By Stefan Nachuk,
Achieving Universal health coverage (UHC) is one of the key priorities of many nations, and embedded within the SDG goals that all countries have signed onto. The approaches to strengthening UHC tend to run into similar challenges across countries, making shared “how to” knowledge a key factor in realizing UHC. One unique response to this challenge was the creation of a collaborative network- The Joint Learning Network for Universal Health Coverage (JLN) – launched over a decade ago as an innovative country-led, country-owned network that focuses on developing, through intensive multi-country “learning collaboratives”, practical approaches to addressing barriers to achieving UHC.
The JLN and its members have helped to fill this gap by developing practical joint tools that enable them to achieve their objectives. Identifying common challenges and developing solutions that are applicable in many countries, enables faster scale-up and smoother implementation than if each country tries to solve every problem on its own, Since 2010, the JLN’s members have published more than 30 knowledge products on topics critical to UHC, including service delivery, health financing and provider payment, data and information systems, and quality of care. JLN’s Costing Manual, which emerged organically from the lack of good costing data to inform provider payment reforms, was also used in Chhattisgarh and Karnataka for costing studies, and in several other countries worldwide.
Globally, there is growing agreement that primary health care (PHC), with its ability to address up to 90% of a population’s diverse health needs in an affordable manner, is central to the achievement of UHC. India, too, has been improving its PHC systems and has recognized the importance of learning from and benchmarking against the experiences of other countries. India’s efforts of providing quality healthcare through Ayushman Bharat by positioning comprehensive Primary Care as a foundational health system pillar has significant potential to chart an affordable pathway towards the country’s goals of achieving UHC. This experience can then in the future assist other developing countries in addressing their health system challenges. Thus, India’s engagement with other countries will also benefit India, as health system leaders and analysts will have larger networks and more analytical tools to call upon in the future.
India’s experiences in moving towards UHC also form a key part of the JLN toolkit and knowledge resources, leading to improvements in other countries as well. For example, from a learning collaborative on strengthening primary healthcare, leaders in Tamil Nadu concluded that if field supervisors have limited capacity to support ongoing assessments of provider knowledge and skills, mentors need to be enlisted to observe as well as provide hands-on training. On the basis of these findings, Tamil Nadu created a program that assigned mentor nurses to visit primary health centers to monitor daily activities and help staff nurses improve their skills. To bolster its health workforce, Tamil Nadu has also developed an intensive training program for its physicians, staff nurses, and medical officers, and the data on the performance of individual providers are collected and used to identify areas for improvement and develop targeted trainings. Data from these assessments are also used to identify high and low performing districts, and on that basis, priorities and mid-course corrections are planned. The state has also strengthened its health services through other tools including a skills checklist, a mentoring guide that provides a brief overview of best practices for mentorship programs, and a tool that outlines essential skills required of staff nurses to identify areas of weakness. These practical ways to drive improved impact proved to be of great interest to other collaborative members, such as Indonesia, the Philippines, and Ghana—who are also trying to identify practical tools for improving primary care performance.
Kerala’s experience of creating a data warehouse to link health information from state databases to the national level faced a critical challenge of duplication and resistance to change. As a solution to this, a planned system that links health information to a unique national ID was formulated. The state also looked to link data from 20 health directorates to support decision making, however, moving to real time data was complex. As a solution, dashboards were customized for each directorate and five zones of access were implemented based on user roles.
More recently, in a series of bilateral exchanges between India and Indonesia, the experience from PMJAY in using information technology and data analytics was an important learning for counterparts from Indonesia participating in this exchange. Likewise, the lessons from Indonesia in integrating multiple health insurance programs into a single payer system, with comprehensive coverage from primary to tertiary care, have been useful for Indian policymakers.
Today, the JLN represents the new paradigm in global health. The network leverages the combination of “country heterogeneity combined with common problems” to serve the collective needs of its members. The network is well poised to increase linkages and broaden impact areas across UHC capacities and help the world move closer to the SDG target of UHC by 2030 in its next decade.
(The author is Senior Advisory, Health Systems, Bill & Melinda Gates Foundation. Views expressed are personal and do not reflect the official position or policy of the Financial Express Online.)