Country Pairings: A new collaborative learning modality deepening engagement with country practitioners
Authors: Nivetha Kannan, Agnes Munyua, Henok Yemane
The Joint Learning Network for Universal Health Coverage (JLN) Primary Healthcare (PHC) Financing and Payment collaborative provides an open, trusted space for practitioners and policymakers from 20 countries to share implementation experience on financing and provider payment for PHC. Traditionally, collaborative participants co-develop the learning agenda, identifying common topics and themes to cover over the two-year duration of the collaborative. At in-person and virtual events, participants discuss new ideas, lessons learnt, challenges and how to overcome obstacles. This is synthesized into practical guidance and knowledge products that are accessible to the full collaborative.
In 2020, the 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 the resource country and discuss details that are relevant to their countries. In this blog, we highlight three country pairings and share overarching lessons implementing this modality.
Operationalizing the Approach
The country pairing modality was designed to facilitate deeper country to country connections and knowledge sharing, building a foundation for country participants to undertake future engagements if needed. Countries initially express an interest in partnering with a resource country – a country that has enacted similar reforms and has relevant experience/lessons to share related to that topic. Once countries defined clear learning questions to be addressed by the resource country (denoted as RC below), the technical facilitation team arranged a virtual session between both countries and worked with the country teams to mobilize additional team members to also benefit from the pairing. 11 countries initially expressed interest in this modality and five pairings were selected to test the modality, four of which are showcased below:
Country Pairing Examples
1. Kenya | Ghana (RC)
Recognizing the importance of PHC as the bedrock to achieving UHC, Kenya proposed a hub and spoke model – the Primary Care Networks (PCNs) – to improve access to quality networked health services. Given Ghana’s pilot implementation of a similar service delivery model (Preferred Primary Provider (PPP) Network), Kenya sought the opportunity to collaborate with Ghana and develop a holistic understanding of how to implement the model, key lessons, and pitfalls to avoid.
2. Indonesia | Mongolia and Vietnam (RC)
Indonesia is increasing their focus on strategic purchasing of health services to get the most value for resources in line with health sector priorities, and improve the implementation and sustainability of their national health insurance program Jaminan Kesehatan Nasional (JKN). In so doing, the Indonesian Board of National Social Security Dewan Jaminan Sosial Nasional (DJSN) aims to conduct an objective assessment of a global budget pilot for ongoing improvement of JKN implementation. In this pairing, Indonesia was interested to learn from Mongolia and Vietnam’s adaptation and implementation of the JLN’s Provider Payment Diagnostic and Assessment Guide and in particular, the rationale for implementing the tool and how findings were used to inform policy discussions on improving provider payment in these countries.
3. Moldova | Mongolia (RC)
Moldova developed an interest in learning more about Mongolia’s health insurance system and their pay for performance (P4P) indicators, how they are monitored, and the basis of calculating P4P payments. This pairing was an opportunity for Moldova to delve deeper into utilizing and revising P4P indicators, as well as an opportunity to probe Mongolia on best practices and lessons learned.
4. Ghana (RC) | Malaysia (RC)
The Ghana-Malaysia pairing was distinct in that both countries expressed an interest in sharing and learning from one another. Malaysia shared their experience financing preventive and promotive care through their flagship program, PeKa B40 and Ghana shared their experience around internal and external audit mechanisms.
Creating more personal and responsive learning environments: This learning modality has been an opportunity for participants to experience more personal learning environments. It is common practice for the collaborative to define learning agendas or topics for virtual engagements based on shared challenges, but sometimes it leaves out specific country interests. This modality was introduced to address niche topics, while facilitating learning between a smaller group of countries that responded to a specific need and allowed a resource country to share their implementation experience that was most relevant to the country expressing the need.
A more cost-effective approach: Previously, similar learning would have taken place in a study tour setting between two or three countries. COVID-19 travel restrictions limited the ability for planning such events. Through the country pairing modality, the collaborative was able to mimic an environment for more personal engagement without travel, at a fraction of the cost.
A wider reach to country practitioners: The majority of collaborative events are limited to country participants/teams nominated at the beginning of the collaborative. In contrast, countries participating in the country pairings invited colleagues beyond the PHC Financing and Payment collaborative participants, allowing for stakeholders across the Ministry of Health, purchasing agencies, and partners to attend these peer-to-peer learning events.
A platform to develop a shared understanding and consensus to address a health system challenge: When windows of opportunity emerge for implementation changes or iterations, the breadth of experiences and implementation lessons present in these conversations could potentially create more alignment on approaches and lessons that can be borrowed and contextualized to improve implementation in their country.
The challenges countries face in UHC are dynamic and multi-faceted. The core facilitation team piloted this new modality with the broad goal of empowering countries to leverage their peers as resources and build networks that can provide invaluable and insightful support on the journey to achieving UHC. It is too early to speak to the successes of this modality, but the facilitation team has received requests for follow on sessions from country practitioners and new requests from other country teams – indications that such modality is needed. In collaboration with the JLN Network Manager, the facilitation team will also be conducting an evaluation of the country pairing modality and will share findings in a subsequent blog post.