Learning for action across health systems

Sharing lessons learnt on strengthening health systems in low-income countries

Project team members

The Bill & Melinda Gates Foundation would like to improve the ability of low-income countries (LICs) to learn from, and act on, the successes and failures of other countries' health systems. This project will develop recommendations for the foundation on how they can target their investment to achieve this goal over the period 2018–2022. These recommendations will be made publicly available in various formats so that the output can be a global public good for other funding agencies, policymakers, and researchers to build on.


Countries with similar levels of income often have widely different health outcomes. What are some countries doing that others are not? If countries could learn from one another and take action based on those lessons, it may lead to healthier populations around the world. Yet, particularly in LICs, very little is known about the learning practices of health actors.

Our approach

We have focused on 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 policymakers sometimes want or not want to learn from one another’s experience?

There is a significant body of tacit/unwritten and explicit/written knowledge on these questions. We have used a combination of a literature review and institutional case studies (landscaping reviews), structured expert meetings, and a series of field interviews (with in-country policymakers) to combine an account of this tacit and explicit knowledge. The literature and institutional case study reviews described the nature of the current landscape that aims to facilitate learning across health systems. The expert meetings enabled us to draw on the tacit knowledge of a selection of international experts and people with extensive practical policy experience. The field interviews enabled us to go into depth in eight country health systems, talking to the people whose decisions have made these systems what they are today. Our final recommendations will be based on the answers to these three questions.


The final deliverable will be a strategy paper and an internal concept brief (ICB) on future investment in learning for action across health systems for LICs by the the foundation.

The strategy paper will provide suggested theories of change, roles, comparative advantage, and investment areas (including vehicles for investment) that the foundation may consider. It will outline anticipated challenges and suggestions for overcoming them, as well as what impact the suggested investments may have on the international policy sphere. The ICB will follow the Gates Foundation template, relaying the content of the strategic paper.

The recommendations will also be published in a variety of formats for wide dissemination (including targeted policy briefs, blogs, a social media presence, and articles for peer review). A side event has been coordinated at the Prince Mahidol Award Conference 2018 to gather further feedback and engagement.

If our recommendations stimulate investment in the ability of LICs to absorb and act on lessons from other countries, it could lead to significant knock-on improvements in health systems around the world. There is so much to learn from one another, it is just a matter of recognising this, and being able to do so.

Areas of expertise