In November, twelve members of the ThinkWell team participated in person and remotely in the Seventh Global Symposium on Health Systems Research (HSR2022). The symposium provided a forum for experts to discuss strategies and practices that will help combat global health challenges, a marketplace to showcase the latest relevant research, and a platform to connect with fellow practitioners and researchers face-to-face for the first time since the pandemic.

The theme of this year’s symposium was “Health Systems Performance in the Political Agenda: Sharing Lessons for Current and Future Global Challenges.”

Our Strengthening Strategic Purchasing for Primary Health Care (SP4PHC) team led and participated in sessions that explored a variety of health financing and purchasing challenges in low- and middle-income countries (LMICs) and showed how the team is supporting countries to address these challenges in pursuit of universal health coverage. The ThinkWell team was actively involved in wider discussions concerning health systems and policy issues, offered their unique insights from health financing practices in several LMICs, and learned further how peers are addressing key challenges to areas like human resources, information flow, and supply management.

In addition to an all-day session cohosted by our team and several of our partners—Results for Development (R4D), the Strategic Purchasing Africa Resource Center (SPARC), the World Health Organization (WHO), and KEMRI Wellcome Trust—members of our Indonesia team also contributed to a two-day satellite session led by the Technical Working Group on Private Sector in Health (PSIH). Our SP4PHC team led a panel debate around telemedicine integration and an oral presentation around how our Philippines team is untangling the complex funding flows for family planning services. Members of our Economics of Last Mile Delivery Hub team also contributed to the UNICEF satellite session on financing the delivery of vaccines. The team also collaborated on a satellite session on ends-driven health systems reform, and you can access recordings of all four parts of that session by clicking the links below.

In addition to these extended sessions, several of our team members shared poster presentations on topics ranging from an analysis of Kenya’s free maternity program performance to the nation’s public financial management issues to adjusted government health financing during COVID-19 in the Philippines.

Find details for satellite sessions, oral presentations, and posters below.

What keeps us from separating ends and means in health system reform? (satellite session)

Agnes Munyua (R4D), Cheryl Cashin (R4D), Edwine Barasa (KEMRI Wellcome Trust Research Programme), Gemini Mtei (Abt Associates), Grace Kabaniha (WHO), Hélène Barroy, Joe Kutzin (WHO), Nathaniel Otoo, Nirmala Ravishankar (ThinkWell), Octavio Gomez-Dantés (National Institute of Public Health), Rozita Halina Tun Hussein (Ministry of Health Malaysia), Scott Greer (University of Michigan), Susan Sparkes (WHO), Wangari Ng’ang’a

Objectives of reform are often conflated with the instruments for achieving them. Ends-driven reform remains a hallmark of health systems research, yet the means continue to motivate change in many settings. This session dug into what “ends-driven” represents in practice, illustrated with specific examples of challenges and progress. You can view a 30-minute highlight reel of the session here and find links to recordings of each part of the session below.

Part 1 | Part 2 | Part 3 | Part 4

Primary care in an increasingly virtual world: Integrating telemedicine into LMIC health systems (panel discussion)

Anooj Pattnaik (ThinkWell), Alfonsius Pratama Timboel (Halodoc), Pura Angela Co (ThinkWell), Regis Hitimana (Rwanda Social Security Board), Shalmali Radha Karnad (HealthX Africa), Lisa Ramon (Bill & Melinda Gates Foundation)

As populations became hesitant to visit health facilities during COVID-19, telemedicine saw an uptick in demand and use. While telemedicine has been growing largely in private marketplaces in low- and middle-income countries, this change because of COVID-19 has prompted governments to try to find better ways to purchase telemedicine services and better integrate them into the health system. This session shared the perspectives from the government, purchaser, telemedicine provider, and external funder sides.

Recordings from this session will be made available shortly.

Contribution of the Private Sector in Health Systems Resilience and Reform: Stronger together beyond COVID-19 (oral presentation)

Edward Sutanto (ThinkWell), Anooj Pattnaik (ThinkWell), Nadhila Adani (ThinkWell), Nirwan Maulana (ThinkWell), Halimah Mardani (ThinkWell), Anita Putri (ThinkWell), Trihono (ThinkWell)

In response to COVID-19, many country governments and private providers have established innovative approaches for meeting pressing health needs and capacity gaps. This has involved new kinds of engagement between government and a variety of private non-state organizations. This interactive session explored examples from different countries to identify lessons from this experience and challenges to be addressed in future strategies for strengthening mixed health systems. ThinkWell presented on “Bridging the Gap: How private midwives have filled family planning gaps in Indonesia since the introduction of national health insurance.”

Health system resourcing: Whose priorities? (oral presentation)

Caroline Whidden (Department of Disease Control, LSHTM), Claudia Vélez (Universidad de Antioquia), Diu Nguyen (Abt Associates), Edson Serván-Mori (Instituto Nacional de Salud Pública, México), Geminn Louis Apostol (ThinkWell), Luciana Souza d’Ávila (Escola de Saúde Pública do Estado de Minas Gerais)

During this session, ThinkWell showed a mapping of the complex and multiple financing roles and expenditure flows for family planning in the Philippines.

Implementing COVID-19 Vaccine Costing Studies: Methodological challenges (oral presentation)

Flavia Moi (ThinkWell)

To address the evidence gap on the cost of delivering COVID-19 vaccines, the immunization economics team implemented bottom-up costing studies in six countries (Mozambique, Cote d’Ivoire, and DRC in Africa and Bangladesh, Vietnam and the Philippines in Asia). At UNICEF’s HSR satellite session on the financing and delivery of vaccines, the team presented on the methodological challenges encountered while conducting these studies.

Mapping the complex and multiple financing roles and expenditure flows for family planning in the Philippines: A nationwide study from 2018-2019 (oral presentation)

Geminn Louis Apostol (ThinkWell)

There are multiple purchasers of family planning (FP) services in the Philippines’ fragmented and devolved health sector with no single, strategic purchaser to drive down healthcare prices and demand quality and efficiency. During this session, the various roles and flows were broken down and presented alongside potential reconfiguration to optimize financing for FP services.

Running Ahead: Scaling Up Primary Health Care Systems in Antique and Guimaras During the COVID 19 Pandemic (poster)

Philip Ian Padilla, Marilyn Sumayo, Joseph Arbizo, Maugri Grace Kristi Laluma, Mary Camille Samson, and Helena Marie Alvior (ThinkWell)

Implementation of the Linda Mama Free Maternity Program in Kenya: Findings from Isiolo County (poster)

Janet Keru (ThinkWell), Shano Guyo, Boniface Mbuthia (ThinkWell), Anne Musuva (ThinkWell), and Ileana Vîlcu (ThinkWell)

Are counties using data to efficiently manage human resources for health? Findings from Makueni County in Kenya (poster)

Felix Murira (ThinkWell), Janet Keru (ThinkWell), Ileana Vîlcu (ThinkWell), Anne Musuva (ThinkWell), Boniface Mbuthia (ThinkWell), and Nirmala Ravishankar (ThinkWell)

Examining the application of public finance management in the health sector within the context of devolution in Kenya (poster)

Boniface Mbuthia (ThinkWell), Ileana Vîlcu (ThinkWell), Anne Musuva (ThinkWell), and Felix Murira (ThinkWell)

Challenges from the Philippines’ Mandanas Garcia ruling (poster)

Rafael Deo Estanislao (ThinkWell)

Policy gaps in managing solid and health care waste during the COVID-19 pandemic: Perspectives from the Philippines (poster)

Geminn Louis Apostol (ThinkWell), Angelina Gabrielle Acolola, Michelle Alexandra Edillon, and Sary Valenzuela

How does integration affect the cost of immunization campaigns? Findings from Nigeria and Sierra Leone (poster)

Christina Banks (ThinkWell), Flavia Moi (ThinkWell), Kyle Borces (ThinkWell), Laura Boonstoppel (ThinkWell), Obinna Onwujekwe (University of Nigeria), Divine Ndubuisi Obodoechi (University of Nigeria), Florence Sibeudu (University of Nigeria), Michael Matthew Amara (MOHS, Sierra Leone), Faisal Shuaib (NPHCDA, Nigeria), Maimuna Hamisu (NPHCDA, Nigeria), Bassey Okposen (NPHCDA, Nigeria), Binta Ismail (NPHCDA, Nigeria), Logan Brenzel (Bill & Melinda Gates Foundation)

Along with R4D, SPARC, World Health Organization, and the KEMRI Wellcome Trust Programme, ThinkWell will be hosting a two-day hybrid satellite session. One session will be held on October 31st from 8 am-4 pm (GMT –5), while another will take place on November 1st from 8 am-4 pm (GMT-5). Objectives of reform are often conflated with the instruments for achieving them. By placing the focus on instruments (i.e., the means), policies can move forward that are actually misaligned, or even work against, the objectives (i.e., ends) reforms seek to achieve. The first session will deep-dive into what “ends-driven” means in practice and how it will be done through specific examples. 

In the second session, we will deep dive into contributory social health insurance (SHI) as a means-driven reform, and how policies can be designed better to focus on the “end” of universal health coverage (UHC). We will share the latest research on contributory SHI in Africa, explore what is driving this policy direction, and what we know about whether, and how, UHC objectives can be met based on the evidence and experience from low- and middle-income countries in Latin America, Asia and Africa. This session will provide a peer-to-peer learning and exchange of ideas, providing advice and lessons for countries considering setting up contributory SHI systems from countries with established SHI and how these SHI systems can be improved to meet country objectives for UHC.  

Speakers at this event will include: 

• Cheryl Cashin, Managing Director, Results for Development 
• Joe Kutzin, Head of the Health Financing Unit, World Health Organization 
• Nirmala Ravishankar, Senior Fellow, ThinkWell 
• Edwine Barasa, Director, Nairobi Programme,, KEMRI Wellcome Trust Programme 
• Susan Sparkes, Health Financing Specialist, World Health Organization 
• Agnes Gatome-Munyua, Associate Director, Results for Development 

 Please register here.

“There is no universal health without sexual and reproductive health” 

The World Health Organization (WHO) and the United Nations Population Fund are launching a Sexual and Reproductive Health and Universal Health Coverage Learning by Sharing Portal (SRH-UHC-LSP). The SRH-UHC LSP, launching on July 19, is a global resource that will feature national-level stories with a focus on sexual and reproductive health (SRH) and its role in universal health coverage. 

The portal will feature, a “Bottleneck analysis for the last-mile distribution of contraceptives in Zambia,” a  story by Joy Walubita. Joy is ThinkWell’s Health and Governance Team Lead in Zambia and has worked for over 20 years to strengthen the Ministry of Health’s systems and rectify risks concerning financial and procurement management systems.  

Increasing domestic funding for SRH is essential to achieving universal health coverage. Joy’s contribution to the LSP advocates for access to quality and comprehensive SRH in universal health care.  

The LSP and WHO’s Handbook on Sexual and Reproductive Health-UHC Integration—released earlier this month—are among the tools WHO and partners will use to incorporate SRH into national health plans, budgets, and programming. 

Mark your calendars for July 19 to read Joy’s contribution to the LSP launch and learn more about the portal here.  

Cervical cancer is one of the most preventable types of cancer. Despite this fact, the lack of access to resources can make it deadly. 90% of deaths attributed to cervical cancer are a result of inaccessibility to necessary resources, treatment, and screening.  

Francophone Africa is one of many areas that struggles with this issue and women’s cancers in general. Currently, the necessary resources for women’s cancers screening and management are slim. Even when services are available, they are not accessible or affordable to those that require them. 

In an attempt to close this funding gap, the Union for International Cancer Control has partnered with ThinkWell to consider and research how an integration approach can work to improve women’s cancers control efforts. 

Integration is an approach that involves assessing the already-existing health programs and considering where and how women’s cancers care can be incorporated into them. To achieve this, Marie-Jeanne Offosse, the Country Director of ThinkWell Burkina Faso, presented a guide to integration during a women’s cancers workshop for UICC.

To begin, it is important to review the financing ecosystem of the community. To do this, we must consider how cancer care is currently funded, and what the barriers to that care are for those who need it. In Francophone Africa, these barriers include limited services and delivery points, little comprehensive care, and a lack of necessary staff and equipment. 

To improve the outcome of women’s cancers care, we can implement an integration approach that promotes partnership with existing programs. To do this properly, we must understand what country-specific issues need to be addressed in order to achieve integration. From there, we can harness local opportunities by assessing current women’s health programs and determining which ones would be able to absorb women’s cancers care as a priority. To decide which program, or programs, are best suited for integration, we can use a grading system that evaluates their existing priorities and goals, financial sustainability, and potential for partnership. 

Finally, we must settle on the most appropriate integration approach. Considering all the above information, we can articulate our approach through targeting, timing, and telling. For example, we can determine who our stakeholders for policy recommendations are. This might include ministers, executives, and civil society leaders. Then, we pay attention to timing: when are the best windows for planning and budgeting to best implement this integration approach? From there, we must pinpoint our key messages and the value integration offers to both our goals and our audience’s objectives. 

By implementing an integration approach through these methods, we can work toward making women’s cancers care more available, accessible, and affordable for those who need it. This will ultimately allow for less women’s  cancer cases leading to death. Providing access to screening will permit women and medical professionals to become aware of the cancer as soon as possible, and by having better access to treatment, they should be able to recover. With these goals in mind as this approach is implemented, women in Francophone Africa will have the resources they need to battle this preventable cancer. 

Immunization campaigns are a vital delivery strategy to improve coverage and decrease morbidity and mortality from vaccine-preventable diseases. Campaigns are used frequently to administer a variety of lifesaving vaccines such as measles, cholera, yellow fever, and Covid-19. Immunization campaigns require significant resources over a short period of time. Inadequate funding can decrease a campaign’s effectiveness, and a low-impact campaign may be a considerable waste of resources. 

It is crucial that the costs of different immunization campaigns are accurately estimated to inform planning, budgeting, and resource mobilization. Although various guidance documents cover the costing of health interventions and routine immunization programs specifically, none discuss the specifics of costing immunization campaigns.  

The How to Cost an Immunization Campaign guide released as part of the ICAN project in 2021 offers methodological advice for field researchers, country practitioners, and academics worldwide on costing an immunization campaign. Learnings from campaign costing studies in India, Nigeria, and Sierra Leone were used to inform the guidance. This guide complements the literature on costing studies with specific methodological considerations for immunization campaigns, clear instructions fitting potential scenarios, and concrete examples. It is intended to improve the standardization of campaign costing processes and reporting, enhance the availability and comparability of evidence, and improve its use by country and global stakeholders.  

The guide is also accompanied by practical tips for costing studies, information on the differences between routine immunization and campaign costing, FAQs on campaign costing, data collection tools at facility, district, state, and national levels plus user manual, and practical examples on how to annualize capital costs and calculate unit costs in Excel, and run a calibration exercise in R. 

You can find out more about ThinkWell’s work on campaign costing here.