Learning for Universal Health Coverage: The role of communities of practice

23 January, 2020

Dear HIFA colleagues,

Here is an excellent article by Bruno Meessen and colleagues, with much potential learning for HIFA and other global health communities of practice:


CITATION: Meessen B, Akhnif EH, Kiendrébéogo JA, et al. Learning for Universal Health Coverage. BMJ Global Health 2019;4:e002059.



The journey to universal health coverage (UHC) is full of challenges, which to a great extent are specific to each country. ‘Learning for UHC’ is a central component of countries’ health system strengthening agendas. Our group has been engaged for a decade in facilitating collective learning for UHC through a range of modalities at global, regional and national levels. We present some of our experience and draw lessons for countries and international actors interested in strengthening national systemic learning capacities for UHC. The main lesson is that with appropriate collective intelligence processes, digital tools and facilitation capacities, countries and international agencies can mobilise the many actors with knowledge relevant to the design, implementation and evaluation of UHC policies. However, really building learning health systems will take more time and commitment. Each country will have to invest substantively in developing its specific learning systemic capacities, with an active programme of work addressing supportive leadership, organisational culture and knowledge management processes.


- Many low-income and middle-income countries are keen to build their systemic learning capacities to progress towards universal health coverage.

- Some lessons from transnational learning programmes have relevance for action at country level.

- Overall, granting a much more central role to ‘learning’ in health system strengthening efforts is crucial.

- In that process, we must acknowledge that the arena of relevant knowledge holders is much wider than the established circles of researchers and international experts alone. Opportunities for learning abound. Knowledge exists in many forms.

- A significant effort is needed to encourage health authorities and academia to embrace a vision to learning more anchored into practice. A cultural shift is also needed at the level of health administrations.


More contemporary views on learning have come to the fore. They present learning as a social process: we learn through our embeddedness in communities of peer practitioners. Of course, updates of knowledge and beliefs remain key, but action and behavioural changes get increasing attention...

A decade of activities in such learning practices has confirmed the relevance and importance of investing in ‘collective intelligence’, defined in Wikipedia (possibly, the paragon of the concept) as ‘shared or group intelligence that emerges from the collaboration, collective efforts, and competition of many individuals and appears in consensus decision making’. These activities have brought home a series of core lessons for advancing UHC.

The facilitation of CoPs has taught us the importance of organising our collective learning around learning agendas. By a ‘learning agenda’ we mean: a collective, reasoned, adaptive and sustained practice of identifying the questions that require a response and of implementing strategies to answer these questions (through analysis of routine data, consultation, deliberation, research, etc)...

‘Inscribing knowledge’ (eg, in reports, scientific papers, guidelines, blogposts) is crucial, but it cannot be the only strategy for the UHC agenda. We have to pay far more attention to the actual processes through which knowledge is shared, contextualised, enacted and embodied. For UHC, we will need evidence, repertoires of practices, but also a large supportive ‘crowds’ of experts and actors26—our experience with the CoPs was proof that many knowledge holders are eager to join and collaborate...

We have to relocate learning within the ‘practice arena’: our efforts must move from delivering UHC ‘knowledge products’ to strengthening systemic learning processes and capacities at country level.


Best wishes, Neil

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org