Transforming the Health System: How a Virtual PHCPI- JLN Collaborative Helped Advance Efforts to Build Resilient Primary Health Care Systems
At the height of the COVID-19 pandemic in 2020, the Primary Health Care Performance Initiative (PHCPI), a partnership dedicated to transforming the global state of PHC, and the Joint Learning Network for Universal Health Coverage (JLN) convened groups of country health leaders in virtual cross-country engagements to amplify and elevate the role of PHC in building more resilient health systems. The Transforming the Health System Collaborative, sought to address the following learning questions:
- How can we (re)prioritize PHC in the recovery phase of COVID-19?
- What might shifting resources and incentives to the PHC-level look like, and what might be required to achieve this?
- How can we meaningfully include the most vulnerable groups in this system transformation to ensure their needs are met?
- How can we generate credible, evidence-based messages to support PHC service delivery innovation and prioritization?
The Collaborative was implemented in two phases: a Collaborative Problem-Solving Phase and an Implementation Learning Phase. At the end of the Problem-Solving Phase, teams from three countries—Ghana, Kenya, and Uganda—presented practical challenges to advance in Phase II.
Phase I: Collaborative Problem Solving
Phase I was country-driven and leveraged the Feedback Labs’ Labstorm approach to help country teams put forth a challenge then crowd-source from the group possible solutions with the support of the technical facilitators. Eight country teams and one group of civil society organizations (CSO)/non-government organizations (NGO) representatives presented challenges they were experiencing on topics, including financing primary health care (PHC), digital health, human resources for health, and data quality. Phase I also allowed for the exchange of experience and practical know-how with technical presentations from topical experts.
Phase II: Implementation Learning
As each country team advanced the lessons learned in Phase I, they had the opportunity to deepen their learning by collaborating with their peers to address a specific challenge. After a series of workshops with interested country teams, the facilitation team selected three implementation case (IC) teams, presented by Ghana, Kenya, and Uganda, to serve as deep dive learning examples and to adapt lessons from the Collaborative.
The Ghana case, led by the Alliance for Reproductive Health Rights (ARHR), set out to increase advocacy for strengthening the country's PHC system by generating and disseminating evidence related to PHC financing and service delivery. The Kenya implementation case, led by staff from the Kenyan Ministry of Health (MOH), sought to strengthen service delivery by piloting a new model of care, primary care networks (PCNs), to connect facilities within a geographic area. The Uganda case, also led by staff from the Ugandan MOH, rolled out their supportive supervision strategy to the regional level to improve service utilization and the referral system.
Operationalizing the Approach
The methodology in Phase II revolved around clearly defining each problem the IC teams aimed to address, creating a long-term vision, identifying outcomes achievable within the length of the Collaborative, and defining the steps—or causal chain—to achieve those outcomes. Thirty individuals from 13 countries in Phase I continued as peer learners, sharing their expertise and tacit knowledge to assist the implementation teams.
Phase II was designed to prioritize implementation of the selected case studies and enable adaptive learning and feedback loops. Monthly learning checks allowed the implementation teams to receive feedback from peer leaners and facilitators on key questions and to discuss their progress and challenges. All three case teams and all of the peer learners convened together in monthly learning exchanges to share experiences and promising approaches on common implementation challenges.
Lessons Learned Over the Course of the Exchange
Peer learning is a valuable tool to address implementation challenges
Over the course of the Collaborative, peer learning was used to exchange ideas, enrich discussion, and provide key insights to address implementation challenges. During Phase I, peer learners provided tacit feedback to country teams that proposed a challenge in the Labstorm. Participants without an implementation case continued in Phase II as peer learners.
Peer learners provided valuable feedback to address specific implementation challenges their peers were facing. In Uganda, peer learners recommended conducting a health care budget expenditure analysis to identify under-utilized resources and lobby for resource reallocation toward PHC. In Kenya, peer learners recommended online/hybrid meetings to disseminate the guidelines at the county level rather than the national level. The Ghana and Uganda IC teams joined a learning check for the Kenya team, which proved to be valuable for all parties as they were able to learn about the PCNs and provide tactical advice.
Documenting and assessing incremental progress is essential
The facilitated peer learning methodology proved valuable in helping the IC teams follow along and document progress. The Kenya team valued the ability to break down their work into achievable parts, enabling them to assess the incremental progress made, especially in their ambitious project of transforming Kenya’s PHC service delivery model. The Uganda IC team similarly appreciated the causal chain as it helped in focusing on priorities and documenting milestones. One team member noted that they began using a similar methodology in their other projects. Furthermore, the Ghana team appreciated having real time feedback to improve their PHC advocacy efforts as well as the ability to access a wide range of technical resources to bolster their evidence-to-policy efforts.
Knowledge gains through virtual engagement are important
In an endline survey assessment of the Collaborative’ impact, participants noted an overall increase in familiarity with technical topics ranging from domestic resource mobilization to strategic communications and referral systems as a result of participation. Survey results also showed IC team members used a wide range of improved knowledge and skills in their day-to-day work, particularly in applying practical lessons, sharing new ideas with others, and influencing country-specific processes and outputs. However, we found a large gap between IC team members and individual peer learners, where peer learners were less likely to report having applied the learning in their ongoing work. This is an important finding that is helping us to continuously improve the implementation learning methodology and increase the value proposition for individual peer learners.
In Phase I, participants also appreciated having outside experts present in the discussions. One of the more popular sessions was focused on visualizing data for decision-making led by David Selassie Opoku where he shared practical advice on how to effectively communicate data. In response to this feedback and to increase the value proposition for peer learners, part of the Phase II monthly learning exchanges was dedicated to allowing peer learners to present and share their technical expertise on the topic at hand.
The JLN and PHCPI team continue to collaborate, and are taking the lessons from the Transforming the Health System Collaborative to support a new virtual learning exchange on Implementing and measuring the performance of primary care networks. The learning exchange launched in March 2022 with a learning community of over 100 participants from more than 25 countries. The learning exchange includes three IC teams, including teams from Ghana and Kenya, as well as a new team from Colombia, tackling important questions about how to design and implement PCNs and how to measure their performance. Learn more and connect with other PHC stakeholders through the PHCPI Online Forum.