Technical facilitation for this collaborative Aceso Global.

• Digital performance dashboards/scorecards for PHC
• Apps for PHC performance data entry and tracking Coaching guidelines for PHC supervisors
• Team building exercises
• Conflict resolution guidelines
• Problem identification, measurement and quality improvement tools
• Sampling; data analysis; data visualization; process mapping; Plan, Do, Study, Act Cycle(PDSA)

There are 13 member countries that applied and were accepted into the Learning Collaborative; Bahrain, Egypt, Ethiopia, Fiji, Ghana, Kenya, Lebanon, Liberia, Malaysia, Mongolia, Nigeria, Philippines and South Africa. The representatives comprised decision makers and practitioners.

Challenges to Solutions: JLN’s collaborative approach intends to drive Primary Healthcare Performance Improvement 

“Traditional methods of knowledge exchange often adopt didactic approaches, assuming static technical requirements and implying the need for tailored solutions within 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. A participatory knowledge production process is explored to provide stakeholders with dynamic insights, enhancing their capacity for effective problem-solving and addressing future challenges.” encapsulates the JLN way of approaching challenges and collectively finding solutions, as articulated by Hashiguchi and Conlin 20241. 

 The Joint Learning Network for Universal Health Coverage (JLN) launched the Learning Collaborative on Primary Health Care Performance Management (PHCPM). This collaborative aims to create a vibrant platform for JLN members to enhance their understanding and implementation of effective performance management systems tailored to primary health care (PHC) needs. 

Early this year, the JLN reached out to member countries, to nominate policy makers and practitioners representing from national and sub-national levels actively involved in PHC program implementation and its performance management. After careful evaluation, 38 participants from 13 countries were selected to be part of this collaborative’s journey. 

In March and April 2024, the facilitation team conducted virtual scoping discussions with each of the 13 country teams. These candid conversations helped unpack on-ground realities – reviewing existing initiatives, understanding pain points, identifying knowledge gaps, and charting out shared priorities for strengthening PHC performance management. 

• The synthesis of new knowledge is primarily from country experience (policy makers and practitioners’ tacit knowledge) which enhances knowledge translation from ‘theory to practice. This improves the quality of implementation of health systems reforms through its unique process of creation, adaptation, and implementation of practical knowledge. And educes and clarifies the need for traditional technical assistance.

Shared Challenges, Shared Ambitions 

While there were many differences and contextual nuances between and within countries, several common challenges resonated across countries during the scoping phase, including: 

• Fragmented data systems across health programs impeding integrated analytics: there are different systems and processes to collect and manage data on different health programs (e.g., MCH, TB, HIV/AIDs, PHC). The lack of integration and reliance on donor support poses a challenge to effective performance management. 

• Underutilization of data for performance improvement, especially at facility levels: poor data quality and/or gaps in reported data undermines the availability of reliable, standardized information, especially in rural areas.   

• Capability gaps among PHC managers in data analysis and driving performance: PHC managers at the subnational level require capacity development to analyze data and use it for work planning.   

• Complexities in strategic indicator selection and overcoming data entry burden: there is a perception that data collection and reporting is excessive or overbearing, especially in countries that use a very high number of indicators (~50-100+) that disproportionately emphasize outputs but not process or quality.  

• Inadequate performance feedback loops reaching the frontlines: in some countries, feedback systems appear limited or non-existent. At the same time, managers and supervisors often lack the capacity or experience to engage frontline providers effectively through coaching, teambuilding, and collective problem solving to build a culture of continuous improvement.  

Despite the challenges, countries highlighted promising opportunities, which they are eager to share, which include: 

• Digitizing data collection using validated PHC indicators  

• Institutionalizing performance review meetings and dashboards 

• Integrating previously siloed supervisory systems for health programs   

• Launching capacity building programs for PHC managers 

• Decentralizing decision-making authorities for agile PHC management 

An Action-Packed Roadmap 

Armed with this understanding, countries have collectively prioritized the core topics for intensive technical sessions in the upcoming “Foundational Learning Phase.” Topics receiving the most priority “votes” included: 

• Strategic selection and use of PHC indicators  

• Leveraging digital tools for measurement, monitoring, analysis and use 

• Building analytical and “hard skill” competencies among PHC managers 

Other high-priority areas include quality improvement, developing managers’ coaching and soft skill capabilities, and integration of performance management across vertical health programs. 

Next Steps 

From May to October 2024, participants will embark on a capacity-building journey featuring a scene-setting workshop, 7 virtual sessions featuring discussions with global experts, peer-learning exchanges of cases and lessons learned, culminating in an in-person workshop. Beyond technical upskilling, this phase aims to cultivate a collaborative spirit, surface real-world insights for application, and set the course for a future implementation and co-production phase. 

The JLN’s PHCPM has hit the ground running, with countries demonstrating remarkable commitment in the foundational stage. An enriching schedule lies ahead to strengthen PHC performance management across the participating countries and beyond. Stay tuned for more updates from this collaborative. 

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 

About the authors: 

Jerry La Forgia, Chief Technical Officer and Founding Director Aceso Global  

Jonty Roland, Associate Director, Aceso Global  Health Systems Specialist, Harvard School of Public Health/Consultant WHO on Primary Healthcare-Implementation Solutions 

James Soki: Program Manager JLN  

Rahul S Reddy Kadarpeta, Executive Director JLN