Workshop "Learning for UHC"

1. A. Belghiti Alaoui MD. MPH.
National School of Public Health, Rabat (Morocco)

2. Challenges of driving
national health system
CONSTRAINTS
• Too many challenges
– Triple Burden of Morbidity (Epidemiological
Transition)
– Threats of pandemics,
– Insufficient funding
– Shortage of health human resources,
– Action on the social determinants of health
– Numerical revolution …
• Too many commitments
– 9 health reform projects (including UHC),
– Too many laws to elaborate;
– Everything is a priority;
– Political Deadlines ...
• Vulnerability of the HS
– Bad press; Dissatisfaction of the population,
– Demotivation of HR
– Low ownership of reforms;
• SDG3: > 13 targets
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How to meet all these
challenges and
commitments ?
---
How do we know if we
are on track to
strengthen the health
system and improve
health?
Need to learn is
more important
than ever

3. SUCCESSFUL EXAMPLE: ESTABLISHMENT THE NATIONAL HEALTH
SECTOR STRATEGY THROUGHT A LEARNING PROCESS
• Learn from national past experiences
– Collect, review, synthesize and lessons learned
• situation analysis method
• strategic formulation method
• impact
• Learning from international experiences
– UK: Tradition of White books
– Québec (Can): Public Hearings
– Tunisia: Political Dialogue Forum (Arab Spring Context, WHA
Resolution)
• Learn from global health
– Reference to the WHO model of 6 building blocks (2007)
• To raise awareness:
– Reference to the new constitution (Analyze the dimensions of health
in the new constitution)
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4. • First national Consultation: Health Expectations
– Tools: radio hearings, press reviews, facebook page,
public hearings (June, 2012).
– Result: 185 expectations (report)
• First national White book on Health (June, 2013)
– 9 reform projects in perspective
• National forum of Political Dialogue: 2nd
National Conference on Health (July 2013)
– Bringing together all stakeholders (600 participants)
– Organized under the chairmanship of
the Primer Minister
– Royal Letter to Participants
– 23 recommendations (Report)
• National Health Strategy 2012-2016
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First result: Strategic documents

5. LESS SUCCESSFUL EXAMPLE: PROGRESS TO UHC
• Basic medical coverage law: 2002
• Coordinator : MOH
– 2006: implement just medical insurance for employees (AMO) (34% population)
– 2012 : implement health coverage for the poor (28% pop)
– but without change in direct expenditures of households Without significate change
in health care access
• Coordinator: Head of government (2012)
– Public Hospital upgrade program
– Medical insurance law for self and informal employed (2017)
– But shortage of HR and lack of funding
• Royal intervention (2018)
– Restructuring oh health insurance funds
– Military service and strengthening of nursing education
Reform take too much time and a little change in the daily reality
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6. Commitment of 5 dynamics
to strengthening the health system
5. Leadership &
Governance
Performance
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7. Knowledge management dynamic
It is possible to initiate promising actions despite the constraints
• Collaborative project with ITM
• Framework to Build the capacity of the Moroccan HS through
knowledge and learning management
• GAA project (Action Learning Groups)
• Audit on Knowledge Management
• Collective learning for UHC (Akhnif & al., 2018)
• Establishment of a specific diploma training for central and regional
decision-makers including internships abroad (CARPeSS)
 Inventory of the capital of capacity building tools used by the
MOH of the then independence (1956) (WHO support)
 National Observatory of Health (in progress with EU support)
 Generating a new knowledge about challenges…
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8. Role of leadership
• Create a favorable environment:
– Multiply spaces for debate and reflection and value
them
– To give the example: Reserve time for reflection
“The time for reflection is not a waste of time, it is an
investment in the capacities”
• Orientate learning towards the right targets
(usefulness and pragmatism);
• Secure the link with action (problem solving,
reforms)
• Mobilization of partnership and support
• Semi-annual assessments and annual reviews
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9. Constraints
 The time required to take advantage of learning is relatively long
 hence the relevance of learning in the context of reforms (UHC)
because their duration makes possible to use learning
outcomes for the future.
 How to institutionalize learning dynamics?
 Creating a KM function in decision-maker process,
 Creating an independent KM entity or a community of
collective intelligence, …
 Absence of evidence of the impact of knowledge management
and learning on HS performance and the sustainability of reforms
 Absence of links between the management of learning in SHS
and the management of learning in the field of healthcare and
the clinic
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10. Findings
• Faced with the increasing complexity of health systems in
resource constraint contexts, policymakers tend to target their
interventions and seek quick wins outweighs the will to
strengthen health systems;
• Providing countries with systemic learning tools is a practical
aspect of HSS that meets certain limitations in the use of WHO
building blocks.
• Decision-making is an unregulated political process witch take
advantage of a body of knowledge and learning in a specific
context and a specific expectation
• the Moroccan experience shows that the commitment of the
leadership is a condition for the mobilization around the dynamics
of learning and for its perpetuation.
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11. Recommandations
• In the context of promoting UHC and SHS, there is an urgent need
to invest in systemic learning and creating a body of knowledge
about what works and what doesn’t work in the HS, so that each
country is better armed to adopt and adapt lessons learned from
their own experience and experiences from other countries.
• Because of its duration and the political commitment it requires,
the field of reforms is the most opportune to take advantage of the
dynamics of knowledge management and learning
• Find mechanisms for involving the population and civil society in
learning dynamics: as a reason of being for the HS and as a source
of knowledge for HSS;
• Apprenticeships should also be designed as a means of motivating
health human resources and performance incentives.
• The concern for learning must precede the concern of performing
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12. A. Belghiti Alaoui 12
A map and a
compass
rather than
a card game
Thank’s for your kind attention