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3 guiding principles for sharing implementation experiences

UHC Day 2019

On the path to universal health coverage (UHC), a podcast might not seem like a typical avenue for learning how to navigate health financing challenges. However, the Primary Health Care Financing and Payment Collaborative from the Joint Learning Network for Universal Health Coverage chose this path to do just that. Their goal: to share implementation experiences that capture the rich dialogue and value of in-person workshops and meetings in a way that a more traditional knowledge product, such as a policy brief or report, could not.

This effort culminated in the JLN Provider Payment Mechanisms Podcast, which captures voices from implementers, facilitators and global experts to unpack the who, the what, and the how of paying for health services and advancing UHC.

For those who have participated in in-person joint or collaborative learning opportunities, the value of experience sharing — both through formal presentations and informal dialogue that occurs on the sidelines — is clear. Collaborative learning functions best when implementers can share their experiences openly: brainstorming, debating and collaborating with peers to identify solutions to common challenges. And yet, replicating the richness of conversation that occurs at such convenings is challenging.

While case studies and toolkits have their place in global knowledge sharing, a common limitation of these static products is the removal of the human element: the sharing of know-how from one person to another that captures the full spectrum of roadblocks, workarounds, lessons learned, victories and next steps that accompany any broad-scale systematic change.

In this four-part series, members of the JLN Provider Payment Mechanisms Technical Initiative — including implementers, facilitators and global experts — share insights on: (1) joint learning, (2) provider payment mechanisms, (3) health benefits packages, and (4) costing of health services.

Whether you’re looking to capture and share country and implementation experiences in a podcast or some other medium, these three principles were helpful in guiding our efforts to ensure the content was diverse, inclusive and potentially useful for other practitioners working through similar challenges.

1. Include a broad range of country voices.

When brainstorming the idea for this podcast, one element was clear from the start: the final product should capture a broad range of country voices, including insights from experts at all stages of implementation. There is no single path toward UHC and ensuring that the series featured the breadth of country experiences in achieving change allows the listener to compare and contrast how different journeys promote different approaches.

In Episode 4: Costing of Health Services, for example, JLN members from Lebanon, Egypt and the Philippines provide insights into how costing of health services can be carried out through different contexts. Dr. Rawan Hammoud and Dr. Ola Kdouh of Lebanon and Dr. Ahmed Khalifa of Egypt discuss some of the common challenges countries face when conducting costing exercises and the creative solutions these countries developed to solve such challenges. Dr. Ish Paragas of the Philippines then demonstrates the value that institutionalizing health service costing processes can have.

The new UHC law in the Philippines, which has just been signed this February, also stated in a provision that our provider payment mechanism should be based on validated costing models and that our facilities and our stakeholders should provide all those cost data.”—Dr. Ish Paragas, Philippines

2. Focus on implementation experience rather than the final outcome.

By doing this, you can stimulate a more open discussion of what worked well and what can still be improved upon. This recognizes that there aren’t “one size fits all” solutions, and also allows listeners at all stages of PHC financing and payment improvement to benefit from the experiences discussed.

In Episode 3: Health Benefits Packages, Dr. Kenneth Munge shares Kenya’s process to develop a health benefits package — defining what services would be included and excluded for the push toward UHC. He unpacks the process of developing the package, including the stakeholder engagement required, as well as the strengths and areas for improvement of their process.

At the conclusion of the episode, Dr. Kamaliah Noh, an R4D senior fellow and JLN technical facilitator, discusses how Kenya’s experience relates to some of the common challenges countries frequently face when developing a benefit package and the importance of discussing how a benefits will be purchased and paid for from the beginning of the package design process.

The fastest way you can reach UHC, or the most cost effective way, will be to actually focus on a Primary Health Care Health Benefits Package, because other countries have shown that it can take care of the health needs, the 95% of the health needs of the population.”—Dr. Kamaliah Noh, R4D senior fellow and JLN technical facilitator

3. Include insights from experts with knowledge of the global evidence base.

To provide context to the country experiences shared, insights from country-based facilitators and global experts synthesize commonalities and highlight key lessons for listeners to reflect on. This mirrors the format of in-person convenings, where presentations from countries are often accompanied by broader conversations to synthesize commonalities and shared lessons.

Episode 2: Provider Payment Mechanisms, for example, features a deep dive into Ghana’s experience managing the escalating costs of the National Health Insurance Scheme, while creating incentives for quality and responsiveness to patients, through provider payment reform. Sister Eugenia Amporfu provides important insights into navigating provider resistance to payment reforms and the importance of political economy and stakeholder buy-in. And Ms. Agnes Gatome-Munyua and Dr. Cashin discuss global lessons that listeners can draw from this experience.

We always want the starting point to be: what are your objectives? What are the service delivery objectives you’re trying to achieve? What are the system challenges you’re trying to solve? And then pick the payment system that’s most likely to create the incentives and provider behaviors that will get you there.”—Dr. Cheryl Cashin, a managing director for R4D’s health portfolio

Looking ahead

As the PPM Technical Initiative enters a new phase of joint learning, the group hopes to experiment with new platforms to promote joint learning and share implementation experiences — including successes and failures. We hope this podcast, and the JLN’s global knowledge products, help countries as they navigate the right combination of provider payment mechanisms for their financial and political contexts.

Be sure to listen to the first four episodes of the JLN Provider Payment Mechanisms Podcast, and leave a comment below to let us know what you think.

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