CHMI's Learning Exchange: Overview and Accomplishments

From 2014-2015, CHMI, in partnership with ACCESS Health International, developed and managed the CHMI Learning Exchange. This blog summarizes our lessons learned from the exchange program.

Why do a “learning exchange”?

CHMI believes that peer learning has the potential to unlock solutions to the challenges preventing scale. The Learning Exchange was designed to enable the scale up, replication or improvement of CHMI programs by allowing programs to engage in a strategic learning activity with a pre-defined partner.  Though a combination of flexible learning grants, ownership over the learning process, and a chance to think creatively and take risks, the Learning Exchange served as a catalyst to test and adapt new ideas.

The Learning Exchange Process

CHMI launched two competitive application rounds for program managers profiled in the CHMI database. Programs applied jointly and shortlisted applications were reviewed by a steering committee that included Results for Development, ACCESS Health International, the WISH Foundation, Innovations in  Healthcare (formally IPIHD), and the Bertha Centre for Social Innovation and Entrepreneurship. The majority of applications received were from East Africa and India and were working in primary healthcare and healthcare technology, which mirrors composition of the CHMI database. Applicants proposed learning models which included training via site visit observation, curriculum development, a mentorship program, feasibility studies for adaptation to a new geography, and development of a mini-collaborative.

The steering committee awarded ten grants in two rounds of applications. In the first round, programs introduced new TB management protocols, replicated vaccine delivery models, shared health management evaluation techniques, promoted financial sustainability, and expanded eye care services. In the second round, applicants developed marketing pilots, introduced new management technology, shared best practices for elderly care, and developed sustainable sales and business development programs. Read about all recipients of the exchange on the Learning Exchange overview page.

What did Programs Accomplish?

Programs made important strides towards improving and growing their models through the Learning Exchange, including:

• Adapting new models across geographies. To increase TB case quality management, the Afghan Community Research & Empowerment Organization for Development (ACREOD) partnered with Operation ASHA to adapt their urban TB control program from India to Afghanistan. Operation Asha trained ACREOD staff on their tablet-based technology program, which uses fingerprint scanners to track patient visits. A pilot of the model has started in Kabul, and ACREOD staff believe the model will improve patient compliance to treatment. Possible Health in Nepal and Last Mile Health (LMH) in Liberia both run a full service primary care platform including facility-based and community-based interventions. During the exchange, LMH learned which components in Possible’s referral and facility based model are adaptable to Liberia, while Possible will introduce new practices from LMH’s community health worker service delivery program.
• Increasing operational efficiency. Through the partnership between IKure Techsoft and Amader Haspatal, 10 new CHW in West Bengal were trained to use IKure’s point of care IT platform to conduct continuous monitoring of MNHC indicators for 90 rural villages. SalaUno, an affordable eye care service, was modeled after Aravind Eye Care in India, but was still working to adapt Aravind’s standardized quality management processes in Mexico. Aravind clinical staff recommended that SalaUno streamline their pre-surgery protocol and criteria, which has reduced their surgical response time to three days. Additionally, SalaUno has modified their counselor process for surgery recommendations; uptake of these services by patients has increased from 50% to 70%.
• Generating Demand through improved sales and marketing. MicroClinic Technologies in Kenya developed Zidi, a technology that streamlines operational processes and report generation, but faced challenges in scaling the technology among clinical providers. They partnered with GlaxoSmithKline Kenya and Spartan in South Africa to develop a strategy to increase adoption of Zidi through social marketing and youth sales agents, called Blue Angels. MicroClinics learned that their target clinics needed more than sales representatives—they also wanted technical support to be willing to implement the product. Now, MicroClinics has re-defined their Blue Angels to serve as Health IT consultants, who can both sell the technology and provide support to clinic managers. Similarly, Care2Communities in Haiti and Access Afya in Kenya were both struggling to drive demand for primary health care in their communities. They identified two gaps in their outreach efforts. For Access Afya, located deep in informal settlements, they improved their signage to help new patients locate the clinic; Care2Communities used coupons to encourage new patients to try their services.   

What did we learn?

The Learning Exchange was a pilot program, and CHMI learned many lessons along the way, including:

• There is a strong demand for peer-learning. Program manager expressed an interest in formalizing partnerships with organizations they work with informally, a need to rapidly test ideas without a huge expenditure of time and resources, and the importance of developing a learning culture within their organization.
• Institutionalizing learning is a challenge. All organizations must learn to navigate the challenge of staff turn-over. Developing a plan to incorporate learnings is essential to ensuring an exchange’s success. Keeping one person consistently engaged in the process helps manage the onboarding of new employees and keeps communication consistent.
• Timelines involve trade-offs. Originally, the exchange was set to take place over a four month time period. Many programs extended their learning exchange to six months and expressed that a longer exchange allows for more iterative testing and impact measurement. Other organizations appreciated the fixed time frame as an incentive to accomplish objectives quickly. As organizers, we must recognize the importance of flexibility in our timelines to meet programs’ individual needs.
• Two-way exchanges can spark positive spill-overs. Although most exchanges were between two programs, the impact of these exchanges grew rapidly. Organic Health Response and KCOMNET organized a one-day sustainability workshop with eight community radio networks that engage in health programming, laying the foundation for the first-ever network of community radio in Kenya. Inspired by sharing their process with neighboring Bauchi and Borno states, the Kano State Primary Healthcare Management Board self-funded an additional exchange with Yobe and Sokoto states, and Bauchi state developed a new exchange with Kaduna state. To date, six states in Northern Nigeria have participated in exchanges with one another to improve vaccine supply chain management in the region, sparked by the initial investment of the Learning Exchange grant.

What’s next?

Inspired by the success of the Learning Exchange, CHMI recently developed two new learning initiatives—Learn and Launch and the Primary Care Adaptation Partnership. We are excited to continue to work with program managers to facilitate peer learning and adaptation within the network, and look forward to sharing more information over the coming year.

Want to engage in a learning activity? Although we are not currently accepting applications to participate in a pre-defined learning activity, you can always use the CHMI database to connect with your peers. For more information on how to connect with profiled programs, please contact Cynthia Charchi at ccharchi@r4d.org .

Photo: c/o Ross Clinics