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Evidence

The JLN Monitoring & Evaluation (M&E) approach systematically documents the JLN’s role in changes at the individual, interpersonal, and team levels and contributions to organizational and health system-level shifts. The M&E system is a living, adaptable system that builds on the historical work done by the network while also pushing the network towards more rigorous and credible linkages to longer term outcomes.

What We Know

The JLN is a country-driven network of practitioners and policymakers from around 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.

Core to the JLN is the cultivation of a “safe space” for practitioners and policymakers to discuss successes and failures in an honest and productive way to learn, adapt and enact changes that will address the root causes of a problem. In the spirit of joint learning, this page illustrates evidence to support the JLN’s approach and areas where there is room to further strengthen the evidence-base.

Where We're Going

The JLN recognizes that there are different types of evidence needed to answer different types of programmatic questions. Evidence exists along a continuum from anecdotes (far left), to more rigorous designs, including case-control or quasi-experimental designs. Some questions are best answered using information from testimonials or anecdotes, whereas other questions require different levels of evaluative rigor to be thoroughly answered.

In this grant cycle, the JLN Network Manager has started to push the JLN rightward along the path to answering more complex questions on behalf of the network.  Activities embedded in the technical initiative M&E function have focused on generating comparative data over time to document participant knowledge, attitude, and practice shifts (see Comparative data in the graphic above). Understanding self-reported changes at the technical team level will clarify the link between participation in JLN learning activities and in-country advocacy and change.

Additionally, while retrospective documentation of knowledge product use (the country case study section below) has some methodological flaws (recall bias, etc.), building in intentional validation processes– like triangulation of data across sources and internal agency reviews– helps us answer more complex questions. More recent work has included documentation of real-time facilitated implementation.

The Network Manager team is constantly working to improve and articulate the network’s impact. Questions like how we think JLN’s implementation efforts contribute to system changes at the organizational, institutional, or system level, help to articulate the network’s impact and improve the JLN model. Continuing to collect data at the right stage of the continuum is an ongoing priority to answer the most critical questions for the network. In combination with pushing to further expand the evidence base of the JLN’s approach, the Network Manager team continues to strive towards an evidence-based, ever improving learning approaches.

Like many networks, the JLN still has gaps in its evidence base. In the spirit of learning, the network is actively working to prioritize new methods–like contribution tracing and more longitudinal data collection– and push boundaries to answer important questions for the network.

CONCEPTUAL FRAMEWORK

KNOWLEDGE PRODUCT UTILIZATION

INNOVATIVE JOINT LEARNING

REAL-TIME FACILITATED IMPLEMENTATION

CONCEPTUAL FRAMEWORK

The JLN is a country-driven network of practitioners and policymakers from around 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.

Practitioners and policymakers work together with technical facilitators to learn together (“joint learning”), to analyze challenges, share experiences, and co-create the development of how-to’s to address challenges based on global evidence and best practices. Technical facilitators play a background role, bringing in organizational capacity and analytic rigor 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 both serve the needs of the country participants who co-created them, and become global public goods for the global health community.

The JLN Theory of Change predicts that JLN outputs will lead to knowledge dissemination, increased advocacy, and knowledge application at the country level. Directly engaging in problem-solving and creating new knowledge with peers in other countries will build the capacity and motivation of local leaders who are well-positioned to implement reforms, leading to changes in policy and practice in their countries.

KNOWLEDGE PRODUCT UTILIZATION

The JLN approach has historically included the co-development of knowledge products as part of the JLN’s longer technical teams. These documents are written collectively by the JLN country members and shepherded along by the technical facilitation team. The JLN has developed over 30 knowledge products in its history and has many examples of application of these tools in JLN countries. The JLN has two terms for knowledge product utilization– adaptation and implementation. What do we mean by these terms?

Medical Audits in India

Thumbnail for the case study about medical audits in India

India drew on its participation in the JLN’s Medical Audits Collaborative and adaptation of the Medical Audit Toolkit to implement a medical audit system that could be decentralized and scaled by India’s states to review claims, identify fraud, and ensure the quality of health services being provided to patients.

Using Strategic Communications in Nigeria

Nigeria’s implementation of the Strategic Communications Practical Guide and Strategic Communications Planning Tool to address underlying facilitators and barriers to the BHCPF led to the first appropriation for the fund and an increase in interest in BHCPF services. The communication plan is thought to have improved the targeting and perception of the rollout communication processes.

Medical Audits in Malaysia

Malaysia’s use of the Toolkit to Develop and Strengthen Medical Audit Systems shaped the operations for a new Medical Audit Section responsible for auditing PeKa B40 claims. The SOPs for the unit support identifying and deterring fraud and review of provider perfomance resulting in improved quality of health care screenings.

Costing of Health Services for Provider Payment in Kenya

Kenya’s use of the Costing of Health Services for Provider Payment toolkit produced findings that were used to change county-level reimbursement models to lower costs, increase efficiency and improve financial sustainabilty. This case study profiles the use of Costing of Health Services for Provider Payment in Kenya. In Makueni County, the government has the mandate […]

UHC PHC Self-Assessment in Malaysia

Malaysia’s use of the JLN UHC PHC Self-Assessment produced findings that were used to improve public private partnerships to increase PHC coverage. This case study profiles the use of the Universal Health Coverage Primary Health Care Self-Assessment Tool in Malaysia. Malaysia piloted this self-assessment tool as a cross-sectional study collecting both qualitative and quantitative data […]

INNOVATIVE JOINT LEARNING

The JLN is continuously improving and iterating on its approach to joint learning. In the most recent grant cycle, there have been two innovative approaches the network has focused on. Both are smaller group modalities with an intensive focus on one country’s challenges, with other countries serving as resource countries, often alongside a technical facilitation team. These newer models are important to countries progress on key UHC objectives by end users and therefore appear to be worthwhile investments for the network.

Country Pairing Modality

In 2020, the PHC Financing and Payment collaborative pushed the boundaries of traditional webinar group-based learning and tested a more intimate and in-depth collaborative learning modality: country pairings. This modality pairs two or three countries with a specific interest in a topic – one that may not be a widely shared interest across the collaborative – to probe deeper into the implementation experience of a resource country and discuss details that are relevant to their countries. The JLN conducted a small developmental evaluation and the purpose was to capture and learn from how these pairings worked and to capture lessons learned from the country pairing approach. By documenting this new method, the JLN will be equipped with data-driven findings on this innovative approach to joint learning for modification, replication, or scale up in the future.

E-Consultation Evaluation

Following the 2020 Joint Learning Network’s Learning Exchange on Patient Pathways and Pandemics: COVID-19 and Beyond, led by Aceso Global, a technical team was launched to focus on implementing and scaling up E-consultations at the primary health care (PHC) level. The CoP was designed to foster practical learning by accompanying implementation in an “implementer” country, Malaysia, which had previously launched an E-consultation initiative during the pandemic and wanted to improve and expand it further. Technical facilitators and country participants provided support and learnings. This mixed methods evaluation aimed to understand how real-time implementation within a technical team supported Malaysia’s preparation for and implementation of the E-consultation extension initiatives.

REAL-TIME FACILITATED IMPLEMENTATION

In the past few years, the JLN has intentionally shifted from a heavy focus on co-created products into an era that also emphasizes the importance of real-time facilitated implementation. This section details real examples of this approach. The following real-time facilitated implementation cases are currently ongoing or have concluded to date:

Bangladesh

National Coordination to Improve COVID-19 Pandemic Response

Liberia

Population Targeting

 

Kenya

National Coordination to Improve COVID-19 Pandemic Response

Ghana

Population Targeting

 

Ethiopia

National Coordination to Improve COVID-19 Pandemic Response