3.4 Self-reliance
Self-reliance is an underpinning that can support and facilitate health systems to be able to set up and maintain processes for learning. Health systems with their own in-built ability to learn are able to 1) set their own priorities, 2) define the appropriate frameworks for action, and 3) optimize their use of existing resources. These health systems are less dependent on external actors and knowledge and intelligence. These health systems are capable of and credited with triple loop learning – when an organization or system questions existing learning frameworks and methods in order to transform them.
Let us look at an example of the self-reliant learning in Lebanon
The Ministry of Public Health (MoPH) in Lebanon had little authority after the country’s post-civil war chaos in the 1990s. In the following decade, the MoPH worked to transform a fragmented health system info a high-performing outlier in the region.
The public purchase of inpatient care for uninsured citizens was one of the challenges they faced. Without many checks and balances on private provider’ billing practices, costs skyrocketed.
The MoPH set up a Performance Contracting Team composed of three committees. The team launched research and analytical work looking at utilization patterns to understand the price structure of various inpatient-related charges. Almost immediately, they were able to negotiate a 13% rebate and better justification for spend. Then, computerization and pre-admission authorization and discharge data gave the MoPH team further opportunities to learn about the costs and billing practice, and determine ways to simplify processes save time and money, and improve patient care.
Once the team had tackled this complex issue, they went on later to also look at discharges and outcomes of patients. Further computerization also streamlined this process, and the team generated a wealth of information and a strong reputation as an organization capable of data-driven regulation. Finally, the team was also able to collaborate with an external technical assistance team and then take over the process internally to shift their accreditation process towards being outcome oriented. Initial funding to support the work came from the MoPH, but then private hospitals provided funding after seeing the benefits first-hand.