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NEWS October 1, 2025

From Ideas to Action: Accelerating Health Systems Change with the Joint Learning Fund

JLN Network Manager

Authors: Dinash Aravind, Animut Ayalew, Suciati Mega Wardani, Tushar Mokashi At the heart of the Joint Learning Network (JLN), a global peer-based organization made up of policymakers and practitioners from 41-member countries, lies a shared commitment to collaborative learning and collective problem solving to advance Universal Health Coverage (UHC).  Through the JLN, in-country stakeholder groups made up of representatives from key government institutions and development partners working together on UHC reforms, come together to define and communicate country priorities, as well as share and apply learnings and guidance. Over the past few years, the CCGs became increasingly aware that more was needed to translate the knowledge acquired from JLN activities into action to address emerging health system challenges. In January 2025, the Joint Learning Fund (JLF) was launched to bridge the critical gap between collaborative learning and implementation. The purpose of the JLF is simple yet catalytic: support countries in translating joint learning guidance and resources into tangible action that strengthens health systems. From Learning to Action JLF seeks to build the confidence, capability, and commitment of CCGs through small grants that can be used to apply learnings from JLN activities to local health system reform. With an overall investment of $1,000,000 the JLF is focused on turning collective insights into meaningful real-world health system impact. Each CCG can access up to $80,000 over a period of 12 months to support the implementation of knowledge products, tools, and strategies co-developed through one of the JLN’s six technical initiatives: health financing, provider payment, primary healthcare, climate smart health systems, performance management digital health and information systems. Unlike traditional funding streams, the JLF helps CCGs create momentum to experiment or scale relevant local health systems solutions while deepening country ownership and stakeholder participation, accelerating reform priorities, and securing the long-term sustainability of health system strengthening efforts. Further, countries don’t just receive financial support—they can also leverage the insights and knowledge of peers facing similar challenges and opportunities, as well as guidance and assistance from technical experts and partners associated with the JLN. First Funding Cycle The response to the JLF’s first funding cycle has been inspiring and insightful. Twelve JLN member countries submitted proposals that reflected both common challenges and unique approaches to developing stronger and more impactful health systems.[1] Several prominent themes emerged from the proposals, including interest in: Improving primary care purchasing and provider payment systems, Strengthening digital health infrastructure for UHC, Developing inclusive health benefit packages, and Leveraging public financial management reforms for health sector improvements. These are a few examples of how the initial JLF investments are being used: Malaysia is rethinking how care reaches its people. With chronic diseases rising and families living longer, the system must shift from patchwork solutions to one that truly connects hospitals, clinics, and communities. Integrated Care Clusters are at the center of this change, and with JLF support, the country is designing the framework that will bring this vision to life—making healthcare more seamless, sustainable, and fair for every Malaysian. Indonesia is taking steps to develop climate-smart health systems (CSHS) as an integral part of its efforts to achieve Universal Health Coverage (UHC). The goal of the JLF is to strengthen knowledge and capacity-building initiatives to maximize climate change adaptation, resilience, and mitigation in the health sector. Climate and health is both an integrated and priority policy issue for the Indonesian government. The JLF is helping translate this ambition into action by developing a policy brief that will serve as a recommendation for the ongoing formulation of the national smart adaptation plan. Ethiopia’s path to UHC depends on strong primary healthcare. But paying providers in ways that reward quality and efficiency has been a challenge. Now, new blended payment models are being explored to make every health dollar go further. With the support of the JLF, these experiments are generating evidence to shape national reforms—so that care at the community level is not only accessible, but also fair, effective, and enduring. The JLF is not just about implementing project—it’s also about generating knowledge, evidence, and tools that strengthen health systems. The outputs emerging from funded initiatives will improve individual health systems while also contributing to a shared pool of learning that can be adapted across JLN member countries ensuring that the benefits of each investment extend well beyond national borders and contribute to collective progress. Looking Forward

NEWS August 10, 2025

Building Health System Resilience: A New Framework for Primary Healthcare Financing

JLN Network Manager

Authors: Norah Mwase, Thulasoni Msuku, Frida Ngalesoni, and James Soki In an era of unprecedented global challenges—from climate-related disasters to pandemics and political conflicts—health systems worldwide are under immense strain. Sustainable and strategic financing arrangements are essential for building resilient, people-centered primary health care (PHC) systems that can maintain essential functions during these crises. Yet countries face persistent financing challenges: budgeting remains largely input-based, allocations are not made directly to PHC facilities, sub-national actors often lack flexibility to reallocate funds to respond to emergency needs, funds are unpredictable and usage rates are low given rigid public financial management processes While several tools exist to track overall health system resilience, they often lack practical guidance for assessing PHC financing. The PHC Financing Framework for Resilient Health Systems was developed by Amref Health Africa through the PROPEL Adapt project to address this gap.  What is the PHC Financing Framework? The PHC Financing Framework is a comprehensive tool that can be used to examine and strengthen PHC financing mechanisms by identifying opportunities to improve health system resilience through enhanced predictability, service continuity, collaboration, multisectoral engagement, awareness, agility, learning, and self-regulation. The framework was developed through a rigorous, multi-phase process, beginning with a review of 57 documents on PHC systems, health financing, and resilience. This desk research was complemented through consultations with government experts from Ghana, Ethiopia, Kenya, and Nigeria, and by adapting and leveraging lessons from existing resources such as the Health Priority Setting and Resource Allocation Benchmarking (HePRA) tool. Several key themes emerged: Flexible Budgeting: Budget structures must allow flexibility to adapt to evolving health needs and priorities. Contingency Funds: Adequate, timely, and ring-fenced contingency funds are critical for managing emergencies. Direct Funding Access: PHC facilities need direct access to funds in order to operate efficiently and responsively. Evidence-Based Advocacy: Using strong evidence is essential for effective advocacy and engagement with political stakeholders. Governance and Political Economy: Governance structures and political economy significantly influence health financing strategies. These themes, along with other findings, informed the development of the PHC Financing Framework, which is comprised of three interconnected components:  Health Financing: resource mobilization, planning, allocation, and tracking;  Health Financing Governance: leadership, coordination, learning, and communication; and,  Political Economy: political dynamics that influence financing decisions.  Together, these components encompass 12 themes with 32 sub-themes, providing a nuanced assessment of how well a country’s financing arrangements are supporting resilient PHC delivery.  The PHC Financing Framework is operationalized through a user-friendly benchmarking tool that employs a visual traffic light system—green indicates meeting benchmarks, yellow suggests areas for quick improvements, and red highlights critical gaps requiring sustained, immediate attention—supporting policymakers in quickly identifying strengths to maintain and weaknesses to address through concrete strategies and deliberate actions. Malawi: Piloting the Framework The Malawi Ministry of Health helped validate the PHC Financing Framework through a participatory process that ensured the framework’s relevance, practicality, and alignment with national priorities. Malawi was an excellent candidate for this role due to its frequent exposure to climate-related hazards that strain its health system, including floods, droughts, and rising temperatures. By contributing insights on sector challenges and opportunities it is facing, the Ministry helped shape the framework’s themes and sub-themes and created an opportunity to test scalable approaches that connect climate change and public health. “Financing is vital for building people-centred PHC, but without strong governance, resources risk being wasted and access undermined. Embedding governance in the PHC financing framework ensures accountability, equity, and real improvements in service delivery.” – Dr. Gerald Manthalu, Director of Planning and Policy Development with the Ministry of Health Malawi. A Call for Action: Why PHC Resilience Matters Now PHC is often the entry point for communities into the health system, and resilient PHC ensures essential services continue even in the face of global shocks. By adapting to both individual and population needs, PHC offers health security today and tomorrow. The PHC Financing Framework represents a significant step forward in supporting more resilient primary healthcare systems—particularly those in resource-constrained or risk-affected health settings. The tool’s design allows for adaptation to different national contexts while maintaining standardized assessment approaches that enable cross-country learning.  The framework is now available as a global good for health financing actors, policymakers, and international partners to use annually in support of their efforts to track their progress in building more resilient PHC systems. The time has come to move beyond fragmented approaches to health financing and embrace systematic tools that can guide countries toward truly resilient PHC systems. A special thanks to those who contributed to the review of the PHC Financing Framework including:  Dr. Gerald Manthalu, Director of Planning and Policy Development with the Ministry of Health Malawi Thulasoni Msuku, Health Economist with the Ministry of Health Malawi Hester Nyasulu, Amref Health Africa Country Manager for Malawi Naina Ahluwalia, JLN World Bank Core Team Member. She is the Focal for the JLN Efficiency Collaborative and Health Emergency Preparedness Collaborative Frida Ngalesoni, Amref Health Africa Health Financing Specialist at the Health System Strengthening Directorate James Soki, Program Manager for the JLN For more information on the PHC Financing Framework, reach out to Frida Ngalesoni ([email protected]) and James Soki ([email protected]).

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