South-South Collaboration: Harnessing Cross-Country Learning for Sustainable Health System Policy Reforms

Authors: Titus Kisangau, Rahul S Reddy Kadarpeta, Cynthia Waliaula, Rispah Walumbe 

Enhancing capacities in health systems strengthening is critical to achieve sustainable health systems reforms towards Universal health coverage (UHC). Traditional methods for capacity building and knowledge exchange often adopt didactic approaches. They assume that technical requirements are static and the need for tailored solutions is for specified timeframes for policymakers and practitioners. However, the ever-evolving technical obstacles in achieving reform objectives and the diverse spectrum of policymakers engaged in this process challenge such conventional approaches.  

A participatory knowledge production process provides stakeholders with dynamic insights, enhancing their capacity for effective problem-solving and addressing future challenges. Cross-country learning, as a method for knowledge sharing and learning aims to build sustainable capacities among policymakers and practitioners involved in health policy reforms within the low- and middle-income country context. This approach recognizes various trajectories associated with achieving sustainable reform, acknowledging the contextual variations and shared elements across countries. 

This blog delves into the practical insights from countries into the application of diverse cross-country learning approaches for countries from the global south. This presents a synthesis of the discussions held during the 77th World Health Assembly 2024 – Side session “South-South Collaboration – Harnessing Cross-Country Learning for Sustainable Health System Policy Reform” organized by Joint Learning Network for Universal Health Coverage (JLN) and UHC Delivery lab anchored by Amref Health Africa on 27 May 2024, Geneva. The session attracted the attendance of 100 global health leaders and public policy practitioners drawn from Ministers of health, policymakers, global health experts drawn from various development partners/ organizations exploring novel ideas for investments, NGOs, Civil society organizations, researchers and academia convened to examine south-south partnerships as an enabler of enduring reforms in national systems. 

The JLN is an innovative community of policy-makers and practitioners from 39 countries around the world engaged in practitioner-to-practitioner learning to address challenges and co-produce practical solutions to implementing reforms toward UHC. Amref Health Africa’s UHC Delivery Lab is a regional hub that supports African countries and institutions to contextualize and action recommendations to accelerate the journey towards UHC and facilitate shared learning within the region. It is dedicated to building capacities of stakeholders on UHC research, policy engagement and advocacy and is currently active in 3 countries, Kenya, Ethiopia and Senegal, with potential for further expansion within the region. 

These platforms hosted by Amref Health Africa bring together policymakers and practitioners, employing a diverse array of cross-country learning methods (such as practitioner-to-practitioner learning workshops, country pairing, coaching, lab storms/peer assists, study visits, etc.) to facilitate collaborative problem-solving and foster an environment conducive to continuous learning and knowledge exchange. 

What does success look like? 

Cross-country learning provides opportunities to enhance knowledge exchange that has impactful policy influence informed by the tacit knowledge of practitioners and policymakers. This tacit knowledge accelerates the translation of best practices and innovative solutions to relevant contexts. Combined with evidence, these learnings can influence rapid re-programming of national policies or strategies to achieve improved health systems interventions. Dr Mercy Mwangangi, Senior Director, Health Systems Strengthening, Amref Health Africa believes that “Country pairing and coaching within the JLN, Strategic Purchasing Africa Resource Centre (SPARC), and UHC Lab have been instrumental in enabling countries to adopt best practices and tailor them to their unique contexts.” She noted that through Amref’s innovative learning platforms, there is firsthand evidence of how adaptive and participatory approaches can effectively address evolving health system challenges, driving sustainable reforms in LMICs. 

Another measure of success is the level of engagement and participation from stakeholders within the country, including governments, civil society organizations, academia, and the private sector. A successful platform would facilitate active engagement and ownership from these groups, ensuring that diverse perspectives contribute to the learning process. For example, the JLN ensures each of its member countries, has a strong Country Core Group, which brings together various in-country stakeholders to inform the learning agenda, articulate the health systems challenges and support the design and implementation of solutions achieved through collaborative learning. Dr. Jean Kagubare, Deputy Director, Primary Healthcare, Bill and Melinda Gates Foundation remarked, “South-South collaboration is a powerful tool for driving sustainable health reforms. Our observation shows that cross-country learning not only accelerates innovation but also builds stronger, more resilient health systems. The real win is seeing these collaborations translate into tangible improvements in healthcare delivery and outcomes.”  

Country Experiences 

Dr. Anthony Ofosu, Deputy Director General, Ghana Health Service: “Being part of the JLN has been transformative for Ghana’s health system. Cross-country collaboration and knowledge sharing have significantly strengthened our policies, driving us closer to achieving UHC. For example, “Ghana being a member of the JLN since 2010, participated in collaborative learning on expanding population coverage under its health insurance program. It also implemented the JLN’s Strategic Communication for Universal Health Coverage: Planning Tool. An outcome of the learning exercise, that provided a comprehensive framework for crafting strategic communication plans, tailored to promote digital products and services crucial for achieving UHC. It led to the establishment of the mobile membership renewal service in Ghana which has won three prestigious awards and serves as the most convenient means to actively stay on the National Health Insurance Scheme (NHIS) for about 80% of the members. The Mobile App has over 77,000 people signing up for themselves and third parties since its launch in December 2022. The National Health Insurance Authority (NHIA) plans to use the tool as a communication guide to the NHIS as the scheme continues to develop new digital inventions to drive its membership.  

Dinash Arvind, Health Transformation Office, Ministry of Health, Malaysia: Noted that JLN has been pivotal for Malaysia’s health system transformation.  Malaysia participated in JLN’s country pairing learning exchange with Ghana and the Philippines to learn about developing and operationalizing mechanisms within primary and tertiary healthcare services for provider monitoring, which informed their strategy to incentivize or penalize providers to improve service delivery for treatment and diagnosis of non-communicable diseases. Further, The JLN Toolkit to Develop and Strengthen Medical Audit Systems detailed how to set up medical audit units and conduct step-by-step claims reviews, as practical guidance for practitioners. This contributed to the establishment of an independent Medical Audit Section in Malaysia managed by Protect Health Corporation (PHCorp). This section regularly reviews more than 2000 PeKa B40 claims per month. The quality of healthcare services provided by both public and private healthcare providers can be evaluated, subsequently, this allows for quality improvement recommendations from PHCorp. For example, many cases, including cases of misdiagnosis and incomplete lab or medical histories, have been identified[1]. PHCorp as implementer of the National COVID-19 Immunization Programme by Private Medical Practitioners, also utilized the audit function to evaluate the quality and compliance of the appointed practitioners. 

Dr. Ganda Gregory, County Executive Committee Member (CECM) for Health, Wellness and Nutrition – Kisumu County, Kenya, shared that the Ethiopia-Kenya country pairing, facilitated by the UHC Delivery Lab, provided ideas and innovative solutions for tackling maternal mortality in the county, one of the county’s measures of success. Ethiopia has seen a significant decline in their maternal mortality rate based on the institution of maternal homes that allow pregnant women in hard-to-reach areas to be housed near a health facility for easy monitoring and rapid interventions for complicated cases. On the other hand, colleagues from Ethiopia gained significant insight into engaging with political leaders to ensure that UHC is clearly outlined as a critical agenda in party manifestos.  Additionally, practical demonstrations of the electronic Community Health Information System and innovative solutions like drone-delivered medications showcased the potential for technology to overcome healthcare delivery challenges. This joint learning fostered a collaborative environment, driving conversations on policy changes and innovative approaches both at sub-national and national levels. 

Takeaways 

The discussion provided valuable insights into the shared elements and common challenges associated with health systems reform, contributing to a deeper understanding of the interconnected nature of global health goals. It emphasized the importance of south-south collaboration and cross-country learning committing resources to purposeful, ongoing, and organized engagement with practitioners from different countries. Additionally, it highlighted the capacity to promptly and adaptively respond to emerging learning requirements, recognizing the evolving nature of technical challenges. 

• Cross-country learning is effective for sharing best practices and tailored solutions.
• Adaptive and participatory approaches are essential for addressing evolving health challenges. as they provide diverse perspectives, shared experiences, and innovative solutions to common challenges.
• Continuous, collaborative learning and engagement are crucial for sustainable reforms.
• Government buy-in and resource commitment are necessary for successful learning exchanges.

About the Authors: Titus Kisangau is Communication Lead for JLN, Rahul S Reddy Kadarpeta is the Executive Director, JLN, Cynthia Waliaula is Policy Analyst, UHC Delivery Lab, Amref, Rispah Walumbe is a Senior Health Policy Advisor, AMREF

Reference

1. Lauren Oliveira Hashiguchi, Maeve Conlin, Dawn Roberts, Kathleen McGee, Robert Marten, Stefan Nachuk, Ali Ghufron Mukti, Aditi Nigam, Naina Ahluwalia, Somil Nagpal Health Policy and Planning, Volume 39, Issue Supplement_1, January 2024, Pages i125–i130, https://doi.org/10.1093/heapol/czad097 Published: 23 January 2024.