Over the past decade, a number of national or state-level reforms have been implemented by governments that are committed to achieving universal health coverage through “demand-side” financing models, often specifically targeting the poorest and informal sectors of their populations. While many implementing countries have not yet achieved universal health coverage, reforms are underway in countries as varied as Chile, Colombia, Estonia, Ghana, India, Indonesia, Kenya, the Kyrgyz Republic, the Philippines, Thailand and Vietnam. While these reforms vary substantially across countries, common characteristics of reforms aimed at achieving universal health coverage include provider payments according to patient volume (thus payments made according to demand, rather than supply) and more varied provider networks often including private providers. In addition to reducing financial barriers and improving access to care, countries recognize that these reforms can also lead to quality and service delivery improvements in areas such as communicable disease prevention and treatment, maternal and child health, and chronic disease management.

Universal health coverage reforms are ambitious in their goals, but often challenging to implement successfully. The variation among these national reform plans suggests that there is not likely to be one type of health financing or delivery scheme appropriate for all countries. The specific nature and timetable for reforms depends on the nation’s economic and political context. For example, countries are relying on various different sources of financing (general taxation, payroll taxes, individual premiums) as well as multiple channels for delivery of services (public and non-state).

Many organizations and initiatives currently provide helpful policy assistance for and generate valuable information on these new and innovative reforms (e.g., GTZ, the Health Insurance Fund, ILO, USAID HS 20/20, the World Bank, P4H, etc.). To complement these existing activities, there is increasing demand for joint learning and practical, issue-specific problem-solving across countries pursuing similar reforms. Joint learning activities are specifically desired by implementing practitioners who feel they can work with peer countries to identify strategies and tactics to overcome the many challenges of successful implementation.

To meet this demand for cross-learning, a group of initiating countries, including India, Ghana, Indonesia, the Philippines, Thailand and Vietnam, in collaboration with several development partners, has developed a plan for a joint learning platform for countries implementing demand-side financing reforms aimed at achieving universal health coverage, designed to support countries in overcoming the challenges associated with designing and implementing these reforms. This platform would result in a network of country-level practitioners, and a series of tools and activities including, but not limited to, ongoing meetings designed for cross-country learning and problem-solving, a repository of existing and new resources that could be used by practitioners, better documentation and dissemination of existing reform efforts, and a practical research agenda around core implementation questions. As a first step toward the development of this cross-learning platform, these countries and development partners convened a Joint Learning Workshop in Delhi, India on February 3 – 5, 2010.

The group of initiating countries has discussed a number of potential activities of a Joint Learning Network, detailed below. The activities of such a network will be demand-driven, resulting from on-the-ground needs and requests from policymakers and implementers within the target countries.

Information – Collect and disseminate timely and relevant information through easily accessible channels. One function of the Joint Learning Network will be to serve as a point for collection and dissemination of information through an interactive, frequently-updated, web-based system. As a starting point, the system could focus on collecting available, published information from research institutions and development partners. More importantly, however, the site could provide key information about specific country reforms, as well as cross-country comparative data and analysis. Over time, the system could develop into a highly interactive site, enabling countries and their research and development partners to directly update information on their reforms in real-time, or disseminating key news and updates in the form of newsletters or news feeds.

Community – Facilitate idea exchange and networking across countries and development partners. The Joint Learning Network will serve as a global hub for connecting policymakers and implementers across countries. This will include a series of formal, multi-lateral interactions aimed at bringing together reform countries through workshops, study tours or web conferences. It will also include the facilitation of ongoing, bilateral interactions between countries that are facing similar challenges or implementing similar models. The network could personally facilitate contacts across countries and international partners that would benefit from interacting with one another and show an interest in doing so. Additionally, the web site will serve as a valuable tool to facilitate connections through lists of key country officials and contact information, or interactive tools such as forums or message boards.

Resources – Provide tools and create linkages to technical and financial assistance. The Joint Learning Network will serve as a “connector” that connects countries with all types of resources. The network could gather tools created by countries that may be leveraged by others, or even facilitate the process of creating new tools in demand from a number of countries. It will also provide information to countries on available technical resources, such as former practitioners who are willing to act as consultants or donate time for technical assistance, or available financial resources to support countries as they implement reforms. The web site will also serve as a useful tool to facilitate these activities and provide maximum visibility and usability.

Analysis – Stimulate practical operational research and formal impact evaluations of coverage reforms. Through the activities described above, the Joint Learning Network would be uniquely positioned to identify areas where research and analysis would be of benefit to countries and to the international community of political and technical champions for health financing reform. Through the web portal, Joint Learning Workshops, direct interviews with countries and other activities, the Joint Learning Network will identify in-demand areas of research and develop a prioritized agenda for research in support of reforms. The Joint Learning Network will work to connect academic institutions, development partners and other research organizations with research topics that would be most beneficial to practitioners on the ground at the country level.

Since the Joint Learning Workshop held in Delhi in February 2010, interest and support for the concept of Joint Learning has grown immensely among both countries and international partners. The Results for Development Institute will serve as one of several “hub” organizations for the facilitation and coordination of Joint Learning Activities. Initially, R4D will focus on identifying and refining the needs and interests of the countries, coordinating and supporting in-person activities, establishing a web portal for the network, developing analytical products, and strategically identifying ways to deepen and expand the Joint Learning Network on an ongoing basis.

Other partner organizations in the development of the Joint Learning Network include the ACCESS Health International, Atlantic Philanthropies, DFID, GTZ, the Bill and Melinda Gates Foundation, the Government of India, IDRC, IHPP, the Rockefeller Foundation, the World Bank, and the World Health Organization.