Five Years of Facilitating Practitioner-to-Practitioner
Learning to Achieve Universal Health Coverage
JLN @ 5
Practitioner-to-Practitioner Learning
Helps Countries Move Toward Universal
Health Coverage
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JLN @ 5: Practitioner-to-Practitioner Learning Helps
Countries Move Toward Universal Health Coverage
Five Years of Facilitating Practitioner-to-Practitioner
Learning to Achieve Universal Health Coverage
Our Members
JLN @ 5:
Practitioner-to-Practitioner
Learning Helps Countries
Move Toward Universal
Health Coverage
Introduction
The Joint Learning Network for Universal Health Coverage (JLN) is an innovative community of
practitioners and policymakers from around the globe who co-develop global knowledge products
that help bridge the gap between theory and practice in working toward universal health coverage
(UHC). The JLN is a country-driven network, which means that all of its activities are prioritized,
shaped, led, and co-facilitated by JLN member countries.
Through a unique model for joint problem solving—which includes multilateral workshops, country
learning exchanges, and virtual dialogue—JLN members build on real experience to produce and
experiment with new ideas and tools for expanding health coverage. The aim is to extend coverage
to more than 3 billion people, many of whom are among the world’s poorest and lack access to
quality health care with financial protection.
This report describes how JLN member countries benefit from the deep expertise of practitioners,
country-led governance, and an exciting collaborative approach to move toward UHC in their own
Members
Associate Members
countries.
The report was produced on behalf of the JLN Steering Group by the JLN Network Coordination team at
Africa
Egypt
Namibia
Asia
Ethiopia
Nigeria
Ghana
Senegal
Mali
Sudan
Morocco
Kenya
Bangladesh
Mongolia
America
India
Philippines
Indonesia
Japan
South Korea
Malaysia
Vietnam
Bahrain
Europe
Colombia
Moldova
Mexico
Kosovo
Results for Development Institute, with generous support from the Rockefeller Foundation and the World
Bank.
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JLN @ 5: Practitioner-to-Practitioner Learning Helps
Countries Move Toward Universal Health Coverage
JLN Steering Group
Five Years of Facilitating Practitioner-to-Practitioner
Learning to Achieve Universal Health Coverage
Table of Contents
The JLN Steering Group oversees the strategic direction of the network and ensures that the
network’s technical areas of focus are aligned with member country priorities. It is composed
of representatives from member countries, funders, and technical partners.
Steering Group Representatives:
Ali Ghufron Mukti, Ministry of Research, Technology and Higher Education, Indonesia
Atikah Adyas, Ministry of Health, Indonesia
Rozita Halina Tun Hussein, Ministry of Health, Malaysia
Sam Adjei, Centre for Health and Social Services, Ghana
Evelyn Bangalan, Philippine Health Insurance Corporation, Philippines
A Message from Outgoing Network Convener
4
A Message from New Network Convener
5
2015 Member Survey: Building a Strong
Global Learning Community
6
P. Boregowda, Suvarna Arogya Suraksha Trust, India
Amadou Diallo, Ministry of Social Development, Mali
Co-Created Knowledge Products
Jennifer Hennig, Gesellschaft für Internationale Zusammenarbeit GmbH
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Costing Health Services in Data-Constrained
Environments
11
Somil Nagpal, World Bank
Modupe Ogundimu, National Health Insurance Scheme, Nigeria
UHC Primary Health Care Self-Assessment Tool
Nathaniel Otoo, National Health Insurance Authority, Ghana
Assessing Health Care Provider Payment Systems
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15
16
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Gina Lagomarsino, Results for Development Institute
Elkana Ong’uti, Ministry of Health, Kenya
Natalie Phaholyothin, The Rockefeller Foundation, Thailand
Nguyen Khanh Phuong, Health Strategy and Policy Institute (HSPI), Vietnam
JLN Partners
Data Analytics Toolkit
Functional Requirements for National Health
Insurance Schemes
Evolution of the JLN and Global UHC Movement
18
Sharing and Disseminating Knowledge
20
Looking Ahead to the Next Five Years
24
Global Knowledge Products
30
Get Involved
32
Many partners and funders have provided support to JLN activities. They include:
ACCESS Health International
Asian eHealth Information Network (AeHIN)
Australian Department of Foreign Affairs and Trade
Bill & Melinda Gates Foundation
Capacity Building Program on Universal Health Coverage (CapUHC)
Centre for Health and Social Services (CheSS)
Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH
Harmonization for Health in Africa Communities of Practice
Health Strategy and Policy Institute (HSPI), Vietnam
Healthcare Accreditation Institute (HAI), Thailand
Hewlett-Packard (HP)
Institute for Healthcare Improvement (IHI)
International Health Policy Program (IHPP), Thailand
Japan International Cooperation Agency (JICA)
NICE International
PATH
PharmAccess Foundation
Results for Development Institute (R4D)
The Rockefeller Foundation
U. S. Agency for International Development (USAID)
World Bank
World Health Organization (WHO)
UK Department for International Development (DFID)
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JLN @ 5: Practitioner-to-Practitioner Learning Helps
Countries Move Toward Universal Health Coverage
A Message from the
Outgoing JLN Convener
Five years ago, I joined a group of policymakers and practitioners from Ghana, India,
Indonesia, the Philippines, Thailand, and Vietnam in Manesar, India, at the request of
colleagues from the Rockefeller Foundation and Results for Development Institute. This group
wanted to better understand how Ghana was implementing health systems reforms to achieve
universal health care.
At the time, India was rapidly expanding coverage for the poor by using smart card biometric
technology for enrollment. Thailand was creating innovative provider payment mechanisms to
create incentives to deliver effective, high-quality, and efficient care. Ghana was in the midst of
restructuring the operations of its national health insurance scheme. As we shared our successes
and challenges, we began to realize the great value of joint learning. As the three-day meeting
concluded, we formed a shared vision for a practitioner-to-practitioner learning network aimed at
tackling the “how-to” of health systems reforms to achieve UHC.
Fast-forward to 2015, and the JLN is a robust and innovative learning platform with members
from around the globe. Led by nine member countries, we recently welcomed 15 associate member
countries from Africa, Asia, Eastern Europe, Latin America, and the Middle East. Having committed
to achieving UHC, each of these countries has demonstrated strong political will for expanding
coverage.
With the passage of the UN Sustainable Development Goals (SDGs), we anticipate that more
countries at various stages of health systems reform will need support to move closer to Target
3.8, which calls for countries to achieve UHC—including financial risk protection, access to quality
essential health care services, and access to safe, effective, quality, and affordable essential
medicines and vaccines for all—by 2030.
To equip the JLN to support increasing demand, we have embarked on an exciting new partnership
with the World Bank and a growing consortium of funding and technical partners to expand the
breadth of knowledge co-production and learning opportunities.
It has been my distinct pleasure to be part of the founding and growth of the JLN and to serve as
Convener of the JLN Steering Group. I am pleased to announce that Rozita Halina Tun Hussein,
Deputy Director of the Unit for National Health Financing Planning and Development Division at
Malaysia’s Ministry of Health, recently succeeded me as Convener. Ms. Hussein has been a highly
dedicated member of the JLN since its inception in 2010, and I am confident she will continue to
support and champion the JLN’s mission as we begin this exciting next phase.
The future looks bright for the JLN. We will continue to support one another and build on
our successes.
Five Years of Facilitating Practitioner-to-Practitioner
Learning to Achieve Universal Health Coverage
A Message from the
New JLN Convener
It’s been three months since countries adopted a new set of global goals to end poverty,
protect the planet, and ensure prosperity for all as a part of the new sustainable development goals. Over the next 15 years, the global community will work together to achieve
17 goals with 167 targets including ensuring health lives and promoting the well-being for all at
all ages.
Under the Millennium Development Goals, major progress was made on increasing access to clean
water and sanitation, reducing the incidence of malaria, tuberculosis, polio and the spread of HIV/
AIDS. However, the Ebola outbreak in West Africa exposed the critical need to strengthen health
systems overall and dramatically re-think our approach to disease reduction.
Over the past five-years, the JLN, with support from our partners, has focused on equipping
practitioners and policymakers with the knowledge, tools, and skills that are required to build
resilient, primary health care focused systems that can quickly respond to emerging threats.
This is an exciting time to be a part of the JLN. Together, we continue to strengthen the JLN’s impact
on country progress toward UHC and expand our technical initiatives to focus on emerging topics
such as the institutional arrangements for governing quality, and payment mechanisms for primary
health care.
In addition, we recently welcomed 15 new countries as associate members bringing our total
membership to 24 countries from Asia, Africa, Latin America, Eastern Europe, and Middle East,
embarked on a new partnership with the World Bank, and officially launched a new collaboration
with the Primary Health Care Performance Initiative that will result in the formation of a new
technical initiative on improved measurement for primary health care.
JLN members regularly speak of how they have drawn on experiences from other countries to
introduce new policies and refine existing processes. It is imperative that the JLN continues to
provide practitioners with more opportunities to exchange first hand, experiential knowledge of
how to implement policies and programs that will advance their countries towards UHC. With its
wealth of experience, I believe that the JLN can help connect these practitioners with peers,
leverage their expertise, build practical knowledge for the world, and help countries build more
equitable health systems.
I would like to thank Nathaniel Otoo for his wonderful leadership as well as his passion and
dedication to the JLN over the last two years. Under his leadership, the network strengthened our
governance model to institutionalize our country-led, country-driven learning agenda, and raised
our visibility on the global stage as a new model for development.
Looking forward, we will continue to seek new partnerships to expand our areas of focus and
support collaborative learning activities. I am genuinely optimistic about the JLN’s future, and
look forward to leading the JLN Steering Group in this next phase.
Rozita Halina Tun Hussein
Nathaniel Otoo
Acting CEO, National Health Insurance Authority, Ghana
Former Convener, JLN Steering Group (2013-2015)
Deputy Director, Unit for National Health Financing
Planning and Development Division at Malaysia’s Ministry of Health
Convener, JLN Steering Group (July 2015-current)
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JLN @ 5: Practitioner-to-Practitioner Learning Helps
Countries Move Toward Universal Health Coverage
Five Years of Facilitating Practitioner-to-Practitioner
Learning to Achieve Universal Health Coverage
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2015 Member Survey:
Building a Strong Global
Learning Community
The JLN’s unique learning approach helps turn
knowledge exchange into knowledge co-creation.
This learning process (depicted in Figure 1) relies heavily on technical facilitation teams that work
closely with members to extract tacit knowledge through a combination of in-person and virtual
sessions, synthesize it with traditional guidance, and develop both country-specific and globally
Identify a common technical
challenge and the underlying
contextual conditions
adaptable knowledge products that help practitioners implement complex reforms in imperfect
environments. Fostering a collaborative learning network doesn’t happen overnight. It is an iterative
Identify
process that requires strong country ownership and commitment from funders, partners, and
members, as well as a shift in approaches to development.
Develop
Share
Share experiences and
strategies that practitioners in
different contexts have used to
address the challenge
Document country experiences
using a standardized approach
Build
Find the gaps in knowledge
Document
Find
Build common solutions that can
be adapted and implemented in
different contexts
Develop a shared vision and
roadmap for filling knowledge gaps
Figure 1. The following process illustrates the “collaborative learning” process.
Santhosh Kraleti from ACCESS Health exchanges tacit knowledge at
the PPM Costing Collaborative workshop in Indonesia (Photo: JLN)
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JLN @ 5: Practitioner-to-Practitioner Learning Helps
Countries Move Toward Universal Health Coverage
Five Years of Facilitating Practitioner-to-Practitioner
Learning to Achieve Universal Health Coverage
In September 2015, 248 individuals from JLN member
countries were asked to take a survey on their
satisfaction with the JLN’s activities and offerings.
All of these individuals had participated in one or more
learning activities in the past.
107
38%
respondents
response rate
90%
Including relationship building,
access to peer technical experts,
and ability to access specialized
tools, guides, and case studies.
benefited from the
network’s offerings
Number of product adaptations by JLN members
89%
Relationship building and networking
20%
15%
13%
13%
12%
8%
12%
60%
of respondents have
adapted JLN
products for use
in their respective
countries
Survey participants provided useful information about the value placed on JLN membership and how
they are applying knowledge acquired through the network in their own contexts.
JLN members have benefited from the
network’s offerings
27%
JLN impacts policymaking processes in-country
through the following modalities:
Knowledge co-production
77%
39%
44%
46%
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2
3
Applying global best practices
in-country
Using network knowledge to
convince policymakers
of health reform
Receiving advice from peers
on major policy direction
Of respondents have
contributed
to the co-development
85%
Access to peer technical experts
85%
Access to tools, guides, case studies
of JLN global
knowledge products
Costing Manual for PPM
IT Core Business Requirements
Open Health Data Dictionary
PPM Diagnostic and Assessment Guide
UHC-PHC Self-Assessment Tool
Population Coverage User Maps
Population Coverage Informal Sector Papers
Other
24
20
16
16
32
9
20
14
9
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JLN @ 5: Practitioner-to-Practitioner Learning Helps
Countries Move Toward Universal Health Coverage
Five Years of Facilitating Practitioner-to-Practitioner
Learning to Achieve Universal Health Coverage
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Costing Health Services in Data-Constrained
Environments
Co-Created Knowledge
Products
As countries expand their health coverage, issues of financial sustainability,
efficiency, and quality of care quickly emerge. By developing robust
provider payment systems, countries can take significant steps toward
improving the quality of care, preventing fraud, and managing costs.
JLN member countries have pointed to costing of health services
for provider payment as a major technical challenge, but they
have lacked guidance on costing in data-constrained
environments. The Collaborative on Costing of Health Services
for Provider Payment was created to provide an ongoing forum
Dr. Afisah Zakariah of Ghana’s Ministry of Health (right)
speaks with Dr. Rozita Halina Tan Hussein of Malaysia’s
Ministry of Health.
(Photo: USAID Health Financing and Governance Project)
Over the past five years, the collaborative
learning process has led to the co-creation
of knowledge products that offer practical
guidance on implementing reforms to
achieve UHC.
for technical-level professionals to share experiences and solve
common problems related to costing of health services.
Costing Collaborative Study Helps Inform
Provider Payment Reforms in Indonesia
and Vietnam
Indonesia used costing information from a Costing
Collaborative study to inform capitation rates for
primary health care under the newly integrated Social
Security Management Agency. In Vietnam, the Health
Strategy and Policy Institute and Hanoi Medical
University collaborated with the Ministry of Health
and other key players (including Vietnam Social Security, provincial and district leaders, and the World Bank)
to revise and refine regulations on provider payment to
create a more equitable, efficient, and effective
system that makes better use of scarce health
insurance resources.
These products include tools and manuals related to
expanding coverage, benefits design, data analytics,
provider payment, and primary health care measurement
and improvement.
Some of the tools and manuals are highlighted in the
following pages.
Members of the Costing Collaborative in Geneva,
Switzerland, in May 2014. (Photo: JLN)
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JLN @ 5: Practitioner-to-Practitioner Learning Helps
Countries Move Toward Universal Health Coverage
Five Years of Facilitating Practitioner-to-Practitioner
Learning to Achieve Universal Health Coverage
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Over the course of 18 months, the Costing Collaborative came together virtually and in person to
co-produce Costing of Health Services for Provider Payment: A Practical Manual Based on Country
Costing Challenges, Trade-offs, and Solutions.
Using their own experiences to illustrate the options, explain the tradeoffs, and offer creative
Members of the Population Coverage technical
initiative visit a health facility in the Philippines.
(Photo: JLN)
solutions, they compiled step-by-step guidance on how to address the many challenges related to
costing for provider payment in low- and middle-income countries
The manual takes traditional guidelines on step-down cost
Aligning PHC Initiatives with UHC
accounting a step further by providing practical ways to overcome
challenges associated with costing—including data
constraints, differing concerns of public and private
providers, and weak cross-institutional collaboration.
Using the Costing Manual to Develop
Costing Experts
The manual also provides tools and templates adapted
“This workshop was a great learning experience.
from the example countries that can be further adapted
I was amazed that the costing experts helped us understand
to suit a variety of contexts. The diversity of experiences
the right methodology and customize costing to the context
reflected in each step of the manual gives practitioners a
of each country.”
range of options as they work to improve provider
—Navneet Jain, Cost Accountant & Managing Partner,
Navneet & Company, India.
payment policy in their own country.
By grounding costing theory in a practical, step-by-step
process, the manual not only provides guidance on
step-down costing, but it also serves as a learning tool for
building capacity. This dual approach helps reduce country
dependence on external experts and allows institutions to
build their own teams of costing experts.
To generate practical knowledge and tools spanning several interrelated
primary health care areas simultaneously or in rapid succession, the JLN’s
Primary Health Care technical initiative launched a series of small, focused
“mini-exchanges” involving representatives from Ghana, India, Malaysia,
and Vietnam.
The participants worked with technical facilitators to co-create a distinct body of work in the areas of
benefits design, private-sector engagement, and ways to identify the best mix of payment
mechanisms for PHC.
In collaboration with Suvarna Arogya Suraksha Trust
and the Government of Karnataka, ACCESS Health
International organized the first Costing Manual “Train
the Trainer” workshop to equip participants with the
skills, tools, and knowledge to inform provider policy
processes in their own contexts as well as to become
trainers themselves. Participants from Bangladesh,
Ghana, India, Indonesia, Kenya, Malaysia, Moldova,
Nigeria, the Philippines, and Vietnam learned how to
design and conduct costing studies and to train other
practitioners using the tools and templates in the
Costing Manual.
UHC Primary Health Care Self-Assessment Tool
Primary health care is frequently the first point of care for patients in
low- and middle-income countries. All too often, it is also the weakest
link in the health system.
While many countries have increased their public spending for health, they will not be able to achieve their
health objectives if their financing approaches are not aligned with national health priorities.
Members of the JLN Primary Health Care technical initiative, representing nine JLN member countries,
co-developed the UHC Primary Health Care Self-Assessment Tool, a multi-stakeholder survey that helps
practitioners and policymakers quickly document and assess whether their national, state, or district
health financing approaches are aligned with PHC initiatives, efforts, and programs, as well as identify key
areas for improvement and potential interventions.
Over the course of 12 months, the initiative participants defined the scope of the tool, documented their
own experiences, conducted interviews with key PHC stakeholders in their own countries, and developed
the outline and survey questions contained in the tool.
Four countries— Ghana, India, Indonesia, and Malaysia—piloted the tool nationally or in specific regions.
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JLN @ 5: Practitioner-to-Practitioner Learning Helps
Countries Move Toward Universal Health Coverage
Five Years of Facilitating Practitioner-to-Practitioner
Learning to Achieve Universal Health Coverage
15
Assessing Health Care Provider Payment Systems
Many countries do not have a systematic way to determine whether their
payment systems serve to improve the quality of health care, stay within
their limited health budgets, and satisfy health care providers.
Dr. Marty Makinen (third from left) with nurses
during a field visit in Vietnam. (Photo: JLN)
The theoretical literature on provider payment offers little practical guidance, and there are no “gold
Engaging Private-Sector Providers in PHC
standards” or perfect payment systems to use as benchmarks.
To fill this gap, the JLN launched a Provider Payment Mechanisms technical initiative that produced
Participants in the Engaging Private-Sector Providers in Primary Health Care
mini-exchange are co-creating a practical guide to help government health
financing agencies better engage the private sector in PHC delivery.
To ensure that the manual reflects the insights that have emerged through the mini-exchange and aligns
with global knowledge, participants will collect feedback from the JLN network and from international
experts on private-sector engagement. The guide focuses on five key areas: initial engagement and
communication; provider mapping; regulation, accreditation, and empanelment; contracting, legal
arrangements, and payment; and monitoring and evaluation.
Assessing Health Care Provider Payment Systems: A Practical Guide for Countries Moving Toward
Universal Health Coverage. The guide was developed by JLN members through virtual and in-person
collaboration over the course of four years, with direct input from provider payment policy professionals
in several countries. The guide lays out a country-led participatory process to systematically answer
questions about the design and implementation of provider payment systems and how those systems
work together.
After an initial framing of the scope, structure, and content
by a group of more than 20 international experts on provider payment policy (from WHO, the World Bank, academia,
and country-level policy institutions), the Ministries of
Leveraging Health Benefits Policies to Promote PHC
Health of Vietnam and Mongolia conducted full field tests in
2013 and 2014. These field tests and the provider payment
policy processes they supported provided the basis for
Participants in the Leveraging Health Benefits Policies to Promote PHC
mini-exchange are co-creating an interactive tool to help countries leverage
health benefits policies to promote the delivery of more effective,
equitable, efficient, and high-quality PHC services.
benefits packages and how those packages can help realize
PHC and broader health goals.
The tool will include in-depth case studies, manuals, and
examples that cover a range of topics: defining the mix of
services; establishing and using protocols and clinical
pathways; costing PHC within the benefits package;
financing and payment for health benefits; ensuring
Aligning Health Financing and Private-Sector
PHC Delivery in Malaysia
After launching a pilot of the UHC Primary Health Care
Self-Assessment Tool at the national level, Malaysia
found that while health financing and PHC efforts were
well coordinated within the government, there was little
alignment between health financing and the private
sector, which delivers a significant amount of PHC
services in Malaysia.
equitable, high-quality, and accessible care; and tracking
progress on PHC and UHC goals.
All mini-exchange participants will convene in early 2016
to present, review, and make final revisions to the technical
products before disseminating the co-developed products.
much of the guidance in the guide and in the accompanying
Analytical Workbook.
By adapting and using the Assessment Guide and the Analytical Workbook, countries can assess whether they are
on the right track with their current payment systems and
The tool will help countries determine what to include in
To provide ongoing support for Malaysia, a JLN
technical facilitation team launched a mini-exchange
focused on engaging the private sector in PHC services.
Participants are developing a process manual that is
informed by experiences from JLN and non-JLN
countries to help improve public-sector engagement
with the private sector in Malaysia.
Mongolia Uses Assessment Guide to Better
Leverage Provider Payment
what steps they can take to improve quality, deliver services
more efficiently, stay within their limited health budgets,
and be more responsive to the population and health care
providers by using different provider payment methods and
systems.
The Mongolian Ministry of Health identified
strategic health purchasing as a key lever for directing
limited government health funding more effectively
toward priority services and populations.
The Mongolian team used the JLN Assessment Guide to
gather information about their own country’s payment
systems and stakeholder views. They also drew on
experiences from an assessment in Vietnam in 2013,
which resulted in a pilot of capitation payment for primary
care at the district level in four Vietnamese provinces.
The Mongolian team worked with the JLN technical
facilitation team to connect via video with the assessment team from Vietnam to better understand Vietnam’s
experience in gathering, synthesizing, and interpreting
stakeholder views. The experiences of Mongolia and
Vietnam were incorporated into the final version of the
Assessment Guide.
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JLN @ 5: Practitioner-to-Practitioner Learning Helps
Countries Move Toward Universal Health Coverage
Five Years of Facilitating Practitioner-to-Practitioner
Learning to Achieve Universal Health Coverage
Maria Lifiu of Moldova’s National Health Insurance Company
delivers a presentation at a meeting of the Collaborative on
Data Analytics for Monitoring Provider Payment. (Photo: JLN)
Philippines Health Insurance Corporation staff members
demonstrate their subscriber management system for JLN
members. (Photo: JLN/Buddy Gancenia)
Improving Data Analytics for Provider
Payment Systems
Functional Requirements for National Health
Insurance Schemes
Given the powerful effects of provider financial incentives on resource
allocation and UHC outcomes, it is essential to have key performance
indicators to measure and monitor quality and effectiveness and to
detect any unintended consequences of payment systems.
Functional requirements are statements that describe what an information
system needs to do to support the tasks or activities of a national health
insurance scheme.
Several JLN member countries, including Ghana, Indonesia, and Vietnam, are in the midst of planning
provider payment reform pilots or major national reform efforts. Other countries, such as Kenya,
Malaysia, India, and the Philippines, are implementing ongoing provider payment policy refinements. As
provider payment systems become more sophisticated, the need for performance data also increases.
All of these countries need appropriate monitoring or early-warning systems, but monitoring for provider
payment is rarely adequate in practice, and very little guidance on developing such systems is available
from international experience. To address this gap, the Provider Payment Mechanisms technical initiative
and Information Technology technical initiative teamed up to co-facilitate the Collaborative on Data
Analytics for Monitoring Provider Payment.
With support from a JLN technical facilitation team, representatives from all nine full member countries
and from associate member Moldova are developing content for a Data Analytics Toolkit, which will
include step-by-step guidance on identifying questions, selecting indicators, and exploring how data
should be captured.
Developing functional requirements for national health insurance schemes can be a slow and laborious
process. Members of the Information Technology technical initiative have developed a set of common
functional requirements that countries can adapt, thereby dramatically shortening and simplifying the
process.
These were developed using the Collaborative Requirements Development Methodology (CRDM), which
starts by having country and global experts describe the work at a high level in a specific context and then
bring together countries to 1) map the work flows for how the work is currently done, 2) determine how
to streamline that work, and 3) identify what the system needs to do. The processes and requirements are
then documented, using shared terminology, for others to use.
As a first step, the technical initiative members met with global experts on health insurance to identify
and understand the business processes required to run a national health insurance scheme. They also
learned about best practices being implemented by Thailand’s National Health Security Office and India’s
Rashtriya Swasthya Bima Yojana (RSBY) and Aarogyasri Health Care Trust. From these schemes, they
determined which business processes had shared functional requirements. Technical initiative members
have come together in four subsequent sessions, starting in October 2011, to develop functional
requirements for six business processes and their sub-process areas, including eligibility determination,
What is really interesting is that almost
all countries have the same problems.
- Mariana Zadnipru
Head, Analysis & Health Economics
Moldova’s National Health Insurance Company.
enrollment, premium payments, and provider payment.
The common requirements were shared with non-member countries in January 2012 and have been
continuously updated during subsequent meetings. Ghana, the Philippines, and Indonesia have adapted
aspects of the common requirements for their national-level requirements.
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JLN @ 5: Practitioner-to-Practitioner Learning Helps
Countries Move Toward Universal Health Coverage
Five Years of Facilitating Practitioner-to-Practitioner
Learning to Achieve Universal Health Coverage
19
Evolution of the JLN and
the Global UHC Movement
2009
2010
2011
2012
2013
2014
May
February
June
January
March
March
Representatives from
Ghana, India, Thailand and
global development partners
discuss the wealth of
experience and knowledge
that practitioners in countries
moving toward UHC have, and
the lack of opportunities for
those practitioners to connect.
Delegations from Ghana, India,
Indonesia, the Philippines,
Thailand and Vietnam come
together for the pilot Joint
Learning Workshop in
Manesar, India with catalytic
funding from the Rockefeller
Foundation.
The JLN hosts its first
network-wide workshop in
Mombasa, Kenya. This meeting
also serves as the launch of
the Population Coverage
technical initiative.
The Quality technical
initiative convenes its first
meeting during the Prince
Mahidol Awards Conference
in Bangkok, Thailand.
Representatives from seven
member countries, each of the
network funders, technical
partners, and Secretariat
organizations come together
at the Rockefeller Foundation’s
center in Bellagio, Italy to
review the findings from a
strategic assessment of the
network and to develop a new
vision for the future of the JLN.
The JLN opens a call for new
countries to apply for Associate
membership.
November
The organizing members —
ACCESS Health, GIZ, IHPP, the
World Bank and the Results for
Development Institute — form
a Secretariat to manage the
network with active
participation from country
leads and delegations.
The World Health
Organization publishes the
World Health Report 2010:
Health Systems Financing, the
path to universal coverage—a
crucial resource for low-income
countries looking to achieve
universal coverage and improve
health outcomes.
December
80 practitioners from six
member countries, plus
observing countries Kenya and
Malaysia, convene in Bangkok,
Thailand to discuss the building
blocks of provider payment
systems and the different
provider payment mechanisms
available.
August
The Provider Payment
Mechanisms technical
initiative officially launches.
Kenya, Malaysia, Mali and
Nigeria join the JLN as Full
Members.
October
The Information Technology
technical initiative convenes its
first meeting in Singapore.
The Information Technology
technical initiative releases
the Determining Common
Requirements for National
Health Insurance Information
Systems paper.
February
Secretariat and technical
initiative representatives come
together in Bellagio, Italy at the
Rockefeller Foundation retreat
facility to conduct technical
planning, discuss operational
issues, and set clear guidelines
to follow in the future.
May
In her address to the Sixty-fifth
World Health Assembly in
Geneva, Switzerland, United
Nations Director-General,
Margaret Chan says,
“Universal health coverage is the
single most powerful concept that
public health has to offer.”
July
The Steering Group holds its
first meeting in Manila,
Philippines.
2015
January
November
JLN launches new partnership
with the World Bank.
The Population Coverage
technical initiative releases the
Closing the Gap: Health
Coverage for Non-Poor
Informal-Sector Worker paper
and five case studies on
extending health coverage to
the non-poor informal sector
and their families.
March
May
The WHO publishes new
framework—Monitoring
universal health coverage
(UHC)—in an effort to track
country and global progress
towards UHC.
September
The Provider Payment Mechanisms technical initiative releases
the Costing of Health Services
for Provider Payment: A Practical Manual at the Health Systems
Research Symposium in Cape
Town, South Africa.
December
More than 500
organizations across the world
unite to celebrate Universal
Health Coverage Day, in
commemoration of the first
unanimous United Nations
resolution calling for countries
to provide affordable, quality
health care to every person,
everywhere in 2012.
JLN launches the Member Portal
to enable virtual connections
between members of the
network and technical
facilitation teams.
September
JLN welcomes Bahrain and
South Korea as Associate
members.
JLN launches a partnership with
the Primary Health Care
Performance Initiative to
strengthen measurement for
PHC improvement.
New SDGs are passed at the
United Nations General
Assembly, including Goal 3.8,
which calls for countries to
achieve UHC, including financial
risk protection, access to quality
essential health care services,
and access to safe, effective,
quality, and affordable essential
medicines and vaccines for all
by 2030.
October
The Primary Health Care
technical initiative launches the
JLN UHC Primary Health Care
Self-Assessment Tool.
JLN events
Global UHC events
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JLN @ 5: Practitioner-to-Practitioner Learning Helps
Countries Move Toward Universal Health Coverage
Five Years of Facilitating Practitioner-to-Practitioner
Learning to Achieve Universal Health Coverage
Knowledge Dissemination
Sharing and
Disseminating Knowledge
Reports and Publications
13
Visits
Downloads
7,019
Guides and Tools
29,792
2012 JLN Update
To complement in-person collaborative learning activities, the
JLN also maintains a robust online presence to support
knowledge sharing among member countries and the global
community. Over the past five years, 100,000 unique visitors
from around the globe have accessed JLN knowledge products.
JLN Case Studies
14
Country Briefs
15
Promising Practices
19
42
3,381
Costing Manual
Case Studies
Journal Citations
2,867
2,668
Health Insurance
Glossary
IT-PPM Paper
35
Media Mentions
Events and Conferences
36
Key Statistics from 2010 to 2015
International Journal
for Quality Healthcare
17
Europe
29,042
Unique Visits
Americas
55,215
Africa
27,918
2010
871
2011
11,320
2012
22,939
2013
28,082
2014
33,047
2015
21,634
Joint Learning Fund
supported events and
cross-country exchanges
E-communications
Asia
47,305
Oceania
2,090
Other
6,223
2,442
469
Monthly
Weekly
395
Member s
3,985
Total contact
116, 718
Social Media Followers
Total Unique Visits
28%
18%
904
1,395
Average Open Rate
Average Click Rate
Social Media
205
Facebook
Twitter
LinkedIn
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JLN @ 5: Practitioner-to-Practitioner Learning Helps
Countries Move Toward Universal Health Coverage
Five Years of Facilitating Practitioner-to-Practitioner
Learning to Achieve Universal Health Coverage
In 2015, the JLN launched the Member Portal
179
A collaborative space that allows members to build valuable connections, participate in vibrant discussions, and
access JLN-specific tools and resources. To date, 179 individuals representing all 24 member countries have
registered on the platform, contributed to 13 discussion groups, and added 130 resources.
The Member Portal is designed to help members connect with the broader JLN
community through several channels:
Members in
24 Countries
Dashboard
Member Directory
Discussion Groups
View and comment on the latest
group discussion threads, access
important network announcements, and keep up-to-date with
the latest UHC news and analyses from around the globe.
Search for colleagues by name,
country, institution, or areas of
interest, and have the option of
connecting with users directly
using the messaging feature
found on each user’s profile.
Post messages, engage in
dialogue with other members,
and share new resources on
topic specific issues.
Resource Library
Access to over 100 specialized
resources and tools, briefing
reports, workshop agendas and
summaries, newsletters, JLF
reports, country profiles, and
more.
Events and
Opportunities
Access curated list of upcoming
workshops, meetings, and other
opportunities.
13
Discussion
Groups
Bahrain
Japan
Morocco
Bangladesh
Kenya
Namibia
Colombia
Kosovo
Nigeria
Egypt
Malaysia
Philippines
Ethiopia
Mali
Senegal
Ghana
Mexico
South Korea
India
Moldova
Sudan
Indonesia
Mongolia
Vietnam
130
Resources
573
Resource
Downloads
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JLN @ 5: Practitioner-to-Practitioner Learning Helps
Countries Move Toward Universal Health Coverage
Five Years of Facilitating Practitioner-to-Practitioner
Learning to Achieve Universal Health Coverage
The JLN will continue to focus on strengthening PHC systems, improving the quality of care, and
improving core functions such as IT and provider payment systems. We will also focus on important
emerging technical areas that are a high priority for member countries, including benefits design,
financial sustainability, and medical audits. To support these technical initiatives, the network will
continue to develop its core “infrastructure”: strong country-led governance, effective communications
and knowledge management, and monitoring and evaluation to continuously improve the quality of
the JLN’s offerings.
Building Partnerships
Looking Ahead to the
Next Five Years
As countries progress toward UHC, they will continue to grapple with the
dual challenges of ensuring financial protection and increasing access to
essential, high-quality health services.
Achieving UHC will depend on domestic financing, strong country leadership, and technical expertise.
This creates a new role and opportunity for funders and technical partners to help countries implement
complex reforms by supporting them with the how-to of achieving UHC.
In 2015, the JLN solidified several new partnerships to expand opportunities for joint learning, including:
• A deeper partnership with the World Bank to further strengthen the network “infrastructure,”
develop new technical initiatives, and co-create a strategy for expanding and sustaining knowledge,
learning, and innovation for UHC.
At the JLN’s five-year anniversary, we are celebrating
the network’s achievements as a vibrant and
innovative platform that has contributed to the
creation of new knowledge, policies, and reforms that
accelerate country progress toward UHC.
• An exciting new partnership with the Primary Health Care Performance Initiative, which was
created by the Bill & Melinda Gates Foundation, the World Bank Group, and WHO. The initiative will
launch a new Primary Care Measurement for Improvement collaborative to develop a menu of PHC
indicators and other practical tools to support data collection, reporting, and practical use by policy
makers and system managers.
• A new partnership with GIZ to launch a Learning Exchange focused on leveraging financing and pro
vider payment to strengthen PHC systems as countries move toward UHC
The JLN community has tested and continuously improved the joint
learning model, expanded its membership to include 24 countries, and
launched new partnerships to create enhanced opportunities for learning.
With a strong and growing network, the JLN looks forward to the next five years, when it will continue
to advance an array of demand-driven and interconnected technical initiatives that push more countries
closer toward achieving SDG Target 3.8.
Emerging Collaboratives
The JLN works closely with member countries to align new collaboratives
and technical areas of focus with country priorities. In 2016, we hope to
kick off several new activities based on feedback from the JLN Member
Survey. A few of those activities are outlined in the following pages.
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JLN @ 5: Practitioner-to-Practitioner Learning Helps
Countries Move Toward Universal Health Coverage
Five Years of Facilitating Practitioner-to-Practitioner
Learning to Achieve Universal Health Coverage
Financing and Payment Models for PHC
There is scant international evidence on effective payment models that
help shift the balance of resources and services toward primary care and
prevention.
Many countries have tried a wide range of approaches and models for primary care financing and payment.
But this experience is rarely evaluated, often incompletely documented, and not easily accessible to an
international audience for peer countries to extract lessons.
Members of the JLN Primary Health Care technical initiative and Provider Payment Mechanisms
technical initiative, with funding from GIZ, will facilitate a new learning exchange on Financing and
JLN members at the Accreditation as an Engine for Improvement
workshop in Bangkok, Thailand, in 2012. (Photo: JLN)
Payment Models for Primary Health Care. Participants will meet virtually and in-person to share
experiences on the technical details, implementation challenges, experiences, and results of different
models in different contexts. This exchange will result in a deeper understanding of how to better leverage
financing and payment models for PHC to improve population health and financial protection in low- and
middle-income countries. The lessons that emerge from the exchange will be synthesized and translated
Health Care Governance
Participants in the “Accreditation as an Engine for Improvement” workshop
in April 2012 expressed a desire to learn from each other and document
experiences related to defining institutional arrangements in national
healthcare delivery—a key problem area in the quest for quality
improvement.
To address this topic, USAID’s Health Finance & Governance Project (HFG) and Applying Science to
Strengthen and Improve Systems (ASSIST) project, along with WHO and the Institute for Healthcare
Improvement (IHI), will jointly facilitate a knowledge exchange in 2016 on Institutional Roles and
Relationships in the Governance of Health Care Quality. Through a series of virtual and in-person events,
participants will co-develop a framework and final product that reflects global evidence on the
institutional relationships that govern quality in the health sector and rich tacit knowledge about the
institutional arrangements that are likely to yield the greatest quality improvements and how to
implement those arrangements.
into a knowledge product that can be adapted and used by other countries that are facing similar
challenges or embarking on this journey.
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JLN @ 5: Practitioner-to-Practitioner Learning Helps
Countries Move Toward Universal Health Coverage
Five Years of Facilitating Practitioner-to-Practitioner
Learning to Achieve Universal Health Coverage
As the global movement toward UHC grows and countries strive to
achieve the SDGs, policymakers and practitioners around the globe will
need more opportunities to exchange firsthand knowledge of how to
implement policies and programs that will advance progress toward UHC.
The JLN can help connect those policymakers and practitioners with their
peers in other countries, draw on their expertise, build practical knowledge
for the world, and help countries make faster progress
toward UHC.
Country-Level Collaborative Learning
JLN members agree that Country Core Groups play an instrumental role in
strengthening member country engagement and leadership within the JLN.
Country Core Groups were introduced in 2013 to promote diverse, cross-institutional representation in
JLN learning activities, facilitate joint learning across institutions within countries, and ensure effective
knowledge dissemination. Most Country Core Groups include representatives from different government
departments, donors, technical experts, and other local development partners and actors involved in
health systems reform to achieve UHC. The precise composition varies depending on the local context.
Country Core Group meetings are great opportunities for participants to share knowledge and develop
solutions in an informal setting. The JLN will continue to encourage member countries to develop strong
Country Core Groups with diverse institutional participation and linkages to existing technical working
groups or UHC forums.
.
In Ghana, our Country Core Group meetings are about
learning what is happening around us, and creating a
platform for sharing and learning.
Dr. Martha Gyansa-Lutterodt,
Director of Pharmaceutical Services,
Ministry of Health, Ghana
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JLN @ 5: Practitioner-to-Practitioner Learning Helps
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Global Knowledge
Products
Five Years of Facilitating Practitioner-to-Practitioner
Learning to Achieve Universal Health Coverage
openHDD
This open-source solution for creating and sharing health data dictionaries (HDDs), or minimum data sets,
is unique in its flexibility with taxonomies. Whatever data or structure you want defined, openHDD can
help you document it.
Closing the Gap: Health Coverage for Non-Poor Informal-Sector Workers
This paper and five accompanying country case studies focus on the challenges that many countries face in
extending health coverage to non-poor informal-sector workers and their families because of the relative
difficulty of identifying and enrolling them and financing their coverage in an efficient and equitable way.
Comparative Country Case Studies
The JLN Network Coordinator maintains a comparative database of country case studies. Much of the
information has been contributed by JLN members and reviewed by our partners for accuracy.
Connecting Health Information Systems for Better Health
This eBook is a reference guide for countries that want to link their UHC and eHealth information systems
using a standards-based approach. It provides a set of actionable steps and links to resources for
developing a national eHealth standards framework. Real-world perspectives are provided by a select
group of eHealth experts who have drawn lessons from their countries’ eHealth and UHC experiences.
Costing of Health Services for Provider Payment: A Practical Manual Based on
Country Costing Challenges, Trade-offs, and Solutions
This is the first costing-specific resource that combines costing theory with practical, step-by-step
guidance on addressing challenges related to costing for provider payment in low-and
middle-income countries.
Determining Common Requirements
for National Health Insurance
Information Systems
This report provides practical information, tools,
and resources that country decision makers can
use as they develop national-level health insurance
information system plans.
Health Insurance Terms Glossary
This list of common health insurance terms provides JLN
member countries with a shared language for discussing
issues related to health.
Assessing Health Provider Payment Systems: A Practical Guide for Countries
Working Toward Universal Health Coverage
This resource helps countries determine their objectives for reform, assess policy options, identify joint
learning and technical assistance needs, and progress through the reform process.
Requirements for National Health Insurance Information Systems
This document includes draft functional-level requirements for insurance-related processes: determining
eligibility, enrollment, pre-authorization, claims processing, and payment collection. These requirements
can be adapted and customized to the specific country context.
Promoting Interoperability of Health Insurance Information Systems Through a
Health Data Dictionary
This paper helps countries that are consolidating health insurance schemes to achieve UHC by providing
an overview for national policymakers on the role of the HDD and why establishing an HDD early on is a
key step in promoting system interoperability.
Provider Payment Reform and Information Technology Systems: A Chicken and
Egg Question for National Health Coverage Programs
This paper addresses key implementation questions raised by countries on the journey toward UHC and
provides concrete data so policymakers and IT professionals can understand the ramifications of provider
payment choices on the IT systems that underpin them. This paper is also available in Bahasa.
UHC Primary Health Care Self-Assessment Tool
This multi-stakeholder survey helps countries assess whether their national, state, or district health
financing approaches are well aligned with primary care initiatives, efforts, and programs.
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JLN @ 5: Practitioner-to-Practitioner Learning Helps
Countries Move Toward Universal Health Coverage
Get Involved
Countries
Partners & Collaborators
Funders
Visit the JLN website to access
The JLN Steering Group
The JLN relies on generous
our co-created tools and
continually seeks ways to align
funding and technical support
guides and find updates on the
with complementary UHC
from a consortium of partners.
latest JLN activities and the
efforts and forums to expand
We are always open to new
global movement toward UHC.
technical areas of focus, devel-
funding partners.
Join our LinkedIn group, “like”
op new training opportunities,
our Facebook page, follow us
and enrich the diversity of
Please contact
on Twitter, or sign up for our
experience represented in col-
Amanda Folsom
email newsletter.
laborative learning activities.
[email protected]
If your organization or initiative is interested in exploring
collaboration with the JLN,
contact us by email at
[email protected].
www.jointlearningnetwork.org