joint learning network global meeting: building strong ... · to meet this demand for cross-country...

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J o i n t Lea rn ing Network G loba l Meet ing : Bu i l d ing S t rong Sy s tems to Ach ieve Un i ve r sa l Hea l th Coverage O v e r v i ew a n d S e s s i o n D e s c r i p t i o n s

PullmanPutrajayaLakesideNo.2,JalanP5/5,Presint562200Putrajaya,WilayahPersekutuan,MalaysiaKualaLumpur,Malaysia,20–22July,2016

Joint Learning Network Global Meeting: Building Strong Systems to Achieve Universal Health Coverage Briefing Packet: Overview and Workshop Agenda

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ContentsIntroductionandcontext........................................................................................................4

Participantsandpartners........................................................................................................6

Pre-MeetingSessionDescriptions(July18th–19th,2016).....................................................7

MainAgendaSessionDescriptions.......................................................................................10

Annex....................................................................................................................................18

Patient-centeredIntegratedCare:FrameworkandDescription.......................................18


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Introductionandcontext

Thelastfivedecadeshaveseengreatimprovementsinthehealthofpopulationsworldwide.However,inspiteoftheseoverallimprovements,thereisconsiderablevariationinhealthoutcomesacrosscountries—evenforthoseatthesameincomelevel—andwithincountries,wherethepooresthouseholdsexperiencethehighestburdenofdiseaseandtheworsthealthoutcomes.Manyofthesechallenges—bothofhealthandpoverty—couldbeaddressedifnecessaryhealthcareserviceswereuniversallyavailableandifprimaryhealthcare(PHC)systemscouldeffectivelymanageactivitiesrequiredforbothpreventionandpromotion,andtreatmentandcare.

Unfortunately,sincetheAlmaAtaDeclaration38yearsagoandsignificantglobalcommitmentstoPHCstrengtheningthatfollowed,PHCsystemsinmostcountriesremainweak.ThearchitectureandinstitutionsforPHCsystemsstrengtheninghaveproveninsufficient,asdemonstratedbytherecentimpactoftheEbolacrisisaswellascontinuedravagesofmaternalmorbidity,under5mortality,andnon-communicablediseases.PHCsystemsaroundtheglobesufferfromanumberofinterlinkedfailures.Forexample,manycountrieshavelargecomplexmarketsforPHC,withnumerousfragmentedpublicandprivateactorsandlittleornogovernmentstewardship.Inthesecountries,peopleatallsocio-economiclevelsareoptingtogotoprivateprovidersandpayout-of-pocketforprivatecare,yetgovernmentsareoftenignoringtheprivatehealthsectorandnotmakingeffortstoshapeorinfluencetheprivatemarket.Inaddition,PHCischronicallyunder-resourced,andevenrudimentaryattemptstounderstandlevelsofPHC-specificfundingarefewandfarbetween.Furthermore,practicalknowledgeabouthowtoimprovePHCmeasurementandperformanceisfragmentedanddifficultforcountriestoaccessandputintopractice.

Tomeetthisdemandforcross-countrylearning,theJointLearningNetworkforUniversalHealthCoverage(JLN),inpartnershipwiththeBill&MelindaGatesFoundation,WorldBank,USAID/HealthFinancingandGovernanceProject,andotherdevelopmentpartners,willconveneajointlearningworkshopin2016.Theworkshopwillbringtogetherpractitionersandpolicymakersfromall25FullandAssociatemembercountriestosharelearningaroundthesuccessesandproblem-solvearoundthechallengesofimplementinghealthfinancingandservicedeliverytoexpandcoverageandpromotePHC-orientedUHC.

Thebroadobjectivesofthejointlearningworkshopwillbeto:

▪ EnergizethenetworkbydevelopingstrongertiesandasenseofcommunityamongallJLNmembers,includingthe16newAssociatemembercountries

▪ ReviewJLNexperiencetodateacrosstechnicalinitiativesandidentifyopportunitiesformorecross-technicalcollaboration

▪ Enableparticipantstogainadeeperunderstandingofwhatworksandhowtopursuestrongerintegratedsystemstoachieveuniversalhealthcoverage(UHC)basedontheexperiencesofmultiplecountries,andproblem-solvejointlywithotherparticipantsonrelevantissues

▪ DevelopasharedvisionofintegratedsystemstoachieveUHCcreatingchampionsforreformwhowillbeginthinkingaboutthepolicy,institutional,andorganizationalreformsrequiredtobuildresilientPHC-orientedsystemstoachieveUHC


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▪ Highlightspecificneeds(e.g.funding,technicalassistance,monitoring/evaluation,research,etc.)ofJLNmembersthatmightbemetbynewtechnicalinitiativesorotherexternalassistance,andsetanagendaforfutureJLNactivities


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Participantsandpartners

Targetcountries:Forthismeeting,weanticipaterepresentationfromall25JLNmembercountries,EOIandotherinterestedcountries(Argentina,Cambodia,Cameroon,Chile,Georgia,Mauritania,Myanmar,Peru,Tanzania,andYemen)aswellastechnicalfacilitatorsandrepresentativesfromkeyJLNpartners

Targetparticipants:TheprimarytargetaudienceoftheJLNGlobalMeetingisthepractitionersandimplementersfromall25JLNmembercountries–thosenotonlyresponsibleforadvisingpoliticalleadersonUHCpolicyanddesign,butalsoresponsiblefortheimplementationofreforms.WewillalsobehostingadelegationofministersforahighlevelpolicydialogueonDay3.

Sponsoringpartners:KeypartnersforthismeetingincludeACCESSHealthInternational,theBillandMelindaGatesFoundation,theInternationalLabourOrganisation,theResultsforDevelopmentInstitute,theRockefellerFoundation,USAID’sHealthFinancingandGovernanceProject,andtheWorldBank.RepresentativesfromtheJLNSteeringGroupandtheMalaysianMinistryofHealthhavealsoparticipatedheavilyinthedevelopmentoftheworkshopobjectives,agendastructure,andspecificactivities.JLNMemberCountries:FullMembers AssociateMembersGhana BahrainIndia BangladeshIndonesia ColombiaKenya EgyptMalaysia EthiopiaMali JapanNigeria KosovoPhilippines LiberiaVietnam Mexico Moldova Mongolia Morocco Namibia Senegal SouthKorea SudanBelowpleasefindsomedetaileddescriptionstoaccompanythemainmeetingagenda,whichcanbefoundonthemeetingwebsite.Pleasenote,theagendaIssubjecttochangeandwillbeconsistentlyupdatedonthemeetingwebsite.Supplementalreadingmaterialcanbefoundhereandintheannexofthisdocument.


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Pre-MeetingSessionDescriptions(July18th–19th,2016)

Optionalsitevisits-TheMalaysianMinistryofHealthhasorganizedoptionalsitevisitsonTuesday,July19th.Registrationandbackgroundinformationcanbefoundonthemeetingwebsite.

TechnicalInitiativeSideSessions–byinvitationonly

Date/Time TechnicalSession Location

Monday,July18th(9:00am-6pm)

JLNSteeringGroupMeeting Putra3

Monday,July18th(9:00am-6pm)

JLNPrimaryHealthCare(PHC)TechnicalInitiative:EngagingthePrivateSectorinPrimaryHealthCaretoAchieveUHC

Perdana3

Tuesday,July,19th(9:00am-1)

JLNSteeringGroupMeeting Putra3

Tuesday,July,19th(9:00am-6pm)

JLNPrimaryHealthCare(PHC)TechnicalInitiative:HealthBenefitsPolicyMini-exchange

Perdana3

Tuesday,July19th(9:30am–6:00pm)

PrimaryHealthCare(PHC)MeasurementforImprovementCollaborative

Putra2

TuesdayJuly19th(9:00am-12:00pm)

ProviderPayment-InformationTechnologyCollaborative(PPM-IT)onDataAnalyticsforMonitoringProviderPaymentSystems

Putra1

FullDaySiteVisit(9:00-17:00)

HospitalPortDicksonKKPasirPanjangHealthClinicKDSungaiRayaCommunityClinic

DeparturefromLobby

HalfDaySiteVisit(2:00-17:00)

KKSalakHealthClinicKDGechingCommunityClinic

DeparturefromLobby


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Pre-MeetingTechnicalInitiativeSideDescriptions

JLNPrimaryHealthCare(PHC)TechnicalInitiative:EngagingthePrivateSectorinPrimaryHealthCaretoAchieveUHC–Monday,July18th(Putra2)

Facilitator:MartyMakinen(ResultsforDevelopmentInstitute,USA)SessionDescription:Inmanycountries,theprivatesectorprovidesasignificantandgrowingportionofprimaryhealthcareservices.PolicymakersandpractitionersareincreasinglyinterestedinworkingwiththeprivatesectortoprovidePHCservicesinordertoachieveuniversalhealthcoverage,butlacktheinformationandresourcestodoso.Tofillthisresourcegap,theJLNPrimaryHealthCareTechnicalInitiativeisjointlyproducingapracticalmanualcalledEngagingthePrivateSectorinPrimaryHealthCaretoAchieveUniversalHealthCoverage:AdvicefromImplementers,toImplementers.Themanualcontainsstep-by-stepguidancealongwithrealworldexamplesandcasestudiestohelpfacilitatepublic-privatesectorengagementaroundPHC.TheInitiativerecentlycompletedModules1–2,whichcoverInitialCommunicationsandPartnershipAroundPHC,andProviderMapping.ThesessionwillfocusondraftingModules3–4,whichwillfocusonProviderandFacilityRegulation,Accreditation,orEmpanelment;andProviderContractingandPayment.JLNcountrymembersandpartnerswillsharetheirexperiencesinthesetopicareas,andtogetherwillco-produceanoutlineandagreeonnextstepsfordevelopmentofthesemodules.Thissessionisbyinvitationonly.However,allmeetingparticipantsareencouragedtoattendthelaunchofModules1-2onDay2:parallelsessionsB,wheretheywillalsobeabletocommentonareportoutfromthisworkshop.

JLNPrimaryHealthCare(PHC)TechnicalInitiative:HeathBenefitsPolicyDesign–Tuesday,July19th(Putra2)

SessionDescription:HealthBenefitsPolicies(HBPs)includearangeofpoliciesthat:1)outlineaminimumpackageofhealthservicesthatwillbecoveredthroughpublicfunding;2)specifyappropriateprovisionandutilizationofthoseservices;3)allocateadequatefinancingforguaranteedservices;and4)ensuredeliveryanduptakeofthoseservices.ManyopportunitiesexisttoleverageHBPsforimproveddeliveryofPHC.However,thereiscurrentlynoplatformthathelpspolicymakersnavigateamongthemanyavailablepolicyoptionsandresourcesthatcanaddresstheissuestheyfaceindeliveringhigh-qualityandaccessiblePHC.Tofillthisgap,theJLNPHCTechnicalInitiativehasbegunco-developingtheinteractive,web-basedHealthBenefitsPolicyTool,whichisdesignedto:1)helpusersunderstandthemultipleandinterconnecteddimensionsofHBPs;2)guideusersfromrootcauseanalysistopolicydesign;and3)directuserstoexistingtools,templates,andliterature.Thissessionisbyinvitationonly.However,allmeetingparticipantsareencouragedtovisitthe


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PHCTechnicalInitiativeboothintheMarketplace,wheretheycanlearnmoreandprovidefeedbackontheToolPrimaryHealthCare(PHC)MeasurementforImprovementCollaborative–Tuesday,July19th(Putra3)

Facilitators:MeredithKimball(ResultsforDevelopment,USA),ChloeLanzara(ResultsforDevelopment,USA)SessionDescription:LaunchedincollaborationwiththePrimaryHealthCarePerformanceInitiative(PHCPI),thegoalofthenewPHCMeasurementforImprovementCollaborativeistodeveloppracticaltoolsandapproachesthatcansupportcountrypolicymakers,healthsystemmanagers,andfrontlineproviderstoeffectivelyusedataforPHCimprovement.DuringtheinauguralworkshopheldinAccra,GhanainApril2016,collaborativemembersidentifiedseveralareasofworktoundertakeoverthecomingyear,including(1)aninventoryofexistingPHCindicatorsutilizedbycountries;(2)methodsforaddressingpriorityareasofmeasurementincludingcommunityengagement,providerperformance,andpatientsatisfaction;and(3)processguidancefortranslatingdataintoimprovement.ThecollaborativeiscurrentlyworkingtogethertodevelopthePHCindicatorinventoryasafoundationalstepinco-creatingthelatteridentifiedtools.ThissessionisintendedtobeadetailedworkingmeetingtoreviewprogressmadeonthePHCindicatorinventoryandbegintoshareexperiencesonwhen,why,andhowtomeasureasafirststeptowardthedevelopmentofprocessguidancearoundusingdataforimprovement.Inaddition,participantswillhavetheopportunitytoprovideinputonthePHCAssessmentGuidecurrentlyunderdevelopmentbythePHCPerformanceInitiativeanddiscussitslinkageswiththeworkofthecollaborative.

ProviderPayment-InformationTechnologyCollaborative(PPM-IT)onDataAnalyticsforMonitoringProviderPaymentSystems–TuesdayJuly19th(Perdana4)

Facilitators:ChelseaTaylor(ResultsforDevelopmentInstitute,USA),CarenAlthauser(PATH,USA);DonnaMedeiros(PATH,USA)SessionDescription:ThePPM-ITCollaborativesidesessionwillbringtogetherasmallgroupofrepresentativesfromJLNcountrieswhoparticipatedintheCollaborativeonDataAnalyticsforMonitoringProviderPaymentSystems.Thesessionwillbeusedasatimetoreviewthecurrentstatusofthetoolkitdevelopedaspartofthiscollaborative,withafocusontheMenuofIndicators–auserfriendlytooldesignedtohelpcountriestochoosetheindicatorsanddataneededtoaddressthepolicyquestionsinmonitoringtheirproviderpaymentsystems.Thegoalistohaveaforward-lookingdiscussionaroundthetoolkitand,specifically,howtodisseminateitandsupportcountriesinadaptingandimplementingit.ThissessionwillbefacilitatedbyJLNpartnersandwilltaketheformofopendiscussionamongtheparticipants.


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MainAgendaSessionDescriptions

DayI:AfternoonPanels

HolisticapproachtoPeople-CenteredHealthCare–NewModelsforServiceDeliverywithPHCasBedrock(AlamWarisanBallroom)

Chair:AtikeltiAberha,DirectorGeneraloftheHealthInsuranceAgency,EthiopiaTBCDiscussants:SafirSumer(TurkeyHealthTransitionPlan(HTP)andFamilyMedicineProgram,Turkey);JoanneM.Shear(VeteransAffairs(VA),USA)Facilitator:JerryLaForgia(AcesoGlobal,USA)SessionDescription:People-centeredandintegratedhealthcare(PCIC)aimstoprovidetherightservice,attherightplace,attherighttimeandatacostaffordabletosocietyandindividuals.Itrepresentsanemergingcaremodelthatultimatelyaimstoimprovetheeffectivenessofhealthservicedelivery–akeycomponentofUniversalHealthCoverage.People-centeredisaboutorganizingaroundthehealthneedsofindividualsandcommunities,andnotaroundspecificdiseases.Primaryhealthcare(PHC)isthefoundationofpeople-centeredcare,anchoringcarecontinuity,healthsystem-citizenengagementandthespreadofcost-effectivepreventiveandhealthpromotionstrategies.IntegrationmeansthatPHCisstructurallylinkedtothebroaderhealthsystem,includinghospitalsandtraditionalpublichealthservices,toensurecontinuousandcomprehensivecare.Drawingonemergingglobalexperiences,eighttenetsoractionareaswillbepresentedascriticalingredientstoachievePCIC.Thesetenetswillbediscussedbywayofexamples,includingtheexperiencesofJLNmembercountries.ThesessionwillalsohighlightcasesfromTurkey,UnitedStatesandMexicowhichimplementedacombinationofPCICtenets.Additionalreferencematerialcanbefoundintheannex.VisioningIntegratedUHCsystemsofthefuture(AlamWarisanBallroom)

Discussants:KokuAwoonorWilliamandAnthonyOfosu(GhanaHealthService,Ghana);SafirSumer(TurkeyHealthTransitionPlan(HTP)andFamilyMedicineProgram,Turkey);JoanneM.Shear(USVeteransAffairs,US);Dr.NazrilaandFauziahZainalEhsa(MOH,Malaysia);OmarAhmedOmar(MOH,Kenya);HumbertoSilva(Argentina);IsraelFrancisA.Pargas(PhilippineHealthInsuranceCorporation,Philippines)FacilitatorsJerryLaForgia(AcesoGlobal,USA)SessionDescription:Usinga“worldcafé”methodology,participantswillbeprovidedtheopportunitytoengagefellowJLNmemberstoshareexperiencesonthe“what”and“how”ofimplementingthe8tenetsofpeople-centeredandintegratedhealthcare.JLNcountryexamplesforeachtenetwillbepresentedateachofeightstations.Presenterswillsharetheirowninnovationsandchallengesandlessonslearnedinpursuingthetenetsofpeople-centeredhealthcare.Participantswillbeencouragedtocommentonthese


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examples,sharetheirownexperiencesandidentifywaysthattheJLNcanhelptoaddressthechallengesandassistmembercountriesdesign,testandrolloutPCICapproaches.

DayII:ParallelSessionA

BLOCK1PHCImprovement:UHCPrimaryHealthCareSelf-AssessmentTool:ProgresstoDateandNextSteps(Putra1)

Discussant:KokuAwoonor-William(GhanaHealthService,Ghana)Facilitator:Dr.MartyMakinen(ResultsforDevelopmentInstitute,USA)SessionDescription:Inthissession,thePrimaryHealthCareTechnicalInitiativewillprovideanoverviewoftheUHCPrimaryHealthCareSelf-AssessmentToolandsummarizeresultsfromfivecountrieswhohavepilotedtheTool.TheToolhelpscountriesidentifyandaddressmisalignmentsbetweenhealthfinancingarrangementsandPHCgoals.Afteranoverviewofthetool,pilotcountryrepresentativeswillbrieflysharetheirimplementationexperiencesandhighlightsomekeyfindings,followedbyaQ&Asession.SessionObjectives:

§ PresentandraiseawarenessaboutwhattheToolisandthepurposeitserves§ DisseminatenewlylaunchedSummaryReportfromFiveCountryPilots§ Highlightkeyfindingsandfollow-upactionsresultingfromthepilotoftheSelf-AssessmentTool§ PromoteandidentifyinterestinapplyingtheTool

BLOCK2PHCFinancing:ProviderPaymentTechnicalInitiative:Costing,PPMAssessmentGuide,PPMforPHCLearningExchange,PPM/ITtoolkit(Putra2)

Discussants:LydiaDsane-Selby(NationalHealthInsuranceAuthority,Ghana);GildaSalvacionA.Diaz(PhilippineHealthInsuranceCorporation,Philippines);TsolmonTsilaajav(Mongolia)Facilitators:CherylCashin(ResultsforDevelopmentInstitute,USA);ChelseaTaylor(ResultsforDevelopmentInstitute,USA)SessionDescription:ThissessionisdesignedtohighlighttoolsdevelopedthroughtheJLNtohelpcountriesstrengthentheirPHCsystemsbyprioritizingfinancingandleveragingpaymentmethods.Thefourtoolsthatwillbesharedare:

1) ManualonCostingofHealthServicesforProviderPayment2) ProviderPaymentAssessmentGuide3) PHCFinancingandPaymentLearningExchange4) PPM/ITCollaborativeonDataAnalyticsforMonitoringProviderPaymentMechanismsToolkit


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Foreachofthesetools,facilitatorswillpresentthetool,describeexamplesofhowithasbeenusedbyJLNcountries,andopendiscussiontoparticipantsabouthowtheyusethetoolsorcouldenvisionusingthetoolinthefuture.BLOCK3PrivateSectorEngagement:EngagingPrivateActorstoReachInformalWorkersandtheirFamilies(AlamWarisanBallroom–FrenchTranslationAvailable)Discussants:CheicknaToure(Mali);NicolasTweneboa(Ghana);NicodemusOdongo(Kenya)Facilitator:LisaMorgan,InternationalLabourOrganization(Switzerland)SessionDescription:Ensuringequitableprogresstowardsuniversalhealthcoverage(UHC)isatoppriorityfordevelopingcountriesanddonorsalike.Yet,progressisnotequalacrossallsegmentsofsociety.Whiletherichestareabletotakeadvantageofbetterservices,formalworkersarebeingcovered,andthepoorestareincreasinglythebeneficiariesofsubsidizedprograms,averylargesegmentfrequentlyremainsexcluded:non-poorinformalworkersandtheirfamilies.InordertoreachUCH,itisvitalthatstrategiesareputinplacetoreachthissignificant“missingmiddle”.Oneofthekeyreasonscoverageisoftenlackingforthemissingmiddleisbecauseoftherelativedifficultyinidentifyingandenrollingthem,andinfinancingtheircoverageinanefficientandequitableway.Public-privatepartnerships(PPPs)with–forexample–insurers,mobilenetworkoperators,banksandothermicrofinanceinstitutionsholdthepromiseofasolution,helpinggovernmenthealthprogramsto:

§ Extendtheirreachextensivelybypartneringwithorganizationswhoalreadyhavealargefootprintintheinformalsectorandunderstandhowtoengagewiththem;

§ LeveragingITplatforms(includingmobileanddigitalplatforms)toenrollandre-enrollmembersintoschemes,makingthegreatestuseofsharedITinfrastructureandsharingassociatedcosts;

§ Communicate–theoptionsaremany,buteasiercommunicationwiththissectorcannotonlyhelpwithremotecare(e.g.telemedicine),butalsohealtheducationandencouraginghealthseekingbehaviors;

§ Collectpremiumsusingmobilemoney.BLOCK4CriticalFunctionsA:LeadershipandGovernanceforUniversalHealthCoverage(Perdana2)

Discussants:FrancisUkwuije(FederalMinistryofHealth,Nigeria);AtikeltiAberha(HealthInsuranceAgency,Ethiopia)Facilitators:LeizelLagrada(NetworkCoordinatorSupport);LydiaNdebele(WorldBank,USA)SessionDescription:Mostcountriesthathavebeenabletoachievemajorprogresstowarduniversalhealthcoveragehavebeenabletodosowithstrongpoliticalsupportandleadership.Unfortunately,suchleadershipandpoliticalsupportforuniversalhealthcoverageislackinginmanycountries.SeveralmembercountriesoftheJointLearningNetworkhaveexpressedaneedfordiscussionsonhowtoinfluenceleadershipandestablishgovernancestructurestodrivethereformsforuniversalhealthcoverage.


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Membercountrieshaverequestedadiscussionabouthowthenetworkcanfacilitatecollaborationsforstrategiccommunicationandstrengthenleadershipforuniversalhealthcoverage.SessionObjectives:

§ ReflectonleadershipandgovernancechallengesthatJLNcountriesfaceinachievingUHC.Thesereflectionsmayfocuson:

o Howtomobilizepeople,institutionsandresourcesforcollectiveactiontoimplementUHCstrategies?

o WhataretheskillsneededtospurandsustainchangetowardsUHC,includingeffectiveengagingofkeystakeholdersandfosteringinstitutionalcooperation?

o Highlightmechanismstofacilitatetransformationalchange,bothatthepersonalandinstitutionallevelsandmovekeystakeholdersfromsiloperspectivestosystemsthinking.

§ Identifytheleadershipandgovernanceareasthatwouldbeamendabletojointlearning(e.g.mappingcreativesolutionsfromJLNtoimprovecooperationamongdifferentagenciesmandatedtoworktowardsUHC,usingRapidResultsApproachtoguidetheCCGstospurtheimplementationofakeystrategythattheyhaveidentified)

BLOCK4CriticalFunctionsB:InformationTechnologyMechanismsforUHC:TheJLNITInitiativeJourney–Buildingtoolstooperationalizeandstrengthennationalpayerinformationsystems(Perdana3)

Facilitators:CarenAlthauser(DigitalHealthSolutionsPATH);DonnaMedeiros(DigitalHealthSolutions,PATH)SessionDescription:ThissessionisdesignedtohighlighttoolsandresourcesdevelopedthroughtheJLNITInitiativetohelpcountriesoperationalizeandstrengthentheirUHCsystems.Thesixtoolsthatwillbesharedare:

1)CommonrequirementsforNationalHealthInsuranceInformationSystems2)SoftwareforUHCDirectory3)HealthDataDictionary4)ProviderPaymentMethodsandInformationTechnologySystems5)ConnectingHealthInformationSystemsforBetterHealth6)ProviderPaymentMethodologiesandITCollaborativeonDataAnalyticsforMonitoringProvider

PaymentMechanismsToolkit

SessionObjectives:Throughthissession,participantswillhaveaclearerunderstandingoftheITInitiativetoolsavailablefromtheJLNandhowthesetoolscanbeusedtoovercomecommonchallengesinstrengtheningnationalpayeroperations,acriticalcomponenttoachievingPHCandUHC.

BLOCK5NewIdeas:HealthTechnologyAssessmentsforDecisionMaking(Putra3)


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Facilitators:SireeshaParabathina(AccessHealthInternational,India);SofiBergkvist(AccessHealthInternational,USA)SessionDescription:Facedwithescalatinghealthcarecostsandlimitedresources,manyministriesofhealthandnationalhealthinsuranceagenciesarelookingatmethodstoimproveefficiencyofhealthcaretreatmentandservice.Onecommoninitiativeistoestablishformalassessmentofthetreatmentandtechnologypriortoincludingtheminthereimbursementlist.Thisprocess,alsocalledHealthTechnologyAssessmentincludesassessmentofefficacy,safety,efficiencyandfinancialimpactofamedicaltreatment,serviceordevice.TheHealthTechnologyAssessmentsrequireclarityininstitutionalresponsibilitiesanddifferentskillstocarryouttheassessments.Manycountriesarefacingpracticalchallengesastheyaretryingtobuildcapacitytomanagetheseassessments.India,Indonesia,Ghana,KenyaandPhilippineshaveexpressedinterestinlearningaboutHealthTechnologyAssessmentandhowitcanbeusedforinformeddecisionmaking.SessionObjectives:

§ ToinitiatediscussionsaboutHealthTechnologyAssessmentandexplorehowtheJointLearningNetworkcansupportcountriesinthisarea

§ SpecifytheneedsforsupporttoadvanceHealthTechnologyAssessments§ Decideontheapproachofjointlearning:Whethertodevelopaproductthroughjointlearning

betweencountriesorbuildcapacitiesofmembercountriesthroughaknowledgeexchangeprogram(temporaryprofessionalplacements)inoneortworesourcecountries.

ParallelSessionB

BLOCK1PHCImprovement:Stakeholder-DrivenImplementationResearchtoAdvanceUniversalHealthCoverage(Putra1)

Discussants:LaksonoTrisnantoro(UniversitasGadjahMada,Indonesia);NaySoeMaung(UniversityofPublicHealth,Myanmar);NguyễnLanHương(VietnamSocialSecurity,Vietnam);LuisMartinezLievano(MinistryofHealth,Mexico);RitgakTilley-Gyado(MOH,Nigeria);GildaSalvacionA.Diaz(PhilippineHealthInsuranceCorporation,Philippines)Facilitators:RenaEichler(BroadBranchAssociates/HFG,USA);AndreaFeigl(AbtAssociates/HFG,USA)SessionDescription:AscountriesimplementcomplexandambitiousUHCpoliciesandinitiatives,inevitablechallengesandunintendedconsequenceswillarise.Implementationresearch(IR)canhelpimplementersunderstandwhatisandisn'tworkingascountriesworktoachieveUHC,aswellasthespecificsofhowandwhy,andwhatcanbedonetoimproveimplementation.IRforUHCseekstoengageimplementers,andthosewhoinfluenceandareaffectedbyimplementationofUHCinthedesign,conduct,anduseoftheresearch.Withitsemphasisonactionable,prospectivelearninginreal-worldsettings,IRforUHCcanstrengthenpolicymakers'andimplementers'chancesofsuccessfullypursuingUHC.

ThediscussionwillfocusonIRforUHCandhowitdiffersfromothertypesofresearch;howIRisbeing


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usedindifferentcountrycontextstostrengthenUHC;andhowtheymightintroduceIRforUHCintheirowncountries.ThissessionwillhighlightthespecificstepsfollowedtoinitiateIRforUHCinIndonesiaandMyanmarandthechallengesandlessonslearnedintheprocess.Thesestepsincludedalandscapeanalysis,identifyingandengagingamaingovernmentcounterpart,selectingandbuildingthecapacityofresearchpartners,gainingmulti-stakeholderconsensusaroundanIRtopic,andcreatinganiterativelearningcyclethroughIR.Supplementalreadingmaterialcanbefoundhere.

BLOCK2PHCFinancing:InnovativeFinancingTechnicalInitiative-RevisitingHealthFinancing:IntroducingthenewestTechnicalInitiativeoftheJLN(Putra2)

Facilitators:SomilNagpal(WorldBank,Cambodia),AjayTandon(WorldBank,USA)SessionDescription:Healthfinancingisconcernedwiththemobilization,accumulation,allocation,andutilizationofresourcesinordertohelpcountriesmakeprogresstowardsobjectivessuchasUHC.SufficiencyofresourcesformakingprogresstowardsUHCisagenerallyaprominentpolicyconsiderationacrossdevelopingcountries.Resourceneedsareinlargepartdependentoncountrycontext,demographicandepidemiologicalfactors,costsofinputs,aswellasonhowthehealthsystemisorganizedandfinanced,amongothers.Resourceavailabilitydependsonthewillingnessandabilityofbeneficiariestocontribute,administrativecapacityofcountriestocollectcontributions,fiscalcapacityofgovernmentstosubsidizecoverageforthosewhocannotcontribute,andextentofcross-subsidizationpossibilitiesfromrichertopoorerbeneficiaries,amongotherfactors.Healthfinancing,however,isnotjustaboutresourcesufficiency:itisalsoabouttheefficiency,equity,andeffectivenessofthewaysinwhichresourcesareraised,pooled,allocated,andusedtoachievedesiredhealthsystemoutcomessuchasthoseforUHC.ThenewesttechnicalinitiativeofJLNseekstodiscussanddevelopuponcountryexperiencesinnavigatingthisbalanceofresourceneeds,resourceavailabilityandresourceutilization,innovatingupontheirownpastpracticestomeetthecomplex,yetcritical,healthfinancingchallengesposedbythepursuitofUHC.

JLNmembercountriesexperienceandreportmyriadchallengesincludingunder-financingofhealthsystems,implicitrationing,over-dependenceonout-of-pocketsourcesoffinancing,difficultiesincollectingcontributionsfromtheinformalsector,fragmentationoffinancingsources,publicfinancialmanagementconstraints,inefficienciesandinequitiesinhowresourcesareraisedandallocated,andcostpressures,amongotherfactors.Theobjectiveofthissessionistoprovideageneraloverviewoftheglobalhealthfinancinglandscape,includinganoutlineofsomeofthemostcommonhealthfinancingissuesfacingJLNcountries,andadiscussionontheproposedkeyareasoffocusandwayforwardforknowledgesharingandjointlearningonthisvitaltheme.

ThepaneldiscussionwillfeatureapanelofparticipantsfromJLNcountriesacrossAfrica,EastAsiaandSouthAsia,tooutlinesomeofthecommonconstraintsfacingtheirhealthsystemsandalsotohighlightwaysinwhichtheirowncountryexperiencesmayberelevanttoinformpolicy-makersinothercountries.Plenarydiscussionswillhelpevolvethenextstepsandworkprogramofthistechnicalinitiative,andtoalsoidentifyinterestedJLNcountriesforpursuingactivitiesontheprioritizedsub-themes.BLOCK3-GovernmentEngagementofthePrivateSector:EngagingthePrivateSectorinPrimaryHealthCaretoAchieveUniversalHealthCoverage:AdvicefromImplementers,toImplementers(Putra3)


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Discussant:KamaliahMohamadNoh(MinistryofHealth,Malaysia)Facilitator:CicelyThomas(ResultsforDevelopment,USA)SessionDescription:MostJLNcountrieshavedefactomixed(publicandprivate)healthdeliverysystems.ToachieveandsustainUHCandensureaccesstoqualityPHCservicesforallpeople,theyneedtoengage(andaimtooptimizeandmobilize)bothpublicandprivatesectorstoprovidePHCservices.Duringthissession,thePrimaryHealthCareTechnicalInitiative’sPrivateSectorEngagementCollaborativewilllaunchModules1and2ofitsguideforEngagingthePrivateSectorinPHCforUHC–AdvicefromImplementers,toimplementers.Participantswillthenengageinadiscussionaboutthekeychallengesthatgovernmentsfacewhenengagingwithandpurchasingfromprivatesectorproviders,aswellasthemostpromisingopportunities.ThisdiscussionisdesignedtoinformthenextphaseofJLNactivitiesontheprivatesectorandfuturemodulesoftheguideforEngagingthePrivateSector,whichwillbefocusedonproviderandfacilityregulation,providercontractingandpayment,andmonitoringandmeasurementoftheprivatesector.Itwillalsobeanopportunitytodiscusshowgovernmentstewardshipcanshapethestructureofprivatemarketstoprovidehigher-quality,moreintegratedprimaryhealthcare.SessionObjectives:

§ HighlighttheimportanceofengagingtheprivatesectorinordertosustainUHCandensureaccesstoqualityprimaryhealthcareservices

§ IntroduceModules1and2ofEngagingthePrivateSectorinPHCforUHC–AdvicefromImplementers,toimplementers.

§ InformthefocusfutureworkofJLNactivitiesrelatedtotheprivatesector,includingproviderandfacilityregulation,providercontractingandpayment,andmonitoringandmeasurementoftheprivatesector.

BLOCK4CriticalFunctions:StrategicCommunicationstoreachthemostvulnerable(Perdana2)

Discussant:IsraelFrancisA.Pargas(PhilippineHealthInsuranceCorporation,Philippines)Facilitators:LeizelLagrada(NetworkCoordinatorSupport);NkemWellington(ResultsforDevelopment)SessionDescription:ManyJLNmembercountrieshaveputsubstantialeffortsinexpandingcoveragefortheirpopulation.However,tosuccessfullyimplementthesestrategiesandmakeprogresstowardsUHC,itisimportanttodevelopandexecuteeffectivecommunicationplanstoeducateandreachthepopulation,providetransparencyinenrollmentandmembershippolicies,informthepopulaceaboutthehealthservicesavailableparticularlyprimaryhealthcare,andbuildbuy-inamongdifferentactorsinthehealthsector.Strategiccommunicationinvolvescommunicatingthebestmessage,throughtherightchannels,attherighttimeandmeasuredagainstUHCgoals.StrategiccommunicationsinUHCmayrangefrominfluencinghighlevelpolicymakersindesigningandimplementingtheUHCagendatoreachingandeducatingthepopulationwhobenefitfromthisreform.Thissessionfocusesoninformingandempoweringthepopulation.Specifically,thissessionaimsto:

§ Developaframeworktoconsiderwhendesigningcommunicationsstrategiesforthepopulation.§ HighlightbestpracticesandchallengesofJLNcountriesininformingtheirpopulationofpolicies

relatedtopopulationcoverageandprimaryhealthcareaswellasthepopulationtonavigatethehealthsystem.Thesebestpracticesmayemployvariouscommunicationchannelsincludinghealthadvocates,digitalcommunicationchannels,events/roadshows,printmedia,amongothers.


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§ CollaborativelearningactivitiesthatcansupporttheuptakeofcommunicationsbestpracticesinJLNmembercountries,andbeyond.

BLOCK5NewIdeas:InformationTechnologyandSystemsforClaimsManagement(Perdana3)

Facilitators:SireeshaParabathina(AccessHealthInternational,India),SofiBergkvist(ACCESSHealthInternational,USA)SessionDescription:SeveralJointLearningNetworkmembercountrieshavesharedthattheyhavedifficultyindesigningandmanaginginformationtechnologyforclaimsmanagementwithintheirhealthinsuranceprograms.Oneofthehighestprioritiesamongthesecountriesistoestablishandstrengthentheirclaimsmanagementstructureandprocess.CountriesthathaveexpressedinteresttounderstandtheclaimsmanagementprocessandtoimprovetheirexistingprocessesandmonitoringsystemsincludeBangladesh,EthiopiaandKenya.Supplementalrelevantmaterialcanbefoundintheannex.

Theobjectiveofthiscollaborativewouldbetoprovidecrosslearningopportunitiesforcountriesfacingchallengeswithclaimsmanagement,findingsolutionstotheirtechnicalneedsandtocreateaguideonhowtodesignandimplementclaimsmanagementfunctionsusinginformationtechnology.

§ Tohaveconsensusonthetopicofclaimsmanagementtobestartedasatechnicalcollaborative.§ Decidemainthemesforaclaimsmanagementcollaborativethroughgroupdiscussion§ Haveconsensusontheendproductoftheclaimsmanagementcollaborative§ Identifylearningcountrieswhowouldliketojoinaclaimsmanagementcollaborative

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Annex

Patient-centeredIntegratedCare:FrameworkandDescription1People-centeredandintegratedhealthcare(PCIC)aimstoprovidetherightservice,attherightplace,attherighttimeandatacostaffordabletosocietyandindividuals.ThePCICconceptisbestdescribedby(Imison,etal.,2011.P.7):“Morecoordinatedacrossservicesettingsandovertime,particularlyforpeoplewithlong-termchronicandmedicallycomplexconditionswhomayfinditdifficulttonavigatefragmentedhealthcaresystems(Imison,etal.,2011,p.7).PCICisashorternomenclaturefortheWHOglobalstrategyofPeople-centeredandIntegratedHealthServices(WHO,2015a).DeliverymodelsembracingkeyelementsofPCICcomeinmanynames:accountablecare,value-basedcare,medicalhomes,intermuralcare,chroniccaremodel,coordinatedcare,tonameafew.

People-centeredmeansthatcareorganizedaroundthehealthneedsofindividualsandcommunities,andnotaroundspecificdiseases.Primaryhealthcare(PHC)isthefoundationofpeople-centeredcare,anchoringcarecontinuity,healthsystem-citizenengagementandthespreadofcost-effectivepreventiveandhealthpromotionstrategies.IntegrationmeansthatPHCisstructurallylinkedtothebroaderhealthsystem,includinghospitalsandtraditionalpublichealthservices,toensurecontinuousandcomprehensivecare.

PCICrepresentsanemergingcaremodelthatultimatelyaimstoimprovetheeffectivenessofhealthservicedelivery–akeycomponentofUniversalHealthCoverage.Itsdriversarecommontomanycountries:increasingburdenofnon-communicablediseases(NCDs),rapidlyagingsocieties,changinglifestylesrelatedtorisingincomesandurbanization,fragmentedcaredelivery,costpressuresandatendencyforhealthsystemstofocusonmoretreatmentratherthanmorehealth.PCICinvolvesshiftingthebalanceofcareacrosshealthcaresettings:fromtreatmenttopreventionand“management”;fromhospitaltoambulatoryandhomesettings;fromspecialisttogeneralpractitionersandfamilydoctors;fromprofessional-drivencaretoself-management;andfromphysicaltovirtualaccessandcommunication.EmergingevidencefromPCIC-likemodelssuggestgainsinefficiencyandqualitythroughlowerhospitalizationandemergencycareuse,improvedprocessesofclinicalcareandimprovedoutcomesandpatientexperience.

Drawingonemergingglobalexperiences,eighttenetsoractionareashavebeenidentifiedascritical,front-lineingredientstoachievePCIC.2Thesearepresentedinthetablebelow.Thefollowingisabriefdescriptionofeach.

1Thisdescriptiondrawsheavilyonthesynthesisof22casestudiescommissionedbytheWorldBankforaforthcoming(2016)bookonservicedeliveryreformfortheChinesegovernment.Synthesisauthors:AsafBitton,MadelinePesec,EmilyBenotti,HannahRatcliffe,ToddLewis,LisaHirschhorn(AriadneLabs)andGerardLaForgia(formerlyWorldBank).


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1. Primarycareasfirstpointofcontact:Oneofthefoundationalcharacteristicsofastrongprimaryhealthcaresystemisthatitestablishesprimaryhealthcareasthefirstpointofacontactforthemajorityofpatients’needs.Whenpatientsconsistentlyusetrustedandcompetentprimaryhealthcareprovidersasanentrywayintoatieredhealthsystem,theycanreceivecarethatiscontinuousandcoordinatedacrosstherangeofhealthcaredeliverylevels(e.g.,hospital,PCP,specialist).ByachievingthesecorecomponentsofeffectivePHC,patientsreceivetheneededcareattheright

placeandavoidunnecessaryhospitaladmissionsandproceduresthusavoidingunnecessaryriskandmedicalexpenses.FourstrategiesforensuringthatPHCisthefirstpointofcontactforpatientsfora

2Itisimportanttonotethatotheringredientsnotdiscussedhereincludequalityimprovementandpatientself-management.Thesecomponentsaresufficientlybroadtorequireaseparatediscussion.

EightCoreActionAreasandCorrespondingImplementationStrategiesinsupportofPCIC

CoreActionArea ImplementationStrategies

1:Primaryhealthcareisthefirstpointofcontact

• Useempanelmenttofacilitatepopulationhealthmanagement• Stratifyrisksofempaneledpopulation• Strengthenandtargetgatekeeping• Expandaccessibility

2:Multidisciplinaryteams • Defineteamgoal,composition,roles,culture,andleadership• Formindividualizedcareplansbetweencareteamsandpatients

3:Verticalintegration,includingnewrolesforhospitals

• Redefinetherolesoffacilities,especiallyhospitals,withinaverticallyintegratednetwork

• Establishprovider-to-providerrelationshipsthroughtechnicalassistanceandskillbuilding

• Developformalizedfacilitynetworks4:Horizontalintegration • Promotehorizontalintegrationthroughserviceco-location

• Integratedcarearoundtheindividualusercanpromotemorepatient-centeredcare

5:eHealth • Establishelectronichealthrecordssystems(EHR)accessibletoprovidersandpatients

• Establishcommunicationandcaremanagementfunctions• EnsureinteroperabilityofeHealthacrossfacilitiesandservices

6:Integratedclinicalpathwaysanddualreferralsystems

• Craftintegratedpathwaystofacilitatecareintegrationanddecisionsupportforproviders

• Promotedualreferralswithinintegratedfacilitynetworks7:Measurementandfeedback • Utilizestandardperformancemeasurementindicators

• Createcontinuousfeedbackloopslinkedtoactionplanstodrivequalityimprovement

8:Accreditationandcertification • Developaccreditationcriteriawhicharenationallyandlocallyrelevant• Settargetsforcriteriaandusetocertifyfacilities


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majorityoftheirhealthcareneedsareidentified:1)empanelment(assigningpatientstoaprimarycareteam);2)riskstratificationofpatients;3)gatekeeping;and4)improvedaccessibility.

2. Multidisciplinaryteams(MDT):MDTsareabuildingblockformostsuccessfulPCICinitiatives.In

principle,MDTsarenon-hierarchicalgroupsofclinicalandnon-clinicalstaffwhosegoalistoprovidecomprehensiveandintegratedcaretopatients.Teamscomposedofclinicalandnon-clinicalmemberswithavarietyoftrainingbackgroundsareabletoprovideafullerrangeofservices.ApproachestomaketheMDT’ssuccessfulincludeensuringappropriateteamcompositionandleadership,andprovidingcomprehensive,coordinatedpatientcareinpartthroughformulatingindividuallytailoredcareplans.

3. Verticalintegration:Thisareainvolvescommunicationandcoordinationamongprimary,secondary,

andtertiaryhealthfacilitiesdeliveringcareacrossthecarecontinuum.Allthreemustworktogethertowardsthe3-in-1principle:“onesystem;onepopulation;onepotofresources.”Itinvolvesredefiningtheroleofandinteractionsamongfacilities,especiallyhospitals.Verticalintegrationcanalsolinkprovidersatdifferentlevelstoprovidesupportandtechnicalassistanceandstrengthenthequalityofcareacrossthedifferentlevels.Strategiescanbecategorizedalongthreedimensions:(i)redefiningfacilityroleswithinaverticallyintegratednetwork;(ii)strengtheningrelationshipsamongprovidersthroughtechnicalassistanceandskillbuilding;and(iii)developingformalnetworksoffacilitiesbasedonthe“3-in-1”principle.

4. Horizontalintegrationaimstoprovidemorecompleteandcomprehensiveservicesinclusiveof

promotional,preventive,curative,rehabilitative,andpalliativecarecoordinatedbytheprovidersatthefrontlinefacility.Inmanydevelopingcountries,itmeansestablishingstrongerlinksbetweenprimaryhealthcareandpublichealthservicesbycenteringontheneedsofthepatient.Horizontalintegrationcanalsocontributetomoreefficientlyuseofresourcesthroughreducingwastefulserviceduplicationsuchasthroughco-location.

5. eHealthnotonlylaysthefoundationforsuccessfulcommunicationbetweenfacilitiesbutalsoprovides

healthworkersandpatientswiththetoolstomorefullyengagewiththecareprocessandimprovecaremanagementanddecision-making.InformationtechnologyalsoactsasanenablerofPCICbyfacilitatingnewformsofinteractionbeyondshortin-personvisits.Thesecanincludemulti-faceted,sharedelectronichealthrecordswithregistries,tele-orwebconsultations,andonlineschedulingsystems.eHealthcangreatlyenhancethefunctionalityandeffectivenessofPHCsystemsbyconnectingproviderstoachievehorizontalandverticalintegration,coordinationandcontinuityofinformationovertime.eHealthstrategiesinclude:(i)applyingelectronichealthrecords;(ii)establishingelectroniccommunicationandmanagementfunctions;and(iii)ensuringinoperability.


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6. Integratedclinicalpathwaysattempttostandardizethetreatmentandreferralpathwaysbetweenprovidersacrossatleasttwolevelswithinahealthsystemtoaddressparticularconditions.Theyclarifyrelationshipsandresponsibilitiesbetweendifferentprovidersinthesystemaswell.Becausethesepathwaysmayoftenleadtoreferralstoanotherlevelofcare,theyaremosteffectiveinthecontextofstronghorizontalandverticalintegration.Dualreferralsincludenotonlyreferralfromprimarytosecondarycare,butalsobacktoprimaryhealthcarefromsecondarycare.Integratedpathwaysandstrongdualreferralsystemsareimportantfacilitatorsofprovidingthe“rightcareattherighttime”.

7. Establishingameasurementandfeedbacksystem:Performancemeasurementindicatorsneedto

reflectnationalstandards,whichinturnreflectthecorefunctionsandgoalsofaneffectivePCIC-baseddeliverycaresystem(coordination,comprehensiveness,integrationandtechnicalandexperientialquality).However,collectingperformancedatawillnotaloneresultinimprovement.Afeedbackloopisneededtoensurethattheresultsarecommunicatedbacktostakeholdersatalllevels,fromthecommunitytoproviderstomanagementandpolicymakers.Themeasurementcanalsoidentifyearlypositiveoutlierswhocanteachothersandidentifyeffectiveinterventioncomponentsforbroaderimplementation.Twocommonstrategiesforpromotingmeasurementandfeedbackinclude:(i)developmentanduseofstandardizedperformancemetrics;and(ii)creationoffeedbackloopstodrivecontinuousqualityimprovement.

8. Accreditationandcertification:Accreditationisadefinedmechanismforexternallyassuring

accountabilityforminimalstandardstobemetandensuringfidelityacrossthehealthcaredeliverysystem.Althoughthetermsaccreditationandcertificationareoftenusedinterchangeably,accreditationusuallyappliesonlytoorganizations,whilecertificationmayapplytoindividuals,aswellastoorganizations.Externalorganizationalandclinicalcertification(oraccreditation)standardsarecriticaltoensurehighquality,reliable,andsafecareorganizations.Strategiestolaunchcertificationincludedevelopingcriteriaandsettingtargets.

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