The Path Toward UHC May Look Different in Each Country, but the Lessons that Emerge can be Universal
The term “global community” may, at first, seem paradoxical. The term community sparks images of commonality, of shared characteristics and fellowship between members, while “global” seems to mean the opposite. And yet the Joint Learning Network for Universal Health Coverage (JLN) Primary Health Care (PHC) Financing and Payment collaborative is just that: a global community. The practitioners involved in the collaborative have a shared goal of achieving universal health coverage (UHC) in their respective countries and come together to learn, debate, and discuss practical solutions to the most pressing challenges their countries face related to PHC financing and payment in pursuit of this goal.
At the recent convening in Addis Ababa, Ethiopia, where more than 60 participants representing 14 countries came together, this sense of community was more pronounced than ever. The steps that each country is taking to achieve UHC are different. Some countries shared their plans to implement new purchasing agencies while others discussed the successes and challenges of adapting new provider payment methods. Among all participants, however, a core commonality exists: each country is navigating a bold and ambitious goal—providing high-quality health services to all members of their population—and the path to get there is not easy. As members of the collaborative discussed challenges and shared innovative solutions about how PHC financing and payment can be used as a core lever in pursuit of UHC, the sense of community in the room was clear.
As the collaborative reflects on the three days spent together and plans for the continuation of this engagement through webinars, podcasts, blogs, and other means, three lessons emerged that highlight the value of joint learning and global community.
1) There is no one approach that works everywhere all the time, and no endpoint.
The building blocks of health systems are shaped by each country’s social, political, and economic environments, and therefore any solutions must be contextualized. The opportunity for joint learning allows participants to better understand the “when,” “where,” “why,” and “how” of what works so that countries are better informed when selecting options for implementation.
2) There are many ongoing country innovations dedicated to improving PHC financing and payment.
Countries are implementing new coverage schemes, presenting an opportunity to test out new purchasing arrangements and payment systems for PHC. Country lessons emphasized that payment systems put in place during a pilot phase may work well in small settings but present challenges during scale-up. Sustainable operational processes and provider payments should be implemented early on as making critical design changes later can be very difficult or nearly impossible.
Countries are becoming more sophisticated in their use of pay-for-performance. A lesson shared with the collaborative was the need to balance the number of indicators with the administrative burden of collecting information for these indicators.
Countries are introducing new PHC service delivery models to form networks of providers to serve beneficiaries more holistically. Countries are increasing private-sector engagement and increasingly formalizing the role of community providers. Stakeholder engagement is important to address concerns and obtain buy-in to successfully implement this reform.
3) Being a strategic purchaser starts with analysis… and analysis starts with using what you have.
Countries can start from the basics and build on the systems already in place. By creating a solid foundation and a culture of data use, countries are better placed to digitize and establish an electronic system in the future.
Future directions: thinking in systems instead of schemes
Participants agree that improving provider payment should be part of a systemic approach. This means looking beyond individual schemes to assess strategic purchasing approaches holistically to identify an approach that provides the most efficient incentives across the health system. As the collaborative kicks off, participants will be digging deeper into the next generation of system-wide issues.
The lessons that emerged from this meeting celebrated the array of experiences, contexts, and voices included in the PHC Financing and Payment Collaborative. As countries continue their journeys toward UHC, learning from one another will be key. A core value of the JLN is that every country has something to share and every country has something to learn. As nations grapple with evolving health challenges, ensuring that the pool of available evidence—in the form of peers, mentors, and friends—is both broad and robust will be essential.
Co-authors: Agnes Munyua, Allyson English, and Nivetha Kannan from Results for Development ↗, which facilitates the JLN’s PHC Financing and Payment collaborative.