

JLN Network Manager

Authors: William Wells; Jacob Hughes, Denise Silfverberg, Sara Wilhelmsen, James Soki, Rahul S Reddy Kadarpeta Accelerating progress towards the health-related Sustainable Development Goals (SDGs) requires concerted efforts by all health systems stakeholders. Country governments anchor these efforts, playing a stewardship role. Still, as part of this stewardship, they need to explore ways of leveraging non-state actors to increase health system efficiency, effectiveness, and accountability. In the context of declining donor funding for many of these non-state actors, identifying government-led sustainable health financing solutions becomes more important. Government-led contracting for health services is where the government contracts with nongovernmental organizations (NGOs)/civil society organizations and the for-profit private sector using the country’s procurement system and domestic funds. This mechanism allows the use of complementary skill sets from the public and private sectors. It can support the optimization of available resources, especially in mixed health systems in low- and middle-income countries where health systems can be under-resourced or fragmented. However, governments in some low- and low-middle-income countries are focused almost exclusively on the direct implementation of health activities by public sector staffing. For such countries, contracting is a new way of conceptualizing the role of government in health sector stewardship and understanding these possibilities is challenging without exposure to other health systems that are already implementing such approaches. In addition, governments (and other key stakeholders) that are considering contracting often do not have a complete understanding of the essential legal, regulatory, policy and procedural requirements. Decision makers may be unaware of lessons learned elsewhere, and of contracting tools already developed by other countries. This can lead to lost time and unnecessary expenditure of effort and resources and can be a deterrent to moving forward with contracting. On the heels of World TB Day, the JLN is partnering with USAID’s Health Systems for TB (HS4TB) project to offer a Collaborative on Contracting Organizations for Health-Related Services for practical learning on this topic. HS4TB’s analysis of available literature found abundant guidance on the ongoing implementation of health contracting, but little available consideration on the qualitative aspects of establishing contracting such as the decision-making, obstacles, opportunities, and processes. This finding provides the rationale for focusing the collaborative on the early stages of contracting: navigating the political, legal and regulatory barriers to make concrete steps towards establishing contracting for TB- and other health-related services; and the initial establishment of systems to manage the contract management cycle. The offering will be conducted with TB as an example. However, the knowledge and tools it produces would be applicable and valuable to any health system leader interested in sustainable health financing options within mixed health systems. Strong political will is necessary for sustainable health contracting in any country. In Bangladesh, the National TB Program and the Health Economics Unit of the Ministry of Health and Family Welfare worked together to outline the potential benefits of health services contracting to key stakeholders in the country through meetings and workshops, resulting in a remarkable change in attitudes. This engagement resulted in the inclusion of contracting for TB services in critical policy documents and helped secure a budget for TB contracting in the National TB Program’s Operational Plan. This HS4TB-JLN collaborative will enable participants to share country experiences on what is needed to initiate the country conversation on health contracting, why challenges and constraints to contracting exist and how to overcome them, and how systems and capacities can be introduced and optimized for the implementation of TB- and health-related contracting. Countries participating in the collaborative will benefit from practitioner-to-practioner learning exchange and sharing of country experiences, which can be used for inspiration as they tackle their unique contracting challenges. Read more about the collaborative here. Please form a country team and join in this joint learning journey by submitting your EoI by April 15. About the Authors: William Wells is a Senior TB Technical Advisor, USAID; Jacob Hughes is a Senior Technical Director, MSH, Denise Silfverberg is a Principal Technical Advisor, MSH and Sara Wilhelmsen, is a Principal Technical Advisor, MSH while James Soki, is Program Manager, JLN and Rahul S Reddy Kadarpeta is the Executive Director, JLN.

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NEWS March 18, 2024

Empowering Policy Reform through Shared Wisdom Beyond Borders: Kenya’s JLN Experience

JLN Network Manager

Authors: Isabella Maina, Rahul S Reddy Kadarpeta, and James Soki Joint Learning Network for Universal Health Coverage – JLN’s 14-year odyssey stands as a remarkable testament, fueled by the compelling narratives exchanged among fervent policymakers and practitioners steering health systems transformation in their respective nations, all in the relentless pursuit of universal health coverage (UHC). These narratives encapsulated the tacit knowledge acquired within their unique contexts, as they grappled with practical challenges that transcended the support of any ‘consultant’ or ‘technical assistance’. When these stories were shared among peers, a collective recognition of shared problems and challenges emerged, motivating them to collaboratively seek solutions. These stories, a potent force in themselves, became the driving impetus behind these leaders as they passionately championed the cause of UHC and achieved significant milestones along the way. In the case of Kenya, its association with JLN since 2009, proved to be transformative. Actively engaging with the JLN community, Kenyan policymakers/ practitioners gained invaluable insights from their counterparts in different countries. Participation in various JLN learning collaboratives enriched our knowledge base and co-produced innovative solutions in health financing, service delivery, and system efficiency. These shared efforts became a catalyst for innovation and informed decision-making significantly contributing to strengthening Kenya’s healthcare system. Kenya’s journey towards UHC began with the constitutional recognition of health as a fundamental human right in 2010. This guided the formulation of the Kenya Health Policy 2012-2030 and subsequent Health Sector Strategic Plans (HSSPs). The policy aimed at enhancing health outcomes and reducing disparities is supported by increased budgetary allocations to the health sector, reflecting a commitment to improve health infrastructure and explore innovative financing mechanisms. The establishment of the Social Health Insurance Fund (SHIF) replaced the National Health Insurance Fund (NHIF). Steps were taken to strengthen strategic purchasing alongside community-based primary healthcare underscoring Kenya’s comprehensive approach to achieving UHC. Responsive monitoring and continual adjustment of strategies through evaluation are ensuring the evolving health needs of its population are met. The lessons learned and solutions adapted from the network’s collective knowledge became instrumental in shaping some of these policies. We present here four highlights drawing from Isabel Maina’s learning experiences with JLN where Kenya was able to tailor and implement strategies that resonated with its specific context, resulting in advancements in UHC goals – improving healthcare delivery, and ultimately enhancing the well-being of the population. JLN PHC financing collaborative and country pairing with Ghana to advance Primary Healthcare Reforms in Kenya The UHC agenda in Kenya is premised on Primary Health Care – an approach that is considered from existing evidence as more efficient and cost-effective in the long run. The Government policy commits to PHC reforms through the establishment of Primary care Networks (PCNs) across all counties in Kenya. PCN is a network of primary care facilities (health centres and dispensaries) that are linked to a county primary hospital and the community units in their area of jurisdiction in the form of a hub and spoke model. The PCN aims to strengthen service delivery and create a seamless connection between PHC level and hospitals. For this ambitious reform agenda to be translated into implementation, the main question in the policy circles was “How to go about it? Where do we start?” Actively engaged with the JLN, there was an awareness that Ghana – a JLN member country was experienced in the formation and use of preferred primary care provider (PPP) networks as an innovative approach to catalyze providers with enhanced capacity to deliver essential primary health care (PHC) services and to use resources more efficiently. The JLN PHC financing and payment collaborative in which Kenya and Ghana policy makers/ practitioners were participating created an opportunity for more learning between the two countries. This collaborative, practitioner-to-practitioner learning and exchange was organized through virtual meetings in June 2020 between the Kenya team (Ministry of Health PHC team, health financing team, NHIF and selected County teams) and the Ghana PHC team. The Kenyan team learnt the nuances of how PCNs could be operationalized – the process of setting up functional PCNs, governance structures, the referral networks within and outside the PCN, the purchasing arrangements, management/ supervision, monitoring and evaluation of quality service delivery. Armed with this information, Kenyan policymakers developed guidelines for National implementation of the PCNs. Additionally, the best practices learnt from Ghana and other key learnings from the JLN PHC financing collaborative informed the PCNs implementation then in 12 counties – a journey that has currently culminated in the establishment of close to 120 networks across 39 counties. Kenya National Benefits Package design and Co-developing the JLN Benefits Package Revision Guide The moral question in Kenya, just like in many other countries on the UHC journey was ‘what to pay for’ in Kenya’s health system and how to arrive at the decision. Hence the journey towards the benefit package reforms was born, with the need to design an affordable, equitable, good-quality package of care for Kenyans in line with the Kenya constitutional guarantee of the right to health care services, and the right to the highest attainable standard of health. In 2018, the Ministry of Health, Kenya established a Health Benefits Package Advisory Panel with the mandate of defining a unified comprehensive and costed benefit package for Kenyans. The panel of experts included JLN practitioners from Kenya and practitioners with expertise from JLN member countries. Further, the Kenyan technical staff used this experience to inform the development of the JLN Health Benefits Package Revision Guide in 2022 (Making explicit choices on the path to UHC – the JLN Health Benefits Package Revision Guide). During this, Kenyan practitioners participated alongside those of Ethiopia, Ghana, Nigeria, South Africa, Sudan, Bangladesh, and India in contributing to the product that would hence guide nations in the revision of the benefits package, demonstrating the symbiotic relationship between JLN and Kenya. JLN Knowledge Products Adaptation and Implementation Kenya adopted and implemented JLN knowledge products to support its UHC journey. In 2018, the UHC-PHC Self-assessment Tool, Costing of Health

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NEWS February 15, 2024

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!

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