Katherine Jennings & Claire Gapare
The World Health Organization recently released a strategy on how to engage the private
sector in mixed health systems. It focuses in on six governance behaviors needed to drive the public and private sector together to address UHC, and, more recently, the COVID-19 crisis. When the pandemic hit, the importance of effective integration of the private health care delivery sector became increasingly clear.
Recognizing the importance of in-country, practical implementation of this new strategy we set out an objective to engage in country led, country driven learning about private sector engagement in the COVID-19 response. WHO and IHI joined forces with the Joint Learning Network to facilitate dialogue, learning and knowledge products with participants. We will now take you through the co-creation process, outlining the six main steps we went through, virtual engagement tools we used, and key lessons learned.
1) Gain understanding of participant experience in the topic
We hosted a scoping session where over 20 countries were represented from a variety of organizations, including Ministries of Health, private sector, national insurance, and non-governmental organizations. When asked about the biggest challenges to engaging the private sector in COVID-19 responses, themes of corruption (in both private & public sectors), lack of trust, and negative perception of the private sector emerged. Lack of data sharing and financing issues also surfaced. Moving forward, participants indicated that they were interested in exploring how to initiate/sustain public-private dialogue, include private sector in data/reporting systems, ensure representation of private sector in response conversations, and contract the private sector for COVID-19 purposes. Collectively, the participants chose public-private dialogue as a preferred workstream of focus.
How?
Use tools to gather information on the baseline experience (challenges, successes) in countries to deepen your understanding of how to support them.
Strategy
We asked the participants to describe their country’s experience with private sector engagement during COVID-19. We presented options for in-depth sessions topics (public-private dialogue, contracting, or financial sustainability) and asked them to prioritize these based on their country’s needs.
Tools
We used Mentimeter, a website that allows participants to provide real-time responses to multiple choice or open-ended questions, to gather input from over 50 participants.
Key Takeaways
Mentimeter is useful for gathering input from a large number of participants. To ensure that participants have enough time to answer and minimize the awkwardness of the silence, it helped to play soft instrumental music.
2) Provide expertise and build participant knowledge on the topic
Thant used the example of Myanmar’s COVID-19 PPD sprint experience to illustrate key steps. When COVID-19 hit Myanmar, the private sector provided financial support and repurposed health facilities. Despite good intentions, these initiatives were fragmented, resulting in uncoordinated donations. The existing national PPD was refocused on the pandemic response, and PPD partners worked to nurture their working relationships. Through this experience, learnings emerged:
Collaboration between the sectors requires time investment to build understanding and form working relationships.
A neutral mediator can catalyze joint-decision making.
An organized structure with trained staff & resources is required to serve as the “backbone” of the PPD process.
PPD partners should be held accountable through data since it is objective and produces evidence to “depoliticize” the discussions during the PPD process.
How?
Deliver expert knowledge on the topic of interest, have a participant deliver practical knowledge, and give the participants the chance to learn the new material through engaging exercises.
Strategy
Barbara O’Hanlon, an expert in private sector engagement delivered a presentation on PPD key steps and best practices, and Thant Zin provided in-country experience with working with stakeholders in the healthcare sector to facilitate dialogue in Myanmar during COVID-19.
Tools
We facilitated an exercise where participants were asked to use Google Sheets to outline their country’s experience with the key steps and best practices that Barbara O’Hanlon outlined.
Key Takeaways
It is important to have contingency plans with regards to unexpected variation in attendance rates. In relation to this, ensure adequate promotion of your event by sending reminder emails and distributing an agenda.
3) Gather individual country perspective
Through conversations with representatives from Ghana, Kenya, Nigeria and Malaysia we discerned that the public-private dialogue context in each of the countries fell into two broad categories.
There is an approach and framework on how to engage the private sector, but the challenge is moving to a practical implementation plan. This is the case in Kenya, for example, where a public-private partnership cooperation strategy exists, but there are challenges in operationalization and implementation.
The public and private sector have been working together in an ad-hoc fashion but there is no formal structure or process to promote sustainable dialogue for COVID-19 or long term UHC. Nigeria falls into this category, whereby COVID provided the right platform to mobilize private sector resources, but coordination between the sectors was sporadic and unorganized.
How?
Connect with country groups or individual participants to build trust, encourage participation, and gain a deeper understanding of their country’s context.
Strategy
We grouped participants by country and scheduled meetings with the four largest groups (Ghana, Kenya, Nigeria and Malaysia). We asked them to describe the stage their country is in the public-private dialogue process, and the challenges they were facing.
Tools
We conducted virtual group interviews using Zoom.
Key Takeaways
Building relationships with your participants, and gaining a deeper understanding of their experiences is invaluable for informing and shaping co-creation sessions.
4) Decide on key outcome
When we asked participants to choose between a pitch deck to get resources from donors or government to initiate PPD, a template deck for training colleagues on PPD, a primer on PPD, or a template/ checklist to support steps within PPD. Originally a pitch deck was the favourable knowledge product but after hearing the perspective of individual participants, we discerned that countries were stuck at specific stages of the PPD process, and together decided that a toolkit to diagnose challenges and identify solutions would be best.
How?
Put the decision into the hands of the participants by providing them with options and asking them to indicate which would be the most practical for them.
Strategy
We committed to the co-creation of a knowledge product at the end of the process and wanted it to be as practical as possible for the participants, so we asked them to decide.
Tools
We distributed a survey through Survey monkey, where we outlined 4-5 potential knowledge products that could come out of the PPD co-creation process.
Key Takeaways
This step should be done after delivering expert knowledge on the topic and hearing individual country perspective. We asked participants to decide before step 2 and because not everyone was aligned on the topic of PPD, our knowledge product decision ended up changing.
5) Co-create the knowledge product
We divided participants into the two key categories of PPD outlined in Step 3 and guided them through a series of questions regarding challenges and solutions. The main challenges identified were lack of coordination that leads to duplication of effort, lack of accountability, and unspecified areas of potential support from the private sector. During crisis situations this generates impromptu support and resource allocation that does not necessarily align with the needs of the population. Participants then identified solutions to overcome these challenges. Countries can conduct needs and landscape assessment to identify gaps and areas of potential support from the private sector, include private sector representatives in policy design, and incorporate perspectives from managers at local levels in the national PPD initiative to ensure alignment with the needs of the population.
How?
Guide participants through specific, thought provoking questions, giving them space to provide input.
Strategy
We asked representatives from Kenya and Nigeria to present their country’s experience with public-private dialogue during COVID-19. We divided participants into breakout groups where they discussed specific challenges their countries are experiencing along the PPD process and identified potential solutions.
Tools
We sent participants into two Zoom breakout rooms and used Miro, a virtual whiteboard program, was used to guide participants through questions.
Key Takeaways
Miro allows for participants to speak out loud or in the Zoom chat, and to virtually follow along with other participant inputs. If participants are not using the board themselves, it is necessary to have a facilitator and a scribe.
6) Synthesis of information gathered and dissemination
Following the co-creation session, we synthesized all participant input into a visual document for dissemination. We will follow up with participants regarding the practicality of the document, how they have used it in their country context, and whether we can update it to reflect their feedback.
We found the use of co-creation in this process to be extremely enriching, and we and hope to use our learnings in our future development of knowledge products.
How?
Synthesize the information gathered from the discussion and disseminate the finished product back to the participants for feedback.
Strategy
We used the discussion points documented in the sticky notes in Miro to incorporate them into a PPD toolkit document. We held drop-in sessions with Barbara O’Hanlon, where participants were invited to ask her questions regarding their PPD processes.
Tools
We used Adobe Illustrator and Adobe InDesign to design the final toolkit document and the Noun Project to incorporate icons.
Key Takeaways
To maintain momentum, disseminate the final product back to participants as soon as possible while still producing a quality document. Make the product as visual as possible. Include the names of the participants on the document; they did co-develop it, after all!