Related Resource: JLN PPM Podcast

Season 2 of the JLN Provider Payment Mechanisms Podcast explores strategic purchasing.

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Results for Development (R4D) serves as the technical facilitator of JLN’s Primary Health Care Financing and Payment Collaborative, which developed the podcast. The Collaborative is made up of 64 technical experts, policymakers and implementors  from 20 member countries who work together to develop practical solutions and distill health financing and strategic purchasing best practices to achieve universal health coverage, or health for all.

“In season two, we’ll chat with country implementers from Mongolia, Malaysia, Liberia, Moldova, Egypt, and the Philippines,” said Dr. Kamaliah Noh, a JLN technical country facilitator and senior fellow at R4D. “We’ll be discussing how they collaborate, co-create, and implement solutions to roadblocks and obstacles in their journey to achieve UHC. They are really the role models of country-driven, country-led learning.”

In 2019, the JLN Primary Health Care Financing and Payment Collaborative developed its first podcast mini-series to promote joint learning  via an accessible learning tool that captures country insights and experiences in the voices of implementers. The episodes of Season 1 — which have been listened to more than 1,000 times — describe the core building blocks of strong provider payment systems, including, improving benefit packages, costing to improve the design of provider payment, and utilizing provider payment to achieve health system goals.

Building on this, Season 2  delves deeper into strategic purchasing as a lever for UHC, utilizing data systems to make strategic purchasing decisions; and incentivizing providers to provide quality health services.

Overview of episodes

• Introduction: Season 2 kicks off with JLN country facilitators, Dr. Kamaliah Noh and Tsolmon Tsilaajav, reflecting on the success of Season 1 and how podcast serve as an accessible and dynamic tool for sharing implementation experience. Dr. Kamaliah and Tsolmon also discuss the three topics that will be covered in Season 2. Access the episode here.
• Episode 1, Use of data for strategic purchasing: Understanding how health care providers are responding to incentives, whether objectives for service delivery and other goals are being achieved, and whether any unintended consequences are occurring can help reduce waste and improve the patient experience. This episode looks at how claims and other routine administrative data are often underutilized because of a lack of capacity within the purchasing agency, weak or underdeveloped data systems, or fragmentation in information systems. This first episode dives into the implementation experiences from Mongolia and Bahrain to understand how data analytics have been used to make provider payment more strategic. Access the episode here.
• Episode 2, Incentivizing quality as strategic purchasers — experience with financial and non-financial incentives: Strategic purchasing can be a key lever to achieve health system goals including equitable access to high-quality health services. This requires providing the right incentives and yet there is no one-size-fits-all solution. In the second episode, JLN member countries delve into a common challenge — how to design the right incentives and encourage health providers to deliver high-quality health services. They discuss country experiences incentivizing quality, both financial and non-financial incentives. The episode also explores what works where, how and why. Malaysia, Liberia and Moldova members share strategies, lessons and best practices. Access the episode here.
• Episode 3, Strategic purchasing as a lever for UHC: Provider payment mechanisms — and any associated innovations or strategic improvements — depend a great deal on the local context in which they are implemented. In the third episode, JLN members from Egypt and the Philippines who have started implementation of big-bang reforms recently introduced legislation to expand UHC. They also discuss their progress so far in implementing these reforms, how they are setting up their strategic purchasers, how they have selected providers for the defined package and how provider payment is being leveraged to address health system goals. Access the episode here.
• Wrap-up: Bringing It All Together: This final, shorter episode will be the capstone for Season 2. It explores common challenges and shared lessons from across the interviews and answer questions from listeners. Access the episode here.

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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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Dr. Horn’s expertise includes project and policy design and execution, system reform, and quantitative analysis for low- and middle-income countries. He has worked with governments and led strategic and operational work in international development on issues that include education quality, system diagnostics, assessment of learning, data systems and system-wide reform.

Dr. Horn’s country experience includes Brazil, Turkey, Nicaragua, Liberia and Moldova. His sub-sector expertise covers early learning, basic education, higher education and technical/vocational education.

Dr. Horn holds a PhD in economics of education from Columbia University. He is fluent in Portuguese and a native English speaker.

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Ms. Brainerd previously worked at Children’s Defense Fund-Minnesota as an AmeriCorps Promise Fellow, addressing youth development and scholarship programs. Later, she worked as a risk analyst for an international security company and interned with the International Crisis Group in D.C. Ms. Brainerd also served in the Peace Corps as a health teacher in Moldova, where she conducted lessons and campaigns on subjects ranging from communicable disease prevention to nutrition.

Ms. Brainerd holds an MA in International Affairs from American University, where she was a Coverdell Fellow concentrating on global governance, politics, and security. She earned her bachelor’s in International Studies from Macalester College in St. Paul, Minnesota. She is a native speaker of English and speaks conversational Spanish and Romanian.

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We know that early childhood personnel — preschool teachers, home visitors, community health workers — are critical in the lives of young children, but who are these workers and how can they be best supported? The Early Childhood Workforce Initiative (ECWI), a global, multi-stakeholder effort, has been working to generate new knowledge and resources to help policymakers and program managers better address these very questions.

To understand country priorities and ongoing efforts around the early childhood workforce, a team from Results for Development and the International Step by Step Association conducted 43 key informant interviews across 15 countries — Bangladesh, Brazil, Cote d’Ivoire, Ecuador, Georgia, Ghana, Jordan, Kenya, Moldova, Peru, Philippines, Singapore, South Africa, Sri Lanka, Zambia — earlier this year. We spoke with 28 country experts from implementing NGOs, multilaterals, and research institutions, and 15 policymakers, including program managers and government officials. This series of interviews helped us identify country priorities, learn about promising approaches, and gauge interest from policymakers and officials in piloting a needs assessment tool for diagnosing gaps and workforce needs.

Countries’ priorities surrounding the early childhood workforce, as well as their main challenges in offering workforce support were unique and context-driven. Nevertheless, we were able to deduce the following four, overarching takeaways from our interviews:

To read the full blog, click here.

Photo © Assistance in Building Afghanistan by Developing Enterprises (ABADE) Program/Sohrab Samanian

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At R4D, Ms. Boothe is a senior communications officer with the African Collaborative for Financing Solutions (ACS) project. It is a five-year project funded by USAID to help advance universal health coverage in sub-Saharan Africa by supporting countries in navigating their own path to universal health coverage. ACS works in partnership with Duke Global Health Innovation Center and Feed the Children.

Ms. Boothe’s career began in journalism. As a reporter, she has covered local, state, national and international news for Minnesota Public Radio, NPR, the BBC, CBC and Christian Science Monitor. She was a co-founding producer of the MPR/Public Radio International “The World.”

Her work in development was launched with a program in Central Asia for the National Democratic Institute and since then she has worked on everything from strategic communications, civic outreach and engagement, social mobilization and behavior change communications, elections communications and elections monitoring, policy advocacy and more.

Ms. Boothe holds an MSc in journalism and an MA in international studies with an emphasis on Middle Eastern Affairs from Hamline University and was a public policy fellow at the University of Minnesota Humphrey Institute of Governance and Policy.

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Over the 5-year period ending in 2018, 16 countries with a combined birth cohort of over 6 million infants requiring life-saving immunizations are scheduled to transition (graduate) from outside financial and technical support for a number of their essential vaccines. This support has been provided over the past decade by the GAVI Alliance. Will these 16 countries be able to continue to sustain these vaccination efforts?

To address this issue, GAVI and its partners are supporting transition planning, entailing country assessments of readiness to graduate and intensive dialogue with national officials to ensure a smooth transition process. This approach was piloted in Bhutan, Republic of Congo, Georgia, Moldova and Mongolia in 2012. The pilot showed that graduating countries are highly heterogeneous in their capacity to assume responsibility for their immunization programmes. Although all possess certain strengths, each country displayed weaknesses in some of the following areas: budgeting for vaccine purchase, national procurement practices, performance of national regulatory agencies, and technical capacity for vaccine planning and advocacy.

The 2012 pilot experience further demonstrated the value of transition planning processes and tools. As a result, GAVI has decided to continue with transition planning in 2013 and beyond. As the graduation process advances, GAVI and graduating countries should continue to contribute to global collective thinking about how developing countries can successfully end their dependence on donor aid and achieve self-sufficiency.

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As many countries pursue universal health coverage in the context of rising incomes and plateauing or declining donor assistance, maintaining and expanding effective coverage of essential immunization services will require careful planning for sustainability within macro-fiscal constraints. The Learning Network for Countries in Transition (LNCT) will bring together practitioners from transitioning countries and development partners to learn from each other around specific Gavi transition-related challenges that exist within broader health system and UHC reform processes.

“Peer learning is an effective and efficient approach for supporting implementation across multiple countries. It responds to the immediate needs of countries and produces practical tools that are likely to be utilized,” said Gina Lagomarsino, president and CEO at Results for Development. “We’ve seen success with this approach through our work on other peer-to-peer learning network models, and hope to build a similarly active and engaged community of experts through this new platform.”

In the coming years, significant increases in domestic financing for immunization programs will be needed to expand and sustain immunization programs in low- and lower-middle-income countries. As a country’s economy grows, it crosses Gavi’s eligibility threshold and begins to transition out of support. Transitioning countries often face challenges in achieving high and equitable immunization coverage, and in planning, budgeting and securing adequate financing of their immunization program after Gavi support ends. Insufficient planning can lead to gaps in vaccine coverage, which in turn result in a rise of vaccine-preventable deaths and debilitating illnesses.

For Gavi-transitioning countries, LNCT offers the opportunity to share transition planning and implementation experience, work together to solve common problems, and add to a global knowledge base of tools and approaches that contribute to successful transition. For development partners, this platform offers the chance to engage across countries on transition-related issues. LNCT will consist of both in-person and virtual engagements. The initial cohort of platform members will draw from 13 invited countries in various stages of Gavi transition, with potential membership expansion in 2018 and 2019.

“The ultimate goal of this platform is to improve sustainability of national immunization programs,” said Meghan O’Connell, program officer and LNCT project lead at Results for Development. “More immediately, though, participation can help countries tackle specific technical challenges related to Gavi transition. This will reduce the chance that vaccines will be dropped after a country transitions away from Gavi support, increase the chance that coverage will be maintained or increased and ensure that countries have the skills and ability to introduce new vaccines in the future.”

The platform, which is funded by the Bill & Melinda Gates Foundation, will host its inaugural meeting in May to identify technical topics that can then be taken forward by the relevant countries for more focused engagement. The countries that will be represented at the launch meeting include Armenia, Congo, Georgia, Ghana, Indonesia, Lao People’s Democratic Republic, Moldova, Sudan, Sri Lanka, Timor Leste, Uzbekistan and Vietnam.

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At Results for Development (R4D), Ms. Vasudevan is a regional Helpdesk lead at the EdTech Hub – a global research partnership led by R4D and partners. Within this role, Ms. Vasudevan supports education decision makers to incorporate evidence based and contextually relevant approaches in EdTech. She manages short term technical assistance requests within the Eastern Europe and Central Asia (ECA) and Eastern and Southern Africa (ESA) regions and leads the management of the Specialist Network. In addition, Ms. Vasudevan supports research on the use of EdTech to improve learning access and outcomes in emergency contexts.

Prior to joining R4D, Sharanya was an education specialist with the World Bank where she provided technical assistance to operational and analytical projects in the ECA and South Asia regions. Her work focused largely on teacher professional development, strategies to increase learning outcomes and equity of service delivery in pre-primary and primary grade classrooms. She has worked on projects in India, South Sudan, Afghanistan, Uzbekistan, Bosnia and Herzegovina, Moldova, Liberia and Timor Leste. Prior to the World Bank, Ms. Vasudevan was an education specialist with the Aga Khan Foundation and led the development and implementation of a civic education curriculum program in Kyrgyzstan. She began her career as a primary school teacher with Teach For India in Mumbai.

Ms. Vasudevan holds a master’s degree in international education policy from the University of Pennsylvania. She is fluent in English and Malayalam and proficient in Hindi.

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