Over the past four years, the Joint Learning Network (JLN) partners have experimented with a number of different approaches to build community, learn, and share practical knowledge between countries. One signature approach of the JLN community is “knowledge co-production,” a blend of structured and unstructured approaches that enables a learning community to identify the best ways to develop and share relevant knowledge.
The JLN uses this approach in several learning collaboratives to advance work on provider payment and information technology. For provider payment, for example, JLN worked with five countries to undertake facility costing studies, producing a compendium of high quality studies that will form the foundation for future work in each country. The group will also co-author a “how to” costing manual for undertaking these studies in low- and middle-income settings, where data availability is usually imperfect. The collaborative is now in the process of selecting a new objective, which is likely to focus on developing concrete approaches for monitoring progress of provider payment reforms.
The information technology learning collaborative has focused its efforts on creating specific “system requirements” for the UHC system, such as enrollment and fraud detection to assist members in mapping out the common requirements for what they want technology to do for them. In many settings, the usual approach is to buy the hardware and software, train people, and then figure out what it can do for you. The JLN approach turns that on its head and asks members to think very clearly regarding exactly what they want to achieve, and then think about the hardware and software that will enable achievement of these objectives. In addition, this collaborative has worked jointly on a common health data dictionary, which is now being customized for use in some countries by collaborative members.
While it is still relatively early on, it is clear that the knowledge co-production process has genuine promise in terms of promoting a deeper debate regarding ways to best promote health systems reforms. While it is hard to find quantifiable measures to capture the notion of “group cohesion,” it is easy to see that there is a high degree of motivation and trust among country participants, and that this is translating into the joint production of high quality, legitimate technical knowledge outputs that are necessary for countries to move towards UHC.
The Knowledge Co-Production Approach
Develop shared objectives
Identifying that which is “common”, “relevant”, and “achievable” within a group is not easy, a learning collaborative has to find objectives that fulfill all three of these conditions.
Understand current approaches among members
A key aspect is to “start where people are, “not “start with what the external expert knows.” Since a key element of collaborative learning is sharing experience, taking the time to understand this experience is the foundation for all good things that come after.
Develop a shared roadmap of activities and milestones
Too many learning processes are either one-off affairs (the big workshop) or involve ongoing meetings, but don’t always feature a clear analytical journey. A good roadmap can link specific steps of a process into a coherent whole without being overly prescriptive and help members build a sense of shared commitment to a larger analytical exercise.
Undertake individual tasks, and meet periodically to review each other’s work and critique progress
While it can be hard to start the ball rolling in terms of members critiquing each other—nobody likes to critique others or be critiqued—it can also be a powerful means of building a sense of community, trust, and shared space.
Co-develop common solutions
Common solutions take time to develop, and their value transcends the solution itself—it enables a group to achieve something that no individual could do on their own, and no external expert could do in isolation. This also ensures buy-in among group members.
Adopt and use solutions
Common solutions do not solve all country-level problems, however, their relevance demonstrates that there are many common UHC challenges across countries, and common elements can be applied in very different settings. Since participants are the central actors in developing solutions, the DNA of these solutions is already well understood, and thus easier for them to apply in their countries.
Disseminate solutions more broadly
The ultimate value of these approaches is their uptake by those not directly involved in knowledge co-production. The working hypothesis is that knowledge products produced by country to country collaborative learning will have greater legitimacy and be more relevant to the needs of other countries moving towards UHC.