The idea for the Joint Learning Network (JLN) was seeded during a 2009 meeting when country experts and global health partners discussed the possibility of strengthening ways for knowledge exchange, joint problem solving and shared learning as low and middle income countries undertake health reforms on the path towards Universal Health Coverage (UHC).
One of the highlights of that meeting was a series of presentations from Ghana, India, Vietnam and Thailand. All four countries have either achieved or have strong political commitment to achieving UHC, and they presented a range of successes and challenges that were fairly similar. When we asked how often they met, we were surprised to learn that with this exception, they had never met, and had not worked together to any extent in the past. A participant said that their engagements were usually with donors who worked in their countries or ad hoc international meetings. The Rockefeller Foundation supported JLN to change this.
One of the most important achievements is the building of a community of practice that is owned by a group of countries.
One key achievement of the JLN is a five-country costing collaborative that provides comparative cost data across countries. They have also co-written a costing manual that will enable other countries to do this faster and better, which is also feeding into a toolkit for developing provider payment systems. We are also developing a health data dictionary, since technical terms are often not very well defined. In Ghana and Kenya, for example, senior technocrats are working on developing common e-claim systems.
In the longer term, one of the most important achievements is the building of a community of practice that is owned by a group of countries. This is more uncommon than you would imagine. There are lots of networks of practice but many of them are run, or heavily influenced, by donor agencies. So when you create a lateral structure with countries in the driver’s seat, it is actually quite unusual.
Quality is often a hidden problem within health systems. While a large majority of people in most countries now have access to a health provider, it is still quite normal for rural and remote areas to have very poor quality services, and thus people don’t use them. This implies three challenges to the health system. First, urban hospitals being very crowded because relatively few people use the primary care system in rural areas. Second, if the system is very low quality, it is wasting a huge amount of money. Finally, as a result, overall health outcomes suffer.
Simply paying for doctors, buildings and equipment are not enough.
Thus, despite building medical facilities, buying machines, and paying salaries, these investments are not paying off optimally in terms of overall population health. Simply paying for doctors, buildings and equipment are not enough. If those things don’t come together in terms of providing high quality care, then the system is underperforming. The problem with quality is that it’s also a little bit invisible. If a facility isn’t there, it’s very obvious. If a facility is providing low quality care, it’s not as visually obvious.
System managers who are members of JLN identify ways to drive improvements in health system quality as they expand coverage. One thing we recognize is that most countries do not have very good systems to measure quality; hence the nature and magnitude of the problem in most cases cannot be identified. Accreditation is a tool to systematically measure quality across a range of health facilities using a common metric. In April 2013, we organized an accreditation workshop to develop effective standards, an accreditation implementation plan to promote quality, and collect accurate and useful data.
From here, our vision is to build a strong legitimate Steering Committee represented by each JLN country. They will be able to identify common priorities for the countries. We will also leverage more political support from the international community and more funding support from other donors who would be interested in supporting a construct like this.
To learn more about JLN, watch the following video and download our update report: