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From Ideas to Action: Accelerating Health Systems Change with the Joint Learning Fund
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
Partage d’idées et d’enseignements tirés : réflexions issues de la première réunion en personne du JLN-CSHS au Maroc, à à São Tomé-et-Príncipe et au Sénégal
Auteurs : Amal Dahri, Codou Badiane Mane, Abdoulaye Diaw, Bekkaoui Hassane, Isaulina Barreto, Leonel Pontes et Ilhame Ouansafi. Des représentants du Maroc, de São Tomé-et-Principe et du Sénégal, accompagnés par des membres du personnel de la Banque mondiale chargés de l’ dans les bureaux nationaux , ont participé à la première réunion en présentiel du à Washington, DC, États-Unis, les 26 et 27 février 2024. La réunion a rassemblé 20 pays d’Afrique, d’Asie, du Moyen-Orient et d’Amérique du Sud et avait pour objectif de faciliter le partage d’expériences et d’enseignements tirés en matière de réponse au changement climatique et de résilience des systèmes de santé. Les principaux objectifs de la réunion étaient de lancer le partenariat, d’identifier les domaines techniques prioritaires et les thèmes clés, de partager les efforts, les outils et les réussites existants, de comprendre et de documenter les attentes en matière d’activités collaboratives, et de définir conjointement les produits de connaissance potentiels qui pourraient être coproduits au cours de la période de collaboration de deux ans. Les participants ont identifié six axes de travail sur lesquels la collaboration devait se concentrer et ont convenu de développer conjointement cinq produits de connaissance en 2024-2025 correspondant aux trois premiers axes de travail : 1) Gouvernance, 2) Financement et optimisation du financement, 3) Données et responsabilité, 4) Action multisectorielle, 5) Engagement des communautés et 6) Modèles de prestation de services. Les discussions ont révélé que le coût de l’inaction face au changement climatique, dont l’impact mondial est déjà évident, dépasse largement le coût des investissements dans les efforts d’atténuation. Ces investissements profiteraient aux systèmes de santé, leur permettant de continuer à servir les populations, en particulier les plus vulnérables. Cet article met en lumière les discussions de la collaboration JLN CSHS sur la situation climatique et sanitaire au Maroc, à São Tomé-et-Príncipe et au Sénégal, ainsi que leurs attentes pour les prochaines réunions et leur engagement en faveur des produits de connaissance. Situation climatique et sanitaire au Maroc, à São Tomé-et-Príncipe et au Sénégal Le Maroc, Sao Tomé-et-Principe et le Sénégal reconnaissent l’impact significatif du changement climatique sur les résultats en matière de santé, et admettent qu’il menace de compromettre des décennies de progrès dans le domaine de la santé publique. Bien que ces pays en soient à des stades différents dans l’intégration des considérations climatiques dans leurs politiques publiques, tous trois ont démontré leur engagement politique à lutter contre le changement climatique. Atténuation du CSHS au Maroc : renforcer la résilience au changement climatique Le Maroc est confronté à des défis croissants liés au changement climatique, avec des vagues de chaleur extrêmes, des sécheresses d’ s et des inondations. Le pays reste attaché aux objectifs climatiques internationaux pour 2030 et prend des mesures décisives pour atténuer le changement climatique et réduire les émissions de gaz à effet de serre (GES) dans tous les secteurs, en particulier celui des soins de santé. D’ici 2021, le ministère marocain de la Santé et de la Protection sociale s’est engagé à mettre en place un système de santé durable et résilient au changement climatique. Une évaluation récente a examiné la durabilité environnementale, la résilience climatique et les émissions de GES des établissements de santé publics marocains. Sur la base des recommandations de cette évaluation, le Maroc élaborera un plan de mise en œuvre visant à renforcer la résilience climatique de ses établissements de santé. Ces mesures substantielles démontrent la volonté du Maroc de renforcer son système de santé contre les effets du changement climatique et de garantir la continuité des services de santé en cas de perturbations liées au climat. São Tomé-et-Príncipe, un petit État insulaire en développement (PEID), a connu des précipitations et des glissements de terrain qui ont entraîné des maladies d’origine hydrique et une augmentation des cas de paludisme et de dengue. La cellulite nécrosante, causée par des micro-organismes normalement présents sur la peau, pourrait également être liée au changement climatique. Le nord du pays, sujet aux inondations pendant la saison des pluies, a mis en place des exercices de simulation afin de se préparer à de tels événements. Bien qu’il participe à la Conférence des Parties (COP), le pays n’a pas encore pris de mesures sanitaires pour s’adapter au changement climatique. L’approche proactive du Sénégal pour intégrer les risques climatiques dans la planification du secteur de la santé Le Sénégal adopte une attitude proactive face aux risques sanitaires liés au climat en intégrant les considérations climatiques dans la planification et la budgétisation des projets d’investissement dans tous les secteurs, en mettant particulièrement l’accent sur la santé et ses déterminants. Cette approche est motivée par la prévalence accrue de phénomènes météorologiques extrêmes tels que les fortes pluies, les inondations, les températures extrêmes, les pluies hors saison, les tempêtes de poussière, la sécheresse et l’érosion côtière, qui ont conduit à l’émergence de maladies telles que la dengue ces dernières années (2017-2023). Les principales initiatives comprennent le renforcement du cadre institutionnel et la promotion de la collaboration intra et multisectorielle, en particulier au sein du groupe Santé et environnement, afin de garantir une compréhension et une intégration globales des risques climatiques dans le secteur de la santé. Le Sénégal démontre son engagement en faveur de soins de santé respectueux du climat à travers plusieurs initiatives. La collaboration entre le ministère de l’Environnement, du Développement durable et de la Transition écologique (MEDDTE) et le ministère de la Santé et de l’Action sociale (MSAS) a abouti à l’élaboration du plan national d’adaptation pour le secteur de la santé (PNAS), en attente de validation politique. En outre, un décret impose l’intégration du climat dans tous les futurs projets d’investissement public dépassant 500 millions de FCFA, et un « budget national vert » complétera la loi de finances 2024. Le Sénégal a réalisé des analyses des lacunes et des études de vulnérabilité afin d’éclairer ces politiques. Le pays est en train de finaliser une note conceptuelle pour un projet d’adaptation sanitaire destiné au Fonds vert pour le climat (FVC) et a intégré les risques climatiques
Compartir ideas y lecciones aprendidas: Reflexiones de la primera reunión presencial de la Colaboración JLN-CSHS en Marruecos, Santo Tomé y Príncipe y Senegal
Autores: Amal Dahri, Codou Badiane Mane, Abdoulaye Diaw, Bekkaoui Hassane, Isaulina Barreto, Leonel Pontes e Ilhame Ouansafi. Representantes de Marruecos, Santo Tomé y Príncipe y Senegal, acompañados por miembros del personal del Banco Mundial de la red en las oficinas nacionales y , asistieron a la reunión presencial inaugural de la en Washington D. C. (EE. UU.) los días 26 y 27 de febrero de 2024. A la reunión asistieron 20 países de África, Asia, Oriente Medio y Sudamérica, y se celebró con el fin de facilitar el intercambio de experiencias y lecciones aprendidas en relación con la respuesta al cambio climático y la resiliencia de los sistemas de salud. Los objetivos principales de la reunión eran iniciar la colaboración, identificar las áreas técnicas prioritarias y los temas clave, compartir los esfuerzos, las herramientas y los éxitos existentes, comprender y documentar las expectativas de las actividades de colaboración, y esbozar conjuntamente los posibles productos de conocimiento que podrían coproducirse a lo largo del periodo de colaboración de dos años. Los participantes identificaron seis líneas de trabajo en las que se centraría la colaboración y acordaron desarrollar conjuntamente cinco productos de conocimiento en 2024-2025 correspondientes a las tres primeras líneas de trabajo: 1) Gobernanza, 2) Financiación y maximización de la financiación, 3) Datos y rendición de cuentas, 4) Acción multisectorial, 5) Participación de las comunidades y 6) Modelos de prestación de servicios. Los debates revelaron que el coste de la inacción frente al cambio climático, cuyo impacto global ya es evidente, supera con creces el coste de invertir en medidas de mitigación. Estas inversiones beneficiarían a los sistemas de salud, permitiéndoles seguir prestando servicio a la población, especialmente a los más vulnerables. Este artículo destaca los debates de la colaboración JLN CSHS sobre la situación climática y sanitaria de Marruecos, Santo Tomé y Príncipe y Senegal, así como sus expectativas para las próximas reuniones y su dedicación a los productos de conocimiento. Panorama climático y sanitario en Marruecos, Santo Tomé y Príncipe y Senegal Marruecos, Santo Tomé y Príncipe y Senegal reconocen el importante impacto que el cambio climático tiene en los resultados sanitarios, y admiten que amenaza con socavar décadas de avances en materia de salud pública. Aunque estos países se encuentran en diferentes etapas de incorporación de las consideraciones climáticas en las políticas públicas, los tres han demostrado su compromiso político para hacer frente al cambio climático. Mitigación del CSHS de Marruecos: Fomento de la resiliencia al cambio climático Marruecos se enfrenta a retos cada vez mayores derivados del cambio climático, ya que sufre olas de calor extremas, sequías e s e inundaciones. El país sigue comprometido con los objetivos climáticos internacionales para 2030 y está tomando medidas decisivas para mitigar el cambio climático y reducir las emisiones de gases de efecto invernadero (GEI) en todos los sectores, especialmente en la sanidad. Para 2021, el Ministerio de Salud y Protección Social de Marruecos se había comprometido a crear un sistema sanitario sostenible y resistente al clima. Una evaluación reciente analizó la sostenibilidad medioambiental, la resiliencia climática y las emisiones de GEI de las instalaciones sanitarias públicas de Marruecos. Basándose en las recomendaciones de la evaluación, Marruecos elaborará un plan de aplicación para mejorar la resiliencia climática de sus instalaciones sanitarias. Estas importantes medidas demuestran el compromiso de Marruecos con el fortalecimiento de su sistema sanitario frente a los efectos del cambio climático y con la garantía de la continuidad de los servicios sanitarios en medio de las perturbaciones relacionadas con el clima. Santo Tomé y Príncipe, un pequeño Estado insular en desarrollo (PEID), tiene un historial de lluvias y deslizamientos de tierra, que provocan enfermedades transmitidas por el agua y un aumento de los casos de malaria y dengue. La celulitis necrotizante, causada por microorganismos que se encuentran normalmente en la piel, también podría estar relacionada con el cambio climático. La parte norte del país, propensa a las inundaciones durante la temporada de lluvias, ha puesto en marcha ejercicios de simulación para prepararse ante tales acontecimientos. A pesar de participar en la Conferencia de las Partes (COP), el país aún no ha puesto en marcha medidas relacionadas con la salud para adaptarse al cambio climático. El enfoque proactivo de Senegal para integrar los riesgos climáticos en la planificación del sector sanitario Senegal está adoptando una postura proactiva frente a los riesgos sanitarios relacionados con el clima mediante la integración de consideraciones climáticas en la planificación y presupuestación de proyectos de inversión en todos los sectores, con especial atención a la salud y los determinantes de la salud. Este enfoque está impulsado por el aumento de la prevalencia de fenómenos meteorológicos extremos, como lluvias torrenciales, inundaciones, temperaturas extremas, lluvias fuera de temporada, tormentas de polvo, sequías y erosión costera, que han provocado la aparición de enfermedades como el dengue en los últimos años (2017-2023). Entre las iniciativas clave se incluyen el fortalecimiento del marco institucional y el fomento de la colaboración intra y multisectorial, en particular dentro del grupo de Salud y Medio Ambiente, para garantizar una comprensión e integración exhaustivas de los riesgos climáticos en el sector sanitario. Senegal demuestra su compromiso con la atención sanitaria consciente del clima a través de varias iniciativas. La colaboración entre el Ministerio de Medio Ambiente, Desarrollo Sostenible y Transición Ecológica (MEDDTE) y el Ministerio de Salud y Acción Social (MSAS) ha dado lugar a la elaboración del plan nacional de adaptación para el sector sanitario (PNAS), que está a la espera de su validación política. Además, un decreto obliga a integrar el clima en todos los futuros proyectos de inversión pública que superen los 500 millones de FCFA, y un «presupuesto nacional verde» complementará la ley de finanzas de 2024. Senegal ha completado análisis de deficiencias y estudios de vulnerabilidad para fundamentar estas políticas. El país está ultimando una nota conceptual para un proyecto de adaptación sanitaria para el Fondo Verde para el Clima (GCF) y ha integrado el riesgo climático en la política de desarrollo del sector sanitario, las estructuras
Partilha de ideias e lições aprendidas: reflexões da primeira reunião presencial da colaboração JLN-CSHS em Marrocos, São Tomé e Príncipe e Senegal
Autores: Amal Dahri, Codou Badiane Mane, Abdoulaye Diaw, Bekkaoui Hassane, Isaulina Barreto, Leonel Pontes e Ilhame Ouansafi. Representantes de Marrocos, São Tomé e Príncipe e Senegal, acompanhados por funcionários do Banco Mundial da nos escritórios nacionais , participaram da reunião presencial inaugural da em Washington, DC, EUA, de 26 a 27 de fevereiro de 2024. A reunião contou com a participação de 20 países da África, Ásia, Médio Oriente e América do Sul e foi realizada para facilitar a partilha de experiências e lições aprendidas sobre a resposta às alterações climáticas e a resiliência dos sistemas de saúde. Os principais objetivos da reunião foram iniciar a colaboração, identificar áreas técnicas prioritárias e temas-chave, partilhar esforços, ferramentas e sucessos existentes, compreender e documentar as expectativas para atividades colaborativas e delinear em conjunto potenciais produtos de conhecimento que poderiam ser coproduzidos ao longo do período de colaboração de dois anos. Os participantes identificaram seis linhas de trabalho para foco da colaboração e concordaram em desenvolver em conjunto cinco produtos de conhecimento em 2024-2025, correspondentes às três primeiras linhas de trabalho: 1) Governança, 2) Financiamento e Maximização do Financiamento, 3) Dados e Responsabilidade, 4) Ação Multissetorial, 5) Envolvimento das Comunidades e 6) Modelos de Prestação de Serviços. As discussões revelaram que o custo da inação em relação às alterações climáticas, cujo impacto global já é evidente, ultrapassa em muito o custo do investimento em esforços de mitigação. Esses investimentos beneficiariam os sistemas de saúde, permitindo-lhes continuar a servir as populações, especialmente as mais vulneráveis. Este artigo destaca as discussões da colaboração JLN CSHS sobre as situações climáticas e de saúde de Marrocos, São Tomé e Príncipe e Senegal, bem como as suas expectativas para as próximas reuniões e dedicação aos produtos de conhecimento. Panorama climático e de saúde em Marrocos, São Tomé e Príncipe e Senegal Marrocos, São Tomé e Príncipe e Senegal reconhecem o impacto significativo que as alterações climáticas têm nos resultados de saúde, reconhecendo que ameaçam comprometer décadas de progresso na saúde pública. Embora estes países se encontrem em diferentes fases de incorporação das considerações climáticas nas políticas públicas, todos os três demonstraram um compromisso político para lidar com as alterações climáticas. Mitigação CSHS de Marrocos: Construindo Resiliência às Alterações Climáticas Marrocos enfrenta desafios crescentes decorrentes das alterações climáticas, sofrendo ondas de calor extremas, secas e es e inundações. O país continua comprometido com as metas climáticas internacionais para 2030 e está a tomar medidas decisivas para mitigar as alterações climáticas e reduzir as emissões de gases com efeito de estufa (GEE) em todos os setores, especialmente na saúde. Até 2021, o Ministério da Saúde e Proteção Social de Marrocos comprometeu-se a construir um sistema de saúde sustentável e resiliente às alterações climáticas. Uma avaliação recente analisou a sustentabilidade ambiental, a resiliência climática e as emissões de GEE das instalações de saúde públicas de Marrocos. Com base nas recomendações da avaliação, Marrocos irá desenvolver um plano de implementação para melhorar a resiliência climática das suas instalações de saúde. Estas medidas substanciais demonstram a dedicação de Marrocos em fortalecer o seu sistema de saúde contra os impactos das alterações climáticas e garantir a continuidade dos serviços de saúde em meio a perturbações relacionadas com o clima. São Tomé e Príncipe, um pequeno Estado insular em desenvolvimento (SIDS), tem um histórico de chuvas e deslizamentos de terra, que levam a doenças transmitidas pela água e ao aumento de casos de malária e dengue. A celulite necrosante, causada por microrganismos normalmente encontrados na pele, também pode estar relacionada com as alterações climáticas. A parte norte do país, propensa a inundações durante a estação chuvosa, implementou exercícios de simulação para se preparar para tais eventos. Apesar de participar na Conferência das Partes (COP), o país ainda não iniciou medidas relacionadas com a saúde para se adaptar às alterações climáticas. Abordagem proativa do Senegal para integrar os riscos climáticos no planeamento do setor da saúde O Senegal está a adotar uma postura proativa contra os riscos à saúde relacionados ao clima, integrando considerações climáticas no planeamento e orçamento de projetos de investimento em todos os setores, com foco particular na saúde e nos determinantes da saúde. Esta abordagem é impulsionada pelo aumento da prevalência de eventos climáticos extremos, como chuvas fortes, inundações, temperaturas extremas, chuvas fora de época, tempestades de poeira, secas e erosão costeira, que levaram ao surgimento de doenças como a dengue nos últimos anos (2017-2023). As principais iniciativas incluem o reforço do quadro institucional e a promoção da colaboração intra e multissetorial, particularmente no âmbito do grupo Saúde e Ambiente, a fim de garantir uma compreensão e integração abrangentes dos riscos climáticos no setor da saúde. O Senegal demonstra o seu compromisso com cuidados de saúde conscientes do clima através de várias iniciativas. A colaboração entre o Ministério do Ambiente, Desenvolvimento Sustentável e Transição Ecológica (MEDDTE) e o Ministério da Saúde e Ação Social (MSAS) levou ao desenvolvimento do plano nacional de adaptação para o setor da saúde (PNAS), que aguarda validação política. Além disso, um decreto exige a integração climática em todos os futuros projetos de investimento público superiores a 500 milhões de FCFA, e um «orçamento nacional verde» complementará a lei financeira de 2024. O Senegal concluiu análises de lacunas e estudos de vulnerabilidade para informar essas políticas. O país está a finalizar uma nota conceitual para um projeto de adaptação da saúde para o Fundo Verde para o Clima (GCF) e integrou o risco climático na política de desenvolvimento do setor da saúde, nas estruturas do sistema e nos procedimentos. Os indicadores de saúde sensíveis ao clima agora fazem parte da Contribuição Nacionalmente Determinada (NDC) e do monitoramento rotineiro do sistema de informações de saúde. Além disso, o sistema de alerta precoce de ondas de calor está a ser reforçado. Aprendizagens dos países e cumprimento das expectativas
Sharing Insights and Lessons Learned: Reflections from the First In-Person Meeting of the JLN-CSHS Collaborative in Morocco, São Tomé and Principe, and Senegal
Authors: Amal Dahri, Codou Badiane Mane, Abdoulaye Diaw, Bekkaoui Hassane, Isaulina Barreto, Leonel Pontes, and Ilhame Ouansafi. Representatives from Morocco, São Tomé and Principe, and Senegal, accompanied by World Bank staff in the country offices, attended the inaugural in-person meeting of the in Washington, DC USA from February 26-27, 2024. The meeting was attended by 20 countries from Africa, Asia, the Middle East, and South America, and was held to facilitate the sharing of experiences and lessons learned regarding climate change response and healthcare system resilience. The primary goals of the meeting were to initiate the collaborative, identify priority technical areas and key themes, share existing efforts, tools, and successes, understand and document expectations for collaborative activities, and jointly outline potential knowledge products that could be co-produced throughout the two-year collaborative period. Participants identified six workstreams for focus by the collaborative and agreed to collaboratively co-develop five knowledge products in 2024-2025 corresponding to the first three workstreams: 1) Governance, 2) Financing and Maximizing Financing, 3) Data and Accountability, 4) Multisectoral Action, 5) Engaging Communities, and 6) Service Delivery Models. Discussions revealed that the cost of inaction on climate change, whose global impact is already evident greatly surpasses the cost of investing in mitigation efforts. These investments would benefit healthcare systems, enabling them to continue serving populations, especially the most vulnerable. This article highlights the JLN CSHS collaborative’s discussions of Morocco, São Tomé and Príncipe, and Senegal’s climate and health situations, as well as their expectations for upcoming meetings and dedication to knowledge products. Climate and Health Landscape in Morocco, São Tomé and Príncipe, and Senegal Morocco, São Tomé and Príncipe, and Senegal acknowledge the significant impact climate change has on health outcomes, recognizing that it threatens to undermine decades of progress in public health. While these countries are at different stages of incorporating climate considerations into public policy, all three have demonstrated a political commitment to addressing climate change. Morocco’s CSHS Mitigation: Building Resilience to Climate Change Morocco faces growing challenges from climate change, experiencing extreme heat waves, drought, and flooding. The nation remains committed to international climate goals for 2030 and is taking decisive action to mitigate climate change and reduce greenhouse gas (GHG) emissions across all sectors, especially healthcare. By 2021, Morocco’s Ministry of Health and Social Protection had committed to building a sustainable and climate-resilient healthcare system. A recent assessment evaluated the environmental sustainability, climate resilience, and GHG emissions of Morocco’s public healthcare facilities. Based on the assessment’s recommendations, Morocco will develop an implementation plan to enhance the climate resilience of its healthcare facilities. These substantial measures demonstrate Morocco’s dedication to strengthening its healthcare system against climate change impacts and ensuring continued healthcare services amid climate-related disruptions. São Tomé and Príncipe, a small island developing state (SIDS), has a history of rainfall and landslides, which lead to water-borne diseases and increased cases of malaria and dengue fever. Necrotizing cellulitis, caused by microorganisms normally found on the skin, could also be linked to climate change. The northern part of the country, prone to flooding during the rainy season, has implemented simulation exercises to prepare for such events. Despite participating in the Conference of the Parties (COP), the country has not yet initiated health-related measures to adapt to climate change. Senegal’s Proactive Approach to Integrating Climate Risks in Health Sector Planning Senegal is taking a proactive stance against climate-related health risks by integrating climate considerations into the planning and budgeting of investment projects across all sectors, with a particular focus on health and health determinants. This approach is driven by the increased prevalence of extreme weather events such as heavy rainfall, flooding, extreme temperatures, unseasonal rainfall, dust storms, drought, and coastal erosion, which have led to the emergence of diseases like dengue fever in recent years (2017-2023). Key initiatives include strengthening the institutional framework and fostering intra- and multi-sectoral collaboration, particularly within the Health and Environment group, to ensure a comprehensive understanding and integration of climate risks in the health sector. Senegal demonstrates its commitment to climate-conscious healthcare through several initiatives. Collaboration between the Ministry of the Environment, Sustainable Development and Ecological Transition (MEDDTE) and the Ministry of Health and Social Action (MSAS) led to the development of the national adaptation plan for the health sector (PNAS), awaiting political validation. Further, a decree mandates climate integration in all future public investment projects exceeding 500 million FCFA, and a “green national budget” will complement the 2024 finance law. Senegal has completed gap analyses and vulnerability studies to inform these policies. The country is finalizing a concept note for a health adaptation project for the Green Climate Fund (GCF) and has integrated climate risk into health sector development policy, system structures, and procedures. Climate-sensitive health indicators are now part of the Nationally Determined Contribution (NDC) and routine health information system monitoring. Additionally, the heat wave early warning system is being strengthened. Country Learnings and Meeting Expectations International Collaboration to Build Climate-Resilient Healthcare Systems The inaugural in-person meeting of the JLN-CSHS partnership fostered a valuable exchange among French-speaking participants from diverse countries. The meeting facilitated a platform to share insights on climate change impacts, discuss region-specific challenges, and learn from each other’s progress in developing healthcare systems that can withstand climate change. Morocco, São Tomé and Príncipe, and Senegal valued the JLN knowledge exchange platform, which allowed them to expand their knowledge base and learn from the diverse approaches other countries have taken to address their unique challenges and constraints. The three countries were particularly interested in learning about initiatives undertaken by other participating countries to adapt and mitigate the adverse effects of climate change on health systems. They emphasized the importance of learning from good practices and successful initiatives in other contexts, with the goal of adapting and replicating these strategies within their own health systems. The three countries highlighted a number of specific features they learned from these meetings, at various stages of integrating climate change considerations into their public policies. Morocco emphasized that governance is the most important
Second In-Person Meeting of the CSHS Collaborative
Event Announcement The Second In-Person Meeting of the CSHS Collaborative October 5-9, Manama, Bahrain The JLN Collaborative on Climate Smart Health Systems will hold its second full-collaborative in-person meeting in Manama, Bahrain, from October 5-9, 2025. At the Second In-Person meeting, members will provide feedback and finalize the knowledge products that have been developed over the previous year (under the three workstreams of Governance, Financing, and Data and Accountability) and identify products for co-production in Year 2 of the collaborative, under the remaining three workstreams of Multisectoral Action, Engaging Communities, and Service Delivery Models. The Governance workstream has developed a Climate and Health Governance Guideline that covers policies, regulations, leadership, and stakeholder coordination. The Financing workstream has drafted two knowledge products: Making the Case for Investment in Climate and Health, which outlines key messages on health impacts and investment benefits, and a Repository on Public Financial Management for Climate and Health that compiles resources for climate-smart health financing. The Data and Accountability workstream has drafted a Data Toolkit on common data integration and visualization challenges, as well as two repositories, with the first focusing on Health Facility Infrastructure and the second focusing on Health Worker Tools. By fostering collaboration and knowledge exchange among policymakers, the CSHS Collaborative aims to strengthen governments’ capacity to build climate-smart health systems and address the challenges posed by climate change. Members of the collaborative have previously convened at the Launch meeting of the collaborative in February 2024 (Washington, DC, USA) and at the First Author’s Workshop in October 2024 (New Delhi, India). The inaugural in-person meeting was attended by 20 countries from Africa, Asia, the Middle East, and South America. The primary goals of the initial in-person meeting of the JLN CSHS Collaborative were to initiate the collaborative, identify priority technical areas and key themes, share existing efforts, tools, and successes, understand and document expectations for collaborative activities, and jointly outline potential knowledge products that could be co-produced throughout the two-year collaborative period. The meeting facilitated the sharing of experiences and lessons learned regarding climate change response and healthcare system resilience. During the launch meeting, participants identified the six workstreams for focus by the collaborative and agreed to collaboratively co-develop knowledge products in 2024-2025 under the first three workstreams of Governance, Financing and Data and Accountability. The First Author’s Workshop in New Delhi, India, from October 7-11, 2024, brought together a select group of participants from 21 member countries to share their practical experiences and implementation knowledge. Attendees discussed the key components and country examples for inclusion in the Year 1 knowledge products and shared their interest in co-authoring and contributing content for specific sections in each knowledge product. The workshop concluded with working outlines for the knowledge products for further virtual deliberation.
From Fragmentation to Focus: Leveraging Strategic Health Purchasing Amid Conflict and Crisis
Africa faces a persistent challenge in financing healthcare, often characterised by limited public spending, high out-of-pocket payments, low domestic funding, and fragmented donor and funding flows. To tackle these challenges, countries are turning to Strategic Health Purchasing (SHP)—a smarter approach to delivering better health outcomes for every dollar spent, ensuring more equitable and accountable use of both domestic and donor resources. “Strategic Health Purchasing can improve how a health system uses information on population health needs and provider performance to more effectively allocate resources to health providers—even in fragile settings.” – Boniface Mbuthia, Technical Director, Health Financing, Amref Health Africa During the recent International Health Economics Association (IHEA) Congress, Joint Learning Network, Amref Health Africa and government representatives from Malawi, South Sudan, and Zambia discussed how SHP is being applied in different country contexts to identify, prioritise, and track health system strengthening opportunities and activities that accelerate Universal Health Coverage (UHC). Speakers also shared how they used the SHP Progress Tracking Framework, developed by the Strategic Purchasing Africa Resource Centre (SPARC), to map purchasing functions across health systems and financing schemes. The framework helps countries gain a clear picture of their current capabilities and gaps in key areas related to SHP, including governance arrangements, policy and legal frameworks, and purchasing functions. To date, policymakers in more than 20 countries across Africa and Asia have used the framework to guide their health financing reforms. Here are four key learnings from the session: 1. Harness Pooled Funding Mechanisms Pooled funds, including those from donors, create opportunities to purchase health services more strategically and sustainably—even in fragile states. South Sudan’s Health Sector Transformation Project (HSTP) is a powerful example, providing significant opportunities for enhancing provider-purchaser engagement, performance monitoring, contracting, and reforming provider payments. “Pooled health funds provide the financial resources, while strategic purchasing provides the mechanism to effectively and efficiently use those resources while aligning them to broader health goals,” Dr. John Rumunu, Director General of Health Policy Planning, Budgeting, and Research, South Sudan Ministry of Health. In Malawi, the Health Sector Strategic Plan III (2023-2030) is being used to advance “one plan, one budget” policy reforms to consolidate health resource flows and encourage the use of service level agreements (SLAs) currently for faith-based facilities. 2. Build Responsive Health Systems Through Strong Governance Strong governance emerges as the foundation that makes strategic health purchasing work in practice. Zambia is navigating ambitious reforms that include strengthening the National Health Insurance Scheme and transferring health system governance to local District Councils under the Ministry of Local Government. While complex, these reforms present an opportunity to reimagine how different purchasing entities can work together to increase utilisation, equity, financial protection, and quality care. In South Sudan, the Ministry of Health chairs the HSTP, creating a platform where donor funding, government priorities, and health system strengthening align. This governance structure doesn’t just manage resources—it offers an opportunity to build sustainable institutional capacity. 3. Contract with Health Facilities When health facilities have more control over their finances and operations and clear performance-based agreements, they deliver better care, respond more efficiently to the needs of their communities, and achieve better health performance with purchasing agencies. In Malawi, faith-based health facilities partner with the government through the Christian Health Association of Malawi or CHAM. They receive direct funding and operate with greater independence, enabling more responsive care. “Lessons from the use of SLAs for faith-based facilities are essential to guide further reforms on how we purchase health services—even from public facilities,” says Gladstone Mchoma, Health Economist with Malawi’s Ministry of Health. Zambia is using the National Health Insurance Management Authority to formally contract with private providers, providing a mechanism to specify service scope, pricing, and quality standards. 4. Connect Performance Data to Funding Decisions Countries across Africa collect vast amounts of health data, but this information doesn’t always influence how funding is allocated. Closing this gap is essential for strategic purchasing to work effectively. To address this, countries can redesign their processes so that performance information motivates purchasing decisions. This means rewarding facilities that deliver quality care efficiently while providing support to those who are struggling. While Zambia has a complex system for tracking health services and managing finances, district officials report that the data don’t always translate into financial decisions and that funds often flow regardless of performance. Local capacity and authority to make evidence-based decisions are crucial for making strategic purchasing work in practice. Dr. Chrispine Sichome, Director of Health Policy for Zambia’s Ministry of Health, emphasised that “tackling these challenges will not only accelerate progress toward UHC but also provide valuable insights for other low- and middle-income countries pursuing similar health financing reforms.” The Way Forward The learnings gathered from these three countries show that SHP can be used to strengthen even constrained health systems, and tools like the SHP Progress Tracking Framework provide a way to move beyond good intentions to measurable progress. Strategic health purchasing represents not just a financing reform, but a comprehensive approach to get better health outcomes for every person and every dollar spent. ———————— These lessons were originally shared at the International Health Economics Association 2025 Congress in Bali, Indonesia (July 19-23, 2025). The authors would like to thank Hallie Goertz for her strategic communications support. Authors: Rahul Kadarpeta, Boniface Mbuthia, Gladstone Mchoma, Frida Ngalesoni, Lizah Nyambura, John Rumunu, Chrispine Sichome Read also here: Amref Newsroom
In-Person Workshop, Istanbul-Primary Healthcare Performance Management Collaborative
The JLN Primary Healthcare Performance Management Collaborative, facilitated by Aceso Global, held an in-person workshop from July 21–24, 2025, in Istanbul, Turkey. This highly interactive convening brought together member country teams to strengthen skills, co-create practical tools, and advance innovations in PHC performance management. The workshop centred on two key work-streams: Hard Skills Capacity-Building (Days 1 and 3): Participants worked on finalizing pilot initiatives in Liberia, South Africa, and the Philippines, focusing on practicum development, mini-project preparation, applied computer literacy, drafting terms of reference, contracting trainers, curriculum walkthroughs, and quantitative analysis. The sessions were designed to be hands-on, combining technical content with interactive learning activities to strengthen district-level management capacity. Dashboard Development (Days 2 and 4): Country teams engaged in data visualization exercises, group presentations, and practical discussions on effective dashboard use. Highlights included country updates from Mongolia and Nigeria, a masterclass on dashboard design and impact by expert Katherine Rowell, and a collaborative session supporting Mongolia’s development of a new in-house performance dashboard. The four-day workshop concluded with a planning session to shape the Collaborative’s final outputs, ensuring that lessons, tools, and resources are captured for use across JLN countries. This gathering not only deepened technical skills but also reinforced the value of peer learning—helping member countries strengthen the foundations of resilient and equitable primary healthcare systems.