A network of nine low-income countries has been working over the past five years on a joint learning effort to make universal health coverage a reality.
Global health experts see the Joint Learning Network for Universal Health Coverage as one of the most important efforts underway in this sector, and this summer it will not only expand to 13 more nations — but also add even more “associate members” to share knowledge on the frontlines of implementation.
Supported by the Rockefeller Foundation and the Bill & Melinda Gates Foundation, the initiative is a country-led effort to share lessons learned and challenges ahead. And by helping to create a clearer path for implementation, partners hope to make sure that countries that take on the ambitious UHC goal won’t have to start from scratch.
The UHC movement has gained increasing support from most stakeholders in the past few years, and the momentum is building for including a specific goal in the post-2015 development agenda. Multilateral institutions and bilateral donors are helping countries from across the income spectrum look at ways to implement, expand and maintain health care systems and coverage. The World Bank in particular sees UHC as critical to its goal of eradicating extreme poverty, as the World Health Organization estimates that 100 million people fall into poverty each year due to health care expenses.
But achieving UHC as a right for those who can least afford it is easier said than done, as many rich countries can attest.
“We've seen that moving in that direction defies the sort of simple one-size-fits-all prescription,” Tim Evans, director for health, nutrition, and population at the World Bank, said during a scientific symposium hosted on Friday by the Pan-American Health Organization in Washington, D.C. “There isn't a vaccine for this, there isn't a pill the ministry of health can take and the system moves; it's a complex process, and therefore the ‘how-to’ is something where there's real value in getting practitioners together and sharing lessons."
And that’s precisely where the JLN has been filling a critical role. Countries like Ghana, India, Malaysia and Nigeria have been ambitious in their efforts to expand health coverage despite limited resources, and while their challenges are unique, they’ve found common ground.
“There was this realization that gee, we’re all facing similar challenges,” said Amanda Folsom, a program director at Results for Development, one of the coordinating partners.
Partner countries work in several technical areas like expanding coverage, information technology and primary health care. Workshops in the technical areas are facilitated by partner organizations like PATH and GIZ, but many solutions that the countries have found most useful come from themselves.
Indonesia, for example, was inspired by an identification system that Thailand has used to increase health data and access, and Mali is working with the French telecommunications giant Orange to develop a system of health coverage enrollment and premium collections via mobile phone modeled on a system developed in Kenya.
The JLN is also producing a number of publications, case studies and resources for countries implementing reforms, including recent work on a “costing manual” that would help governments build data on the cost of health care procedures in order to set prices for coverage systems in developing countries, where this kind of data is extremely limited. The network will also be merging with the UHC Forward web platform to “create a robust UHC knowledge hub that is grounded in the practical experiences of reformer countries.”
Folsom said that the network “has a really important role to play as a lab for building knowledge that’s grounded in the experience of the countries themselves.”
The JNL, she explained, is looking to recruit as future members a handful of countries that are already committed to reform and have political buy in but are in the early stages of implementation, as well as expand its associate membership to up to 20 middle- and high-income countries that can learn from, and share lessons with, the network.
Folsom cited Japan as a great possible future member based on its experience implementing UHC.
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