Peer Learning and Leadership Strengthening Help Global South Achieve Health Goals
March 22nd, 2019 | Viewpoint
March 22nd, 2019 | Viewpoint
The recent PMNCH Partners’ Forum in New Delhi highlighted the power of partnerships to achieve the Sustainable Development Goals (SDG) and Universal Health Care (UHC) goals. And while all attendees learned from each other’s experiences, everyone acknowledged that country health leadership is critical for achieving any type of global health goal.
Indeed, leading international health institutions have prioritized leadership within their own strategies. Gavi’s 2016–2020 strategy highlights actions that foster sustainable delivery of immunization programs. These include strengthening government EPI teams to improve their structures, capabilities, processes, and practices. WHO’s Global Vaccine Action plan’s first objective identifies the need for country ownership and prioritizes domestic resource mobilization and technical advisory leadership.
Despite the demonstrated benefits of peer learning in the global south, rarely had the approach been applied in Africa. In October 2018, JSI led an initiative to foster technical leadership through inter-country peer-to-peer exchange in sub-Saharan Africa. The initiative convened national and subnational EPI and primary health care managers and experienced country-based technical advisors from Ethiopia, Nigeria, and Uganda. While each of these countries has made progress in strengthening routine immunization (RI) systems and improving coverage and equity, immunization coverage in 2017, as estimated by a third dose of pentavalent vaccine, was 73 percent in Ethiopia; 85 percent in Uganda; and 42 percent in Nigeria, well below the global target of 90 percent. Each country has persistent challenges in reaching every child and reducing the numbers of unimmunized. Bringing these countries together to exchange learning, successes, and lessons triggered a major shift in how they implement technical leadership. The tri-country exchange went beyond localized peer learning to cross-country peer-to-peer learning and achieved the following objectives:
The JSI-managed Nigeria Maternal and Child Survival Program Routine Immunization (MCSP-RI), Uganda SS4RI, and Ethiopia UI-FHS projects organized an exchange visit to Ethiopia from October 7 to 13, 2018. The teams visited UI-FHS implementation sites and travelled to the Southern Nations and Nationalities Peoples Region to meet their counterparts at the regional health bureau. They also travelled to Wolaita zone and met staff from the zonal health office, the Sodo Zuria and Humbo woreda health offices, and several health facilities. Throughout, participants learned how each other’s projects contribute to health and immunization systems strengthening efforts.
While the three countries have common approaches to RED strategy implementation, they are tailored to each country’s context. The Ethiopian UI-FHS and Ugandan SS4RI projects have been implementing the RED approach since 2011 and have adapted quality improvement tools and strategies to that have led to better outcomes in a number of regions and districts. All countries work with ministries of health to improve RI service delivery and with established community structures to support EPI service delivery through social mobilization, defaulter tracking, and enumeration of children. Nigeria implements the RED approach within a unique MOU model led by Bauchi and Sokoto state governments, Bill & Melinda Gates Foundation, Dangote Foundation, and USAID. JSI’s technical support through MCSP since 2015 in Bauchi and 2016 in Sokoto has contributed to improved service quality, immunization coverage, and stronger immunization systems.
At the end of the visit, the teams from Nigeria, Uganda, and Ethiopian had observed:
The visiting country teams also identified actions and take-home messages:
Overarching take-home messages agreed upon by the end of the visit include:
While the country exchange was just a week long, it triggered a long-term learning relationship between the three countries. The teams continue to communicate and plan to update each other on their progress every quarter. The peer-to-peer communication provides real-time focus on issues and accelerates adaptation and application of effective solutions. This model can be replicated to help countries achieve UHC and the SDGs.
Written by Folake Olayinka, Lisa Oot, and Asnakew Tsega