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NEWS October 1, 2024

Evaluating the Impact of Learning Networks: Insights from the JLN

JLN Network Manager

Author: Donnelly Mwachi, Amanda Folsom, Mahlet Gizaw and Rahul Kadarpeta The JLN is a country-driven network of practitioners and policymakers from 40 countries across the globe who come together to problem solve, co-develop global knowledge products, and implement solutions that help bridge the gap between theory and practice. This collective wisdom of network members is harnessed to address complex health systems challenges ultimately accelerating progress towards Universal Health Coverage (UHC). The joint learning approach evolved over a period since 2010, when JLN was launched, drawing on several global best practices in action-oriented adult learning. It emphasizes a locally led approach, where country practitioners determine priorities, set the learning agenda, and co-develop effective strategies and promising practices. Knowledge exchange among countries is organized into learning exchanges (3-6 months) and collaboratives (18-24 months). Technical facilitators play a critical role, providing organizational capacity and analytical rigour to help countries frame issues and articulate their insights in a structured manner. The JLN encourages flexible thinking, enabling practitioners to synthesize new knowledge into knowledge products – including tools, assessments, policy analysis frameworks, decision-making tools, implementation guidance, and case studies – that serve the needs of the country participants who co-created them and become global public goods for the global health community. Challenges in evaluating learning networks, such as JLN Practitioner-to-practitioner learning, managed by knowledge exchange networks or platforms, is emerging as a key pathway for building in-country capacities and contextualizing global best practices for strengthening health systems and sustainable health reforms. However, the empirical evidence on influence of these initiatives is scarce because of the challenges faced in measuring their impact. Measuring the impact of such networks can be challenging due to several factors. First, these networks often consist of a diverse range of practitioners with varying levels of expertise, and organisational backgrounds. The fluid nature of membership, with participants joining or leaving, makes it difficult to track and measure consistent outcomes over time. In addition, the ‘intangible’ benefits of developing connections with peers through the network and maintaining them, even after participating at network related activities, are difficult to measure. Further, the impact of knowledge exchange in these networks may not follow a linear path and can be diffuse, with knowledge being applied in varied contexts and at different times. This makes it hard to attribute specific outcomes directly to the network’s activities or interventions. Evaluating their effectiveness requires a comprehensive understanding of their design, functionality, and focus on purpose, membership, and knowledge-sharing mechanisms. Other challenges include the complexity, indirect and distributed nature of networks, including the long time it takes to achieve systemic changes.

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NEWS July 3, 2024

JLN Knowledge Product Showcase Series – Spotlight on JLN Revision of Health Benefit Package Guide

JLN Network Manager

Authors:Vrishali Shekhar, Leon Bijlmakers, Jeanne-Marie Tucker The Joint Learning Network for Universal Health Coverage (JLN) is uniquely positioned in the global health space as an innovative community of country practitioners and policymakers from around the world actively engaged in exchanging tacit knowledge on challenges faced and co-developing pragmatic solutions to implementing universal health coverage (UHC) reforms. The co-created knowledge attempts to harnesses the in-field practitioner’s experience and expertise to develop the how-to’s of designing and refining efficient, equitable and sustainable healthcare systems, while contributing to the global knowledge resource for achieving UHC. The JLN proudly hosts a growing community of 39 member countries across the globe. Over the last 14 years, JLN has had at least 8,000 practitioners and policymakers interact on 50 technical initiatives or thematic groups resulting in over 65 knowledge products. The JLN technical offerings are used both by the member countries and non-member countries driving change in their health systems by helping address issues related to advocating for more health for money and more money for health; costing for provider payments; undertaking medical audits, designing IT systems, and how to assess primary care and integrating care, where appropriate. In this regard, the JLN is delighted to initiate the JLN Knowledge Product Showcase Series (JLN- KPSS), with the objective of providing the JLN community with greater exposure to JLN’s recently concluded and ongoing work.  The JLN KP Showcase Series provides an opportunity for the key decision and policy makers to get better acquainted with available products and approaches for development and scaling of sustainable innovations for the attainment of UHC priorities in their respective countries. It also aims to develop a thriving ecosystem by providing a platform to JLN member countries to share their experiences of documented successes and challenges in the adaptation and implementation of JLN Knowledge Products, hence fostering collaboration and knowledge sharing within the JLN community. Making explicit choices on the path to UHC – JLN Health Benefits Package (HBP) Revision Guide, the latest product of the JLN Efficiency Collaborative under the umbrella of the Health Financing Technical Initiative, was developed based on experiences from 18 countries, featured in the first event of the JLN-KP series. The event was aimed at introducing the technical aspects of the knowledge product as well as illustrating successful examples of adaptation and implementation of the Guide by highlighting country stories of Ghana, Ethiopia, South Africa and Kenya. About the Guide: The lead technical facilitator, Dr. Leon Bijlmakers highlighted the universal quest for countries to explicitly define publicly funded essential services given their fiscal constraints to create a sustainable system of UHC as the motivation behind the development of the knowledge product. The dynamic nature of the HBP is on account of the evolving nature of disease burdens and epidemiological patterns; economic cycles and their impact on fiscal budgets; availability of innovative service delivery mechanisms; and overcoming implementation challenges. Such trends compel regular revisions of the HBP to ensure efficient allocation of fiscal and human resources for the delivery of healthcare. Experiences from countries suggest that any HBP revision is reflective of local circumstances and the prioritization of services needs to be evidence based to make it a rigorous and transparent process. It goes without saying that countries face various challenges during the process of HBP revision and the Guide offers a basket of tailored methodological approaches (e.g., whole package review, partial review, incremental analysis, or a rapid review) for countries to choose from to overcome implementation concerns related to affordability and efficiency of HBP revisions.  The Guide also offers guidance on how to go about collecting and interpreting different sets of data and evidence that is crucial for achieving high quality of HBP revision related decision-making. Finally, the Guide underscores the importance of maintaining policy dialogue, establishing communication and appeal mechanisms to warrant that all stakeholders (particularly the Ministry of Finance) are aligned in the process, as well as conducting regular monitoring and evaluation of all revisions, once implemented. Customizing the HBP revision process in local country contexts is an ongoing challenge, hence it becomes imperative for countries to learn from other countries which face similar challenges and have a comparable decision-making context. In this respect, the session provided inspiration and practical guidance from the experience of four countries on how to organize the HBP process; the analytical approaches and the types of data and evidence used in the decision- making process; how to engage in effective and sustaining policy dialogue; and institutionalizing periodic HBP revisions.  Country Spotlights: The Ghanaian experience with the Guide elaborated on the process of reviewing the 5% explicitly excluded diseases conditions from the benefits package designed by the National Health Insurance Scheme. The National Health Insurance Authority (NHIA) which manages the scheme is mandated by law to review the implicit benefit package that currently covers 95% of the diseases on a periodic basis. Ghana’s story underlines the importance of documentation of the revision process for standardization, ease of reference, transparency and avoiding ad-hoc changes to the benefits packages. Additionally, the cost-effectiveness of inclusion requests is assessed to ensure the sustainability of the scheme. Going forward, NHIA is looking to implement an important recommendation of the Guide by establishing a priority setting mechanism to assess inclusions by leveraging the existing structure and outputs of the Health Technology Assessment in the Ministry of Health. Ethiopia’s illustration of the adaptation and implementation of the Guide highlighted the need to conduct a fiscal space analysis for the effective implementation of the Ethiopian Essential Health Services Package Revision. Ethiopia applied the seven principles as outlined in the JLN Guide to revise their benefits package including disease burden, cost effectiveness, equity, financial risk and protection, budget impact, public and political accountability and acceptability hence making the process participatory, inclusive, and evidence based. The process identified 1,018 health interventions from an initial list of 1,749 and ranked around 56% of them as high-priority interventions. Cost estimation of the interventions recognized a 30% budget gap in the fiscal space, rendering

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NEWS July 1, 2024

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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