Reflections on Year 1 and Looking Toward Year 2- Allison Kelley ACS Project Director

On behalf of the African Collaborative for Health Financing Solutions (ACS) project team, I would like to wish you a very Happy New Year. May 2019 bring peace, lots of learning, and much needed expanded health coverage to everyone.

As we move into this new year, our second of implementation, we want to share some 2018 reflections, in terms of what ACS set out to do, where we are finding traction and highlight challenges we encountered. We also hope to interest you in ACS plans for the upcoming year, which should bring us many opportunities to collaborate.

As you all know, many things are happening in the UHC space, and so a main objective of ACS in 2018 was to define the value-add ACS could bring. If our three pillars of collaboration, learning, and accountability all resonated at the country level during our consultation phase, perhaps where we have found the most glaring gap to try to narrow is around collaboration – or more precisely –the inclusion of vital voices and a range of stakeholders in the whole UHC space. At country level, we continue to find that genuine, sustained engagement in the UHC dialogue across stakeholders (and sectors) still needs building to make operational progress and strengthen accountability for sustainable health financing.

2018 marked a transition for ACS, away from a very intensive (and instructive) consultation phase, read our country reports and synthesis paper or, towards defining activities that reflected common priorities we heard. We began concentrated engagement in three countries (Uganda, Namibia, and Botswana), each with specific contexts and needs. Not surprisingly, the start-up phase is complex and has taken longer than anticipated. Nevertheless, because we invested the time up front to methodically listen to a broad range of stakeholders and document the challenges and priorities countries are facing to advance their UHC goals, ACS has a robust and grounded base on which we are building a demand-driven program of support. We will continue to listen and learn as we move forward and remain flexible to adapt as needed. We are excited to add Benin to our growing community of ACS-supported countries in 2019 and continue to dialogue with the USAID Africa Bureau and Missions to assess further opportunities.

We are more convinced than ever that the way to expand effective health coverage requires country actors across profiles to roll up their sleeves and lead the way through the messy political economy issues that are part of the road to UHC. It can take longer and is harder to fit neatly into traditional definitions of activities and support, but we firmly believe it has more staying power and better odds to advance toward UHC. This past year we developed, and have been testing (in Uganda), a methodology to document UHC processes so that countries can better understand the dynamics, necessary stakeholders, and key inflection points in a country’s progress towards UHC. We will use findings to learn and iterate on our own approaches to supporting progress at country level. We hope that 2019 will teach us all a lot more about what this looks like in another three countries and allow us to share what we learn more broadly.

Regarding the challenges we face, it has become clearer to us that the concept of being demand-driven feels rather more idealistic than realistic for now.  When you get right down to it, it’s behavior change that flows from listening a lot, and building relationships and trust with country counterparts, and with funders who are often times accustomed to operating differently. It also requires flexibility and adaptability as we test and learn about support modalities. One learning goal for ACS in 2019 will be to bring more definition, substance, and evidence to what “assessing country demand” and “demand-driven” really mean, who are the “holders” of demand, and what are practical ways to systematically and continuously built it in to guide, measure and evaluate support. In the future, and based on ACS experience to date, we will engage in this very intentionally in a structured, thorough manner at the beginning of additional engagements at country level before defining ACS support modalities, and then in a continuous fashion throughout that engagement, adjusting where needed.

2019 will see the launch of our first regional collaborative and learning agenda on Accountability for Sustainable Financing for UHC, a priority topic identified during the consultation phase and further refined within the three country contexts in which ACS is currently providing support. For Namibia and Botswana, this is paramount, as both countries near HIV epidemic control, and must find the means and mechanisms to ensure those gains are sustained while advancing broader UHC goals. As Benin launches an ambitious pilot of a health insurance scheme meant to feed into its comprehensive UHC approach, building in mechanisms for participation and dialogue and a case for adequate and sustainable financing is critical. Stay tuned as we reach out to convene a core group to co-design and guide this first regional collaborative around accountability.

In 2018 ACS joined its support to an emerging but dynamic group of African experts looking to build a community of coaches and mentors to provide the facilitation, technical support and capacity building countries need to navigate the process of advancing UHC successfully. In 2019, this “Force,” as they call themselves, plans to develop core skills-building modules around process facilitation and link to key health financing training fora to which their members will have access. ACS is supporting module development and will also be seeking to collaborate with Force experts in “ACS countries” to bring regional expertise to coach and mentor those important skill sets at country-level.

We are happy to have added two new Africa-based partners to ACS at the end of 2018, Amref and Synergos/Namibia. We are committed to deepening and expanding partnerships with regional institutions in 2019, as well as to documenting our experience with building effective, productive, and mutually beneficial partnerships to bolster UHC across the continent.

As a learning project, we are committed to sharing our results and experience continuously. Our growing team will take time to evaluate our approach in an annual Pause and Learn where we take an in-depth, critical look at one or two key project activities or approaches to take stock, iterate, and make adjustments where warranted. One topic this year is around our research and learning agenda, so more information to come soon on how and when we will share ACS learnings and results. We plan to communicate what we are learning in multiple ways, from more scholarly articles to blogs, and webinars. We count on your continued collaboration and interest throughout 2019.

Allison Gamble Kelley
ACS Project Director