Collaborative learning amid a pandemic

Collaborative learning is an approach that brings together communities of learners to tackle common challenges by exchanging knowledge and co-developing practical solutions.

For many years, R4D has been a leader in designing and leading global and regional learning and action initiatives, such as the Joint Learning Network for Universal Health Coverage (JLN). These networks help to strengthen how evidence is generated at the global level and put into practice by policymakers.

The JLN, in particular, has played an important part in supporting policymakers navigate complex challenges that are crucially important to make progress toward universal health coverage (UHC).

Together, JLN member countries co-develop global knowledge products that help bridge the gap between theory and practice. Country-driven, the network’s members set the learning agenda and identify UHC priorities across five technical initiatives, including the Provider Payment Mechanisms (PPM) technical initiative.

R4D has led the technical facilitation of the PPM technical initiative for 10 years, convening policymakers from across the JLN membership, synthesizing learning from these policymakers’ shared experiences, and packaging the new knowledge as a global public good.

Changing and refining PPMs to encourage more efficient and responsive service delivery is part of the roadmap to UHC in many low- and middle-income countries. The PPM technical initiative brings together policymakers to address common challenges related to provider payment design and implementation. These topics are identified by the JLN countries as the most pressing technical problems they are facing addressed through learning activities referred to as collaboratives.

The most recent learning activity under the PPM technical initiative focused on primary health care (PHC) financing and payment bringing together policymakers from 20 JLN member countries, with a common interest in sharing implementation experience on financing and provider payment for PHC. The objectives for this collaborative were to enhance experience sharing and learning, based on accumulated experiences over the many years of the PPM technical initiative.

Our learning has been a journey. Countries have evolved and matured over 10 years from addressing fundamental questions of how to get money to providers, and how to define how much to send to providers; to tackling more complex issues such as the governance requirements needed for provider payment, how to blend payment systems together and how to link provider payment to quality of care.

In more recent years, countries are looking at provider payment policy as part of the broader health system strengthening and how to use provider payment to advance health systems’ goals and redesigning service delivery to focus more on the communities’ access to quality care, and how provider payment hinders or promotes access to care.

Learning is also getting deeper into country experience. As health systems evolve and mature, we are getting valuable implementation lessons for sharing with others. Countries are now contributing experiences as resources to others and supplying content to the learning agenda. COVID-19 disrupted how we usually facilitate collaboratives, from a blended format of in-person and virtual engagements, to fully virtual engagements.

As the collaborative draws to an end, the technical facilitation team shares six lessons from the past two years of virtual facilitation during the COVID-19 pandemic.

1. Pivoting during the pandemic

COVID-19 created new demands for country participants, and it was important to adapt to changing demands. Through outreach to members, the technical facilitation team identified topics of interest and quickly adapted to share relevant country experience available within the collaborative on leveraging PHC service delivery, financing and payment systems for the COVID-19 pandemic.

2. Maintain a safe space.

The technical facilitation team decided early on in the collaborative that virtual events would be exclusive to collaborative members, to allow for discussion and open questions, and to deepen the quality of sharing. The collaborative nature of our participants led to the high quality of experience sharing and contributed to the success of our learning events.

3. Leverage technology to sustain connection and participation.

The technical facilitation team developed clear objectives for each technology tool to avoid duplicating messaging or working at cross-purposes. A monthly bulletin was useful for organizing information to participants and to avoid sending multiple informational emails and creating email fatigue. In addition, WhatsApp was used as an informal channel to connect one-to-one with participants from country teams, particularly as the pandemic took a toll, and considering that participants bore the brunt of managing the pandemic in their countries. This helped to foster the sense of community between the technical facilitation team and participants; it also increased the number of touch points beyond the more formal virtual webinars. The technical facilitation team used biannual surveys to check in with participants, confirm the learning agenda remains relevant, and source for new topics of interest for virtual meetings. However, technology has limitations in bandwidth constrained settings and these tools are better adapted for tech savvy audiences. For example, using two or more platforms during meetings was found to be cumbersome and it was common to find that few participants switched to a second platform to participate in a poll or survey.

4. Test new modalities to connect country practitioners for joint learning.

The country pairing approach — a new modality designed and tested by the technical facilitation team — brings together two to three countries with a shared interest to delve deeper into country experience. As the virtual nature of the collaborative reduced opportunities for deep interaction between countries, the country pairing resembled a study tour and was ideal for the realities of the pandemic.

5. Be flexible in approaching knowledge products.

The PPM technical initiative has been at the forefront of developing knowledge products such as adaptable tools and guidance documents for country application. Over the years, these has been less demand and interest for such foundational toolkits, and with the maturity of some countries’ PHC Financing and Payment systems, the technical facilitation team focused on capturing country experiences as public goods. This led to the development of the COVID-19 case studies which profiles experiences of six member countries; season two of the PPM podcast that builds on season one by exploring three key themes from eight member countries, and the PPM video — a capstone product that shares the experiences of countries in the JLN and some of the benefits they have drawn from the participation in the PPM technical initiative over the years. The PPM podcast has had a reach beyond the 34 member countries of the JLN, with listeners in 90 countries across six countries.

6. Blend learning.

With the COVID-19 pandemic there was a proliferation of webinars and virtual meetings as new guidance and best practices emerged and changed rapidly. This increased the pressure on participants’ time while pivoting to virtual and working from home arrangements for some participants. Collaborative participants were bombarded with requests for webinars on a daily basis from multiple sources. Although the collaborative was able to sustain engagement, “zoom fatigue” eventually began to set in and we propose a blended approach of in-person and virtual learning engagements may be more ideal for collaborative learning.

The journey does not end here but continues through the community of peers and friends. Provider payment continues to be a topic of interest to the JLN membership, and more broadly as conversations on how to use limited health resources more effectively gains traction. R4D brings value to country implementation in countries through experience sharing and creating global public goods that can be adapted at country level. As a core pillar of R4D’s strategy, R4D will continue to support collaborative learning into the future through the JLN and other learning networks — including the new Primary Health Care Performance Initiative, Linked Immunisation Action Network and the Partnership for Evidence and Equity in Responsive Social Systems, among others.