Crafting Local Health Systems Solutions from Cross-Country Learning: A reflection 

About the author: Jane Nyambura serves as a Program Officer for the Joint Learning Network for Universal Health Coverage (JLN), a position she has held for the past two years. She is currently furthering her expertise by pursuing a Master of Science in Health Economics at the University of Nairobi. Jane’s role at JLN involves facilitating collaborative learning and capacity-building efforts among member countries, leveraging her growing expertise in health economics to enhance the network’s impact on universal health coverage initiatives. 

As an early career professional in Kenya delving into the realm of health economics, the concept of Universal Health Coverage (UHC) stands as a beacon of hope. The promise of ensuring that all individuals and communities can access essential health services without enduring financial hardship is not just utopian but a practical necessity for the well-being of communities in low- and middle-income countries. The journey towards achieving UHC is far from straightforward, as each country grapples with its unique set of challenges and contextual factors. It’s widely acknowledged that there is no one-size-fits-all approach to attaining UHC¹. While the overarching goal remains clear, the solutions required to address a country’s specific challenges must be tailored to its distinct health system architecture, political landscape, economic conditions, and cultural nuances. Moreover, the success of these solutions is contingent on the capacities and interrelationships of policy makers, practitioners and various stakeholders within the health system.  

Health systems strengthening efforts traditionally, have relied on conventional methods of knowledge exchange, such as training programs, on-the-job learning initiatives, or secondments attached to technical assistance. These approaches, while valuable in certain contexts, tend to operate under the assumption that challenges and technical requirements are static—a notion that couldn’t be further from the truth². To accelerate progress towards UHC one needs an approach where in-country stakeholders’ capacities are enhanced to address the needs of the landscape of health reform that is ever evolving. With new obstacles emerging and the needs of policymakers and practitioners shifting over time, they should be equipped with skills and tools they can implement with minimal external support. This dynamic nature of the field necessitates a more adaptive and participatory approach to knowledge production—one that empowers stakeholders with the insights and skills needed to tackle both current challenges and those that lie ahead.  

 Over the past decade, collaborative learning has gained traction in global health as an innovative and complementary model of technical assistance (TA) that is country-led, demand-driven, and action-oriented³. Engaged in this approach is the Joint Learning Network for Universal Health Coverage (JLN), which works to enhance capacities through practitioner to practitioner and cross-country learning. JLN was launched in 2010 with six countries; Ghana, India, Indonesia, the Philippines, Thailand, and Vietnam, and the support of global partners coming together to articulate the need for this approach. As of April 2024, the network has grown to host 38-member countries. I learnt of the work of JLN through COVID-19 Network for Open Dialogue and Exchange (NODE). NODE was a platform or initiative related to discussions and exchanges about the COVID-19 pandemic.  

I later joined the JLN in 2023. As I reflect, in my two years of association with the JLN, I have learnt that, at its core, context specific cross-country learning serves as a powerful mechanism for knowledge sharing and capacity strengthening. It facilitates knowledge exchanges and co-production of knowledge products as a collective problem-solving exercise. It requires a safe space for continuous learning and peer support, for policymakers and practitioners. Rather than prescribing rigid solutions, it encourages participants to collectively explore and test new approaches, leveraging their collective wisdom to address complex challenges. The JLN impact has remained evident in advancing member and non-member countries strides towards attainment of UHC. To date 30+ countries are known to have applied one or more of the 60+ collaboratively co-produced knowledge products by hundreds of policymakers and practitioners from JLN countries over a decade. 

Kenya serves as a testament to capacity of this model to drive positive change on a national scale. Through collaborative learning, Kenyan policymakers and practitioners gained invaluable insights from their counterparts both regionally and globally. Participation enriched our knowledge base as we co-produced innovative solutions in health financing, service delivery, and system efficiency. In 2018, the Ministry of Health, Kenya established a Health Benefits Package Advisory Panel with the mandate of defining a unified comprehensive and costed benefit package for Kenyans. The Kenyan technical staff used this experience to inform the development of the JLN Health Benefits Package Revision Guide in 2022 (Making explicit choices on the path to UHC – the JLN Health Benefits Package Revision Guide). During this exercise, Kenyan practitioners participated alongside those of   Ethiopia, Ghana, Nigeria, South Africa, Sudan, Bangladesh, and India in contributing to the product that would guide nations in the revision of the benefits package.⁴ 

Nigeria successfully adapted and implemented JLN’s Strategic Communications Toolkit. As shared by the country core group members, who are senior policy makers in the government, this informed the design of an advocacy plan that secured a $180 million appropriation for the Basic Health Care Provision Fund. The initiative aims to offer free primary health care to the poorest and most vulnerable and has impacted approximately 8.6 million Nigerians. This demonstrates that the impact of this approach extends far beyond individual capacity building.  

Integrating theory and application, thanks to my role at the JLN has greatly enhanced my learning experience. Through examining how economic and policy principles are applied in different country contexts within the various technical initiatives, I have gained a deeper understanding of their practical implications and developed a more global perspective on these concepts. Collaborative learning stands out as it lays the foundation for sustainable health systems strengthening efforts and fosters a culture of experiential learning and continuous improvement. By empowering stakeholders to become active agents of change within their own systems, it contributes to the long resilience and effectiveness of efforts towards UHC. 

  As I continue my journey in health economics, I am inspired by initiatives that exemplify collaboration and shared learning in driving progress towards universal health coverage. By embracing participatory knowledge production and cross-country exchange, we can chart a sustainable course towards a healthier, more equitable future for all.