Providing access to health care is widely recognized as a fundamental human right, as outlined in the World Health Organization (WHO) constitution.
The 1978 Almata Declaration attracted global attention on the goal of “health for all” that establishes it as a central priority in public health. The concept of universal health coverage (UHC) gained momentum in 2005 and was further strengthened in 2010 with the World Health Organization’s resolution and the publication of the World Health Report. For the first time, we considered population compensation, services compensation, financial coverage or protection (population coverage).
The promotion of UHC has gained even more momentum in the 20th and 21st centuries, particularly in the global health situation, playing an important role in promoting it as a priority for the United Nations and other international organizations. Even the idea of ensuring access to health care can be traced back to ancient society, demonstrating a longstanding recognition of the importance of individuals and communities’ health.
This raises an important question: Why was it difficult to achieve, especially with low and middle-income earners, despite the country’s recognition of the importance of UHC as a means of improving access to health?
Furthermore, fragmented knowledge sharing exacerbates the challenge. Learning opportunities are frequently overlooked as countries struggle with limited mechanisms for documenting and exchanging successful practices.
Even with a perception of global best practices, adapting these lessons to local political, economic and cultural contexts remains a hurdle. The complex interaction between global UHC strategies and local reality requires a coordinated approach that promotes local ownership and maintained technical support. The concept that “translating literature and global best practices into our own context is very difficult” is at the heart of the challenges faced by low and middle-income countries.
UHC’s Collaborative Learning Network
UHC’s Cooperative Learning Network (JLN) arose from the urgent need for a more collaborative, state-driven approach to solving these challenges. Founded during early discussions at UHC in 2010, the network was born when a small group of countries, including India, Thailand, the Philippines, Ghana, Vietnam and Kenya met with a global health bystander convening global health in May 2009.
As Kadarpeta explained, “The idea of having a platform to regularly discuss certain aspects of universal health compensation implementation came naturally when we realized that we could address similar challenges and learn from each other.”
In the network, JLN countries share information and ideas and develop solutions and tools to support the reform and achievement of UHC’s health system. JLN currently includes 40 member states in Africa, Asia, Europe and Latin America, as well as 12 non-member countries participating in the JLN joint research, collaborating to share experiences through multilateral workshops, country learning exchanges and virtual dialogues.
At one moment, Rahul Kadarpeta said, “We had to work together to exchange ideas and share what was working and what was importantly not working.”
This process not only distills complex global policies into actionable field advice, but also supports members by transforming shared experiences into co-created knowledge products ranging from toolkits to policy briefs based on real-world practices.
JLN distinguishes itself by being completely country driven. Rather than relying on traditional top-down technical assistance, the network utilizes the tacit knowledge of member countries. As Kadarpeta explained, “The integration of new knowledge comes primarily from national experience and comes directly from senior policymakers and practitioners on the ground.”
All member states form a national core group consisting of key stakeholders, including staff from the Ministry of Health, National Health Insurance Organizations, Treasury Agency, Technical Partners, and private and civil society organizations. In addition to setting learning priorities, these groups also select steering groups for the network to manage the agenda.
Despite the focus on modern health financing, senior policymakers and practitioners have said, “It has been extremely difficult for policymakers and practitioners to translate what actually meant on an operational basis UHC-related strategies such as provider payment mechanisms, strategic purchasing, government fund management, and other mechanisms. This fully encapsulates the struggle to translate abstract policies into practical, context-specific actions.
Collective problem solving
Over the past decade, JLN’s model has created measurable impacts in low- and middle-income countries.
Practical Learning and Applications: JLN has promoted learning exchanges with collaborators on over 40 subjects, resulting in the co-production of 45 practical tools. These tools, such as case studies and toolkits, can help the country “fastly organize policy notes” following research visits and country pairing engagements. Wide Usage: The JLN Tool has been downloaded more than 8,000 times in at least 94 countries, including 69 non-JLN countries. These tools are used across member countries to contribute to global guidance from organizations such as the World Bank and WHO. ” National and Regional Change: Ghana (since 2010), Kenya (since 2011), and Nigeria (since 2011) have seen the impact of clear policies from JLN. Kadarpeta says more than 400 technical experts are involved across sectors in more than 75 participating countries, three-quarters of which are lower.
Evolving Global Health Dynamics
We understand that the thematic areas at the heart of UHC reform are inherently dynamic. What worked in 2012 may not be effective by 2020 as the dynamics of the country’s systems evolve.
One of the key dynamics JLN continues to address is the revenue of national policymakers and practitioners who have shaped their networks over the years. As leadership transitions occur, key individuals who have long advocated for JLN jobs in the country through retirement or promotions will leave the system and sometimes limit the continuity of their strategic vision.
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Looking back on this challenge, Kadalpeta told us to catch up with new leaders, particularly as newcomers must accustomed to not only the core principles of JLN, but also the decorations needed to maintain safe spaces for open discussion, so we will conduct a consistent orientation on JLN’s methods to maintain network continuity. JLN champion mentorship is always supportive. ”
One important observation within the JLN is the different levels of progress between member states. Some countries have been part of their networks since their early days, working together through basic reforms to expand into complex and new fields such as climate-related health policies, digital health innovation, emergency preparation, and artificial intelligence applications in healthcare.
In contrast, new participants in JLN, including Burkina Faso, Botswana, Lebanon, Mali and South Sudan, have just begun to tackle the basic UHC challenges that older member states began working on nearly 15 years ago.
This natural advancement in the country through the development cycle requires a coordinated approach to knowledge sharing within the network. Simply applying the same strategies used by early adopters, the economic and institutional contexts operating may or may not work for new members, taking into account a variety of circumstances. To address this, JLN is considering enhancing the pairing models and learning exchanges of small groups of countries where countries with extensive experience in UHC reform are actively paired with newcomers for direct regionally related exchanges.
