How the JLN Kept Its Promise on Strengthening Primary Care Systems Despite COVID-19 Uncertainty

November 01, 2022

How the JLN Kept Its Promise on Strengthening Primary Care Systems Despite COVID-19 Uncertainty

By: Management Sciences for Health, as JLN Network Manager, with contributions from technical partners Aceso Global and Results for Development (R4D)

This article was original published on Health Systems Global.

This blog is part of a curated blog series, “Prioritizing Universal Health Coverage in the Political Agenda: Needs, Barriers & Opportunities.” aligned with HSR 2022 from the UHC2030 Health Systems Related Initiatives. It focuses on the HSR 2022 sub-theme: The role of comprehensive PHC in promoting sustainability and the contribution of new technologies.

In the throes of the COVID-19 pandemic, the Joint Learning Network for Universal Health Coverage (JLN) rapidly pivoted to meet the needs of its 34 member countries but also more generally all countries caught in the uncertainty in those early days of what the pandemic might mean and how best to respond to it. Throughout the pandemic, the JLN and its member countries worked to increase inclusiveness and keep people at the center of care systems. Below, we highlight five JLN member countries’ work towards comprehensive PHC. While topics range from using digital health to tackling non-communicable diseases (NCDs) to population targeting, peer learning is central to our approach and how we facilitate knowledge sharing and learning.

Improving access to PHC services through digital health technologies

Non-communicable diseases (NCDs) are a health crisis in all countries, including JLN member countries. The JLN community has been at the forefront of innovative responses to the dual challenges of COVID-19 and NCDs. Many emerging economies face the daunting challenge of expanding access and quality of health services for NCDs using healthcare resources that grow at a far slower rate. Country members involved in the Patient Pathways During Pandemics: COVID-19 and Beyond Learning Exchange focused on digital health tools as a way to close this gap. In Ghana, members worked to pivot a COVIDConnect app towards hypertension and diabetes (NCD Care App), adding a new digital access point that can improve access to care. To read more about areas where JLN members are brainstorming a ‘new normal’ of digital health technologies, click here. In Malaysia, a team of PHC/MOH officials and clinic directors worked to launch the expansion of an e-Consultation pilot initiative (known as “PHC telemedicine” in the global context) in order to improve access for patients with chronic conditions. The main objective of the pilot was to reduce congestion in PHC clinics as well as people’s reluctance to use the same due to crowded conditions, improving patient access to COVID and non-COVID services. One participant commented, “In the community where I work, the biggest barrier is access to health information, services, and products. We can use tech to ensure clients can access services.

The PCIC team in Shai Osudoku 2018 Photo Credit: Momodou Cham
The PCIC team in Ghana. Photo Credit: Momodou Cham

Learning from this JLN learning exchange provided evidence that tech can bridge this barrier, linking clients to services. A key thing I learned is understanding the user journey of the client from community to facility: where the client faces barriers, and how we can intervene to address these barriers to the client’s journey.” Based on positive patient access and satisfaction results, the Malaysia MOH now plans to expand e-consultation services to additional 240 PHC clinics.

Strengthening PHC at the community and sub-district levels

Ghana’s path towards achieving UHC is complemented by the roll out of Networks of Practice (NoPs), which work to strengthen PHC at the community and sub-district levels. The strategic roll out is not only to ensure comprehensive PHC at the lower level of care, but also to ensure sub-district referral systems are more resilient and responsive to the health needs of the community members they intend to serve. As a member of the Person-Centered Integrated Care Collaborative (PCIC), Ghana co-created an empanelment assessment tool which they plan to pilot to identify and assign community members to care teams within the NoPs. To read more about Ghana’s experience, click here.

Improving service delivery with new models of care

Continuing along the path started by PCIC, Ghana, Kenya, and Colombia are strengthening service delivery by piloting a new model of care – primary care networks (PCNs) – to connect facilities within a geographic area. The Implementing and Measuring Primary Care Networks Learning Exchange convenes these case countries to tackle questions about how to design, implement, and measure the performance of PCNs. In the words of JLN’s Steering Group convener, Isabel Maina, “Primary care networks is an important theme for the JLN as a service delivery mechanism towards UHC.” She commented that this exchange responds to the Asana Declaration on PHC and noted that, “we are going in the right direction if we set up PCNs in our countries.” To learn more about this work, click here.

Designing targeted health programs

As members of the Learning Collaborative on Population Targeting, Liberia and Ghana worked to better identify poor and vulnerable population sub-groups so as to target them with specific health programs or benefits. In Ghana, a three-way link is planned between the national health insurance scheme (NHIS), social registry (GNHR), and national ID scheme (Ghanacard). Initial stages are complete, including partial completion of the NHI-Ghanacard link allowing 150,000 health beneficiaries to access care without their NHIS card. In Liberia, building blocks were put in place for the creation of a technical coordination unit that will ensure alignment between the ongoing reforms to create a national health insurance scheme, social registry, and national identity program. A participant from Nigeria commented, “It was a great experience and a very timely one as we are currently in the midst of a huge enrollment, but we were unsure of what proportion of those enrolled are really poor so need help to know how to map and target the very poor. Following the lessons and the information shared, we are currently starting off a new enrollment process where we have to now properly identify the poor, [and] get them enrolled into a system that meets the international best practice.”

The JLN is committed to promoting PHC on its global agenda with upcoming learning opportunities on rehabilitation and UHC as well as Reimagining PHC. One technical facilitator summarized the JLN ethos: “When you put people together, they learn from each other and it becomes provocative. There’s something valuable to that.” The JLN plans to continue providing this catalytic learning platform for years to come.

The Joint Learning Network for Universal Health Coverage is a part of the UHC2030 Health Systems Related Initiatives.  The UHC2030 Related Initiatives promote collective action for stronger health systems that protect everyone. Watch the following video to learn more about how the different partnerships and alliances are contributing toward stronger health systems for achieving UHC goals.