Background Study

Commissioned by the Bill & Melinda Gates Foundation, an 18-month study was conducted by Oxford Policy Management to better understand how low- and middle-income countries (LMICs) improve their health systems and health outcomes by learning from other countries’ experiences. The exercise would inform possible investment options that the Foundation, governments and other development partners could consider in order to facilitate better knowledge brokering and cross-country learning, particularly in Africa.

The problem

• Countries with similar levels of income often have widely different health outcomes. What are some countries doing that others are not?

The objectives

Improve the ability of low-income countries to learn from, and act on, the successes and failures of other countries’ health systems. This project aimed to develop recommendations on how investments can be targeted over the period 2018-2022. The three questions:

1. What can countries learn from one another’s experiences?
2. How can countries learn from one another’s experiences?
3. Why do policy-makers sometimes want or not want to learn from one another’s experience?

There is a significant body of unwritten and written knowledge on these questions. This project used a combination of a literature review and institutional case studies, structured expert meetings and a series of interviews to combine an account of this knowledge. The final recommendations are based on the answers to these three questions.

Key findings

• Five key knowledge brokerage activities for cross-country learning in health
  A brief description of knowledge brokerage, why it is needed, and five key activities that can help health systems learn from one another.
• Eight key messages about how lessons spread between health systems
  The idea that countries should learn from each other is clearly appealing. But if it is actually to reap benefits, we need to think more about how that learning process works beyond just the availability of information.
• What can be done to help low- and middle-income countries learn from others as they build and strengthen their health systems?
  High-level observations and technical recommendations. While Learning For Action Across Health Systems is clearly a global issue, these recommendations focus on sub-Saharan Africa.

Landscaping reviews

• Part 1: Review of comparative health systems literature
• Part 2: What types of institutions currently facilitate learning between countries about improving health systems?
• Part 3: Review of international health policy transfer literature