Related Resource: Primary Health Care Financing and Payment

Lessons and Best Practices from the COVID-19 Pandemic

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WASHINGTON, D.C. — Results for Development and the Joint Learning Network for Universal Health Coverage (JLN) have published a new report, Primary Health Care Financing and Payment: Lessons and Best Practices from the COVID-19 Pandemic, which includes six new case studies, sharing how Bangladesh, China, Kenya, Nigeria, the Philippines and Republic of Korea have coordinated their COVID-19 pandemic responses. The case studies, which were developed by the JLN Primary Healthcare (PHC) Financing and Payment Collaborative sub-group, also cover how these countries are financing and paying for essential health services at the primary health care level.

Dr. Subrata Paul, Focal Person, Bangladesh National Health Accounts cell, Health Economics Unit – Ministry of Health and Family Welfare Bangladesh, said: “The most fabulous thing about this case studies are you already know what will work and what will not in your country context from other countries experience. Learning about how the countries are implementing their self-invented methods to combat COVID is always helpful. Bangladesh will try to pilot a few case studies in small scale and will share the experience.”

The JLN is a country-driven network of practitioners and policymakers from around the globe who co-develop global knowledge products that help bridge the gap between theory and practice to extend health service and care to people who need it. Results for Development (R4D) has been one of the core partners of the JLN since its inception in 2010, helping to conceptualize, shape and develop the network, which now includes 34 countries. R4D currently serves as a technical facilitator for the JLN Primary Health Care (PHC) Financing and Payment Collaborative sub-group, where we have brought 20 JLN member countries together to learn more about various countries’ COVID-19 responses and specifically the role of PHC and community health systems.

The new report is a product of the sub-group and features the following six case studies:

• Bangladesh: With high population density, a thriving informal economy and many inter-generational families, officials in Bangladesh focused on data to identify clusters for transmission, to target different levels of restrictions and safety precautions.
• China: Officials in China developed a strategy that sought to minimize infection by identifying, addressing, and conducting contact tracing for infections as soon as possible.
• Kenya: Kenya’s response prioritized the efficient collection and synthesis of data at both the national and county level, to ensure timeliness and accuracy. This approach allowed the Kenyan government to stay abreast of the rapidly evolving situation, monitoring human resources, test kits, drugs, and personal protection equipment levels to direct resources where they were needed.
• Nigeria: Nigeria’s systems-based response not only helped reduce the burden of morbidity and mortality in the immediate term but has also helped prepare Nigeria to better handle a resurgence of COVID-19 — or any other pandemic of similar magnitude.
• Philippines: At the onset of the COVID-19 pandemic, The Philippines Health Insurance Corporation (PhilHealth) played a pivotal role in financing healthcare services, leveraging existing systems to quickly respond and contribute to the pandemic response.
• Republic of Korea: In the aftermath of the Middle East Respiratory Syndrome outbreak in 2015, the Republic of Korea implemented many policy changes to boost pandemic preparedness and provided a crucial foundation for the COVID-19 response.

Click here to download the full report.

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About Results for Development
Results for Development (R4D) is a leading non-profit global development partner. We collaborate with change agents around the world — government officials, civil society leaders and social innovators — to create strong systems that support healthy, educated people. We help our partners move from knowing their goal to knowing how to reach it. We combine global expertise in health, education and nutrition with analytic rigor, practical support for decision-making and implementation and access to peer problem-solving networks. Together with our partners, we build self-sustaining systems that serve everyone and deliver lasting results. Then we share what we learn so others can achieve results for development, too. For more information, visit our website at: www.r4d.org.

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Bangladesh
Bangladesh was able to overcome the pandemic by creating localized solutions – a necessity given the reality of their population density, informal economy, and inter-generational families. Bangladesh used data to identify clusters for transmission, to target different levels of restrictions and safety precautions depending on new cases, recoveries, and deaths. Download the Bangladesh brief.

China
Officials developed a strategy, dubbed the “Four Early’s”, that sought to minimize infection by identifying, addressing, and conducting contact tracing for infections as soon as possible. This strategy was bolstered by a triaged approach for different regions based on the level of risk identified, which allowed policymakers to direct resources more efficiently to where they were most needed. Officials also recognized the importance of access to high quality health services in curbing the pandemic. The priorities that guided China’s response, timeliness, and access, proved to be largely effective. Download the China brief.

Kenya
Kenya’s response prioritized the efficient process of incoming data, collected, and synthesized at both the national and county level, to ensure timeliness, completeness and accuracy. This approach allowed the Kenyan government to stay abreast of the rapidly evolving situation, monitoring human resources, test kits, drugs, and personal protection equipment levels to more effectively direct resources to where they are needed. Download the Kenya brief.

Nigeria
Nigeria’s systems-based response not only helped reduce the burden of morbidity and mortality in the immediate term but has also helped prepare Nigeria to better handle a resurgence of COVID-19—or any other pandemic of similar magnitude. Care was taken to minimize the impact of the pandemic on critical social, economic and health infrastructure systems and speed-up post-pandemic recovery and rehabilitation. Download the Nigeria brief.

Philippines
The Philippines Health Insurance Corporation (PhilHealth) administers the National Health Insurance Program to provide health insurance coverage and ensure accessible and affordable healthcare services for all Filipinos. At the onset of the COVID-19 pandemic, PhilHealth played a pivotal role in financing healthcare services. This brief documents actions taken by PhilHealth and how it has leveraged existing systems to quickly respond and contribute to the pandemic response. Download the Philippines brief.

Republic of Korea
The Republic of Korea’s preemptive and transparent public health response was instrumental to slowing the spread of the virus and flattening the curve of new infections. In the aftermath of the Middle East Respiratory Syndrome outbreak in 2015, policy changes that were implemented to boost pandemic preparedness and response provided a crucial foundation for the COVID-19 response and became investments that were quickly leveraged, and supported a faster and more effective response. Download the Korea brief.

These country briefs revealed several lessons about how policymakers and practitioners may bolster pandemic preparedness and response in the future, including the following:

Strategic purchasing for COVID-10
Strategic purchasing is a lever to achieve UHC goals, by using limited resources most efficiently to achieve equitable access to quality health services. Policymakers in all six countries coupled incentives for patients to access care with assurances to providers that they will receive the appropriate reimbursement for services, providing a concrete foundation for health system responsiveness.

Leveraging Primary Healthcare and Community Health Systems
PHC and community health are the first point of entry into formal health systems in many countries. Although many investments for the pandemic focused on “surging hospital capacity” with more intensive care beds and ventilators, and “flattening the curve”, the reality is that many cases remain mild or asymptomatic, and PHC and community health systems remain the backbone to support contact tracing, testing and home-based care.

Governance and coordination across sectors and between levels of government
The pandemic response goes beyond the health sector – all six countries have pandemic national coordination units that bring together all sectors such as immigration, security, finance, transport, trade, education, hospitality including – state and non-state actors – to develop multi-sectoral strategies addressing the multiple facets of community life affected by COVID-19 and enforce their implementation.

Evidence-based strategies
Data is a vital component in helping governments, researchers, and policymakers battle the COVID-19 pandemic. With accurate, timely and complete data, governments can make informed decisions to ensure the safety of the population.

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Dr. Islam has led and contributed to many influential initiatives in global health and development. She co-led the creation of USAID’s first Health Systems Assessment Approach: A How-to Manual, used in more than 25 countries to guide sector strategies and programming. As chief of party for USAID’s Sustainable Financing for HIV Activity in Vietnam, she supported the country’s transition from donor to domestic financing through national health insurance. She has supported financial sustainability in Gavi countries through innovative financing options and domestic resource mobilization, as well as for primary health care (PHC) networks in Bangladesh through the USAID activities, Health Finance & Governance and Advancing Universal Health Coverage in Bangladesh..

Her work has also included supporting Bangladesh’s COVID-19 response, developing strategic plans for private PHC networks, advancing public-private engagement, and producing investment cases for life-course immunization. Dr. Islam’s research and publications span health financing reform, public financial management, immunization and urban health.

Dr. Islam earned her Ph.D. in development, environment and natural resource economics from the University of Illinois at Urbana-Champaign, an M.A. in international economics and econometrics from the Maxwell School at Syracuse University, and a B.S. in economics from Massachusetts Institute of Technology (MIT). She is completing a certificate in ESG sustainable investing from the CFA Institute. She speaks English and Bengali fluently, and conversational Urdu and Hindi. Dr. Islam spends her time between New York, USA and Dhaka, Bangladesh.

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Innovation is an essential part of responding effectively to development challenges that are continuously changing. If we can keep pushing ourselves to work faster and smarter, we have a much greater chance of building stronger, more sustainable health and education systems around the world.”

Tom Feeny has 25 years of international development experience, with significant project management, organizational management and strategy work. He has worked in range of countries Including Afghanistan, Bangladesh, India and Senegal.

As a senior program director and manager of the Results for Development office in London, Mr. Feeny leads R4D’s innovation practice and manages a range of programs within this portfolio, including the International Development Innovation Alliance (IDIA) — a collaboration platform bringing together senior innovation executives from the World Bank, USAID, the Rockefeller Foundation, the Bill and Melinda Gates Foundation, the U.K. Department for International Development, Grand Challenges Canada, the Australian Department of Foreign Affairs and Trade, the Swedish International Development Agency, the Dutch Ministry of Foreign Affairs, GIZ, the Skoll Foundation, UNICEF and UNDP.

Mr. Feeny also leads a multidisciplinary team from R4D working with a consortium of partners that is delivering Phase 2 of the multi-year Frontier Technologies program funded by the U.K. Department for International Development. This global initiative is working to test and accelerate the uptake of a range of technologies (including UAVs, Fintech and artificial intelligence) within international development policy and practice.

Before joining R4D in 2015, Mr. Feeny held a range of senior management roles for organizations in the U.K. and Australia. He led the secretariat for HANSHEP, a group of development agencies and governments seeking to improve the performance of non-state actors in delivering better health care to the poor. As chief of staff to the CEO at The Smith Family, one of Australia’s largest children’s charities, he designed and oversaw a transformational pivot in organizational strategy from a welfare-based model to one centered around overcoming disadvantage through education and lifelong learning.

During his years as a consultant, Mr. Feeny was part of a team that designed the strategic and operational merger of Save the Children Sweden and Denmark’s programs in Bangladesh. He co-authored a series of research articles or reports for UNICEF, PLAN and Child Fund International to inform their child protection, child participation and child poverty policies. For UNICEF and Save the Children USA, he conducted fieldwork with child soldiers and child sex workers in Afghanistan, India and Bangladesh.

He has also worked as a researcher at the Refugee Studies Centre at the University of Oxford and lived in Northern India for two years working with the Dalai Lama and the Tibetan government-in-exile on research presented at the UN World Conference on Racism in 2001.

Mr. Feeny holds master’s degrees in English and social anthropology from the University of Cambridge and the School of Oriental and African Studies at the University of London. He speaks English and French.

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Dr. Bear has contributed to global market shaping and scale-up efforts since the early 2000s, beginning with GAVI’s PneumoADIP and the Hib Initiative, where she co-led the country support mechanism, providing technical assistance to Ministries of Health for vaccine rollout and impact evaluation. At USAID (2009–2015), she led the development of flagship U.S. Government health initiatives — including the Global Health Initiative, Ending Preventable Child and Maternal Deaths Action Plan, and the Global Health Security Agenda. While based in Bangladesh and Mali, she oversaw catalytic investments in cold chain systems, digital health, health workforce, and governance. She collaborated closely with ministries to co-design frameworks for scaling high-impact interventions as part of national health sector strategies.

From 2016 to 2019, Dr. Bear led strategic and evaluative work that shaped major global health investments. She revised USAID’s maternal and child health investment frameworks to align with the SDGs, evaluated its flagship maternal and child health program, and designed a $1B successor strategy. She also led evaluation of the $3.5B Feed the Future nutrition portfolio, providing evidence that informed its Congressional reauthorization. Her advisory work includes digital health evaluations, such as a telecom-based health insurance product in Bangladesh that informed regional scale-up strategies. From 2019 to 2024, she led global portfolios managing integrated development programs across 25–45 countries, overseeing teams of 500–1,650 staff.

Dr. Bear holds degrees in social policy (BS, Northwestern) and public health (MPH, DrPH, Johns Hopkins). She has lived and worked for over a decade in Burkina Faso, Mali, Indonesia, Bangladesh and Palestine. She is fluent in French (professional) and English (native), and currently resides in Baltimore, Maryland.

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