In many low-income countries, private sector innovations make up a large part of the health system. Private innovations can be a key source for responsive care, but are also largely unregulated – meaning that quality, affordability, and accessibility of care ranges drastically. The public sector is in a unique position to regulate, help finance private healthcare and contribute to national health goals.
Innovations do have great potential for impact, but they face challenges of quality, affordability, sustainability, and scale. New improvements are being developed to overcome these challenges, but the rate at which they are spreading between organizations and geographies is too slow. CHMI launched both the Primary Care Learning Collaborative (the Collaborative) and the Learning Exchange to test whether collaborative learning approaches can help speed up the transmission, replication and improvement of these innovations.
Testing the Learning Approach
On Day One of the first meeting of the Collaborative in Delhi, my hands were sweating. What if the program managers decided not to share with one another? What if they decided that the competitive stakes were too high, and that this open collaborative model was not going to work? As the program managers started filing in, my fears dissipated. The motivated innovators immediately shared details about the challenges they faced in finding good talent, infrastructure problems, and regulatory barriers.
The Collaborative was launched to facilitate knowledge-sharing, joint problem-solving, and the cooperative development of new approaches among organizations providing primary care in low-income communities. The peer-learning approach allowed members to learn from each other’s experiences, increasing the speed and efficacy of innovation. The collaborative consists of five organizations: Access Afya and Penda Health in Kenya, LifeNet International in Burundi, and Swasth Health Centres and Ross Clinics in India.
The Value of Connecting People
The CHMI approach brings together groups that are addressing similar challenges using similar models, and pools collective wisdom and resources to solve problems. In the Collaborative, much of the learning and collaborating happened outside the formal agenda. Our open schedule ensured that members could meet and learn about each other on a personal level. Over conversations over bus rides and meals, ideas began to sprout, such as leveraging this branded group as a way to fundraise. The leaders opened up quickly, sharing honest thoughts on the challenges of burnout, marketing, and building a strong team. While exploring Delhi, members spent much of their time discussing HR challenges, reflecting on similar challenges and approaches.
Developing Opportunities for Learning Exchanges
After seeing the great success of in-person collaboration from the Collaborative’s field visits, we decided to test a new method for the learning approach. The CHMI Learning Exchange invites programs to apply for $8,000 to create learning partnerships that help programs improve business practices, adopt innovations, or scale-up or replicate an aspect of their model to a new market. Five winners were selected in the September call for proposals, and another call is expected in February 2015. The winning applications for the first Learning Exchange came from Afghanistan, Nigeria, Burundi, Kenya, and Mexico. Read about the winners of the first grant here.
CHMI hopes to diffuse the impact of these partnerships and encourage wider adaptations of these promising practices by disseminating lessons learned to the broader innovator network. The sense of community created by the cohort of winning programs will allow for further peer-learning and collaborative opportunities.
Measuring the Impact of Peer Learning Models
Many innovators note that formal impact evaluations take a long time to produce and can’t keep up with changing technologies and business models, creating inefficiencies when relying on them as a form of knowledge transfer. Peer learning models offer innovators a platform to hear about challenges faced and tacit lessons learned by specific programs, so that they can test ideas and rapidly iterate.
From the beginning, we were intent on finding ways to measure and evaluate the success of our learning models. In the Collaborative, we regularly collected data from members on which ideas they had tested and implemented in their own organizations, and which other member organizations they had interacted with over the previous month.
The Collaborative has already seen a number of changes in the models of its members, ranging from marketing innovations, to expansion of services, to rethinking the way that a model expands to new geographies. In the long run, the Learning Collaborative members and Exchange winners are committed to creating change beyond their own organizations to improve quality and expand access to healthcare in low- and middle-income countries. To ensure a broad ripple effect, CHMI is coordinating the co-development of knowledge products useful for policymakers, global health experts, and other innovators. These products are capturing the lessons, strategies and innovations discussed throughout the course of the collaborative and learning exchanges.
In October, Collaborative members advocated for Patient-Centered Innovation in The Lancet’s Global Health blog. CHMI has also been busy facilitating the development of a Handbook, written by the innovators themselves. The Primary Care Innovator's Handbook: Voices from Leaders in the Field will be published in February. These products share collective insights and provide a guide for program managers focused on successful implementation and scale.
When innovators work together to create new healthcare models, these models have the potential to scale to build stronger health systems worldwide. Our goal is to support an ongoing conversation among implementers, funders, policymakers, and thought leaders to share and build knowledge on what works. Although these learning models are only small steps in this process, our hope is that this work will begin new discussions and encourage a culture of open and candid dialogue, allowing those working to improve healthcare for the poor to work together more effectively and push the entire sector forward.
Photo Top: Members of the Primary Care Learning Collaborative discuss strategies at the first meeting in Delhi.
Photo Above: The Collaborative on a field visit to Penda Health's primary care clinic in Kenya.