Fostering learning health systems in low and middle-income countries

January 13th, 13.00 - 14.15 GMT
Prof Sophie Witter

Summary of the Planned Session

Learning is fundamental to health systems strengthening and the achievement of health goals. This participatory session will engage policymakers, civil society advocates, researchers and funders in structured conversation on experiences of learning health systems in LMICs, and shape a shared understanding of how to foster this critical health system function.

Session description

Learning – at individual, organizational and systemic levels – is essential to create lasting change, and systems that do not learn from (their own or others’) experiences tend to repeat their mistakes. However, health systems, especially in low and middle-income countries (LMICs), have often not fulfilled their learning potential at scale, and this impedes their effectiveness in achieving and sustaining improvements in population health. There are numerous experiences of learning having contributed to strengthening systems, or its absence contributing to failures. A supportive culture for learning is fundamental to health systems strengthening and the achievement of health goals, but this is not adequately addressed in conceptualisation and in practical understanding of how to support this vital function. Learning Health Systems (LHS) is a multifaceted subject, and existing conceptual as well as empirical knowledge on the topic is currently fragmented across different bodies of literature on health systems.
This session will be participatory drawing on the literature as well as on lived experiences from a range of actors in diverse settings to draw out lessons for extending the depth and quality of LHS, which are a key determinant of health system strength and therefore of delivering health and social justice goals.

Purpose and objectives

This participatory session seeks to advance thinking on LHS based on experiential and academic knowledge and to move towards a shared understanding of how to conceptualise and foster LHS in diverse LMIC settings.


  • To share insights gained from reviews of literature and experiences on LHS
  • To elicit diverse actors’ (policymaker, civil society, researcher, funder) experiences and lessons on LHS (successes, failures, lessons on supportive factors and overcoming challenges)
  • To engage the audience in a reflective and creative dialogue on LHS
  • To reach a collective understanding of how to foster this critical but neglected health system function in LMICs

Session contributors

Sophie Witter, UK, will make a pacesetting presentation drawing on papers developed by her and commissioned by the Alliance for Health Policy and Systems Research, in which she reviewed existing frameworks for and approaches to conceptualizing learning health systems and examined experiences of systems learning in LMIC health systems to draw out enablers and characteristics of LHS.

Walid Ammar, Lebanon, will reflect on his long-standing experiences as Director General in the Ministry of Public Health, promoting approaches for LHS in a conflict-affected country.

Walter Flores, Guatemala, will reflect on the significance of lived experiences of users of health services on learning health systems. Dr Flores is the Director of the Center for the Study of Equity and Governance in Health Systems, a civil society organization in Guatemala specializing in research, capacity building and advocacy around issues affecting indigenous and other marginalized populations

Helen Schneider, South Africa, will reflect on her experience of researching and advancing better governance for learning health systems at subnational and national levels. She is Professor and Chair in Health Systems Governance at the University of the Western Cape’s School of Public Health, an equity-oriented academic institution with extensive links to the South African health system.

Lola Adedokun, USA, will present reflections from her experiences as director of Doris Duke Charitable Foundation’s African Health Initiative advancing LHS at country and subnational levels in several Sub-Saharan African countries.

Kabir Sheikh, Switzerland will moderate the session and provide opening and closing remarks. Dr Sheikh coordinates the Learning Health Systems initiative at the WHO Alliance for HPSR and is one of the authors of the Alliance’s flagship report on LHS.

Session plan and flow

  • Introduction by moderator (Kabir Sheikh) (3 minutes).
  • Pacesetting presentation by Sophie Witter drawing on a review of approaches to conceptualizing LHS and experiences of learning health systems in LMIC (10 min).
  • Round table participants will be asked to reflect on a series of questions in turn, with a few minutes per response, to keep the session dynamic (15 minutes).
  • This will be followed by questions and comments from the floor (20 minutes).
  • This cycle of roundtable reflections and questions from the floor will be repeated (35 min).
  • Summary by the moderator (3 min).


Sophie Witter – What do we know about learning health systems in LMICs?

Professor Witter will present finding from a review of literature on LHS and key informant interviews with health policy and research experts. She will discuss how LHS are conceptualised, how well they are documented (and what gaps exist), and what can be learned from different case studies, focusing on characteristics and enablers, organised into eight domains. She concludes that health systems are knowledge producers but learning, from internal and external organisations, is not automatic. It needs to be valued and facilitated through supportive actions in these domains.

Walid Ammar - Learning Health Systems: Insights from Lebanon’s health sector experience

Dr Ammar will reflect on experiences of the Ministry of Public Health which has systematically engaged in the used of evidence for policymaking, leading to major gains in accessibility to quality care. A focus on “practice-based evidence” has capitalized on the wealth of information generated by daily health systems operations. Researchers and policy makers have worked closely to generate learning to improve health system practices. Practical examples discussed will include the generation and use of vital statistics, epidemiological surveillance and response networks, and performance-based private sector contracting.

Walter Flores – lived experiences of service users and their significance for learning health systems in Guatemala

Dr Flores will reflect on experiences of users of services who organized themselves to produce and analyse information about health services, which was presented to authorities and used to monitor the performance of those services. The evidence produced by users emphasises lived experiences while seeking care, and barriers to access that may go unnoticed by authorities. This evidence complements official information systems and has helped facilitate learning health systems at local, subnational and national levels.

Helen Schneider – governance for LHS in subnational health systems in South Africa

Based on her research at sub-national (provincial and district) level in various parts of South Africa, Professor Schneider will reflect on the theme of governing for learning health systems. She will examine emerging experiences, both with micro-level (typically plan-do-study-act cyles), and meso-level organisational practices (typically in health districts) that enable learning. Governance is understood broadly as the structures, processes and accountability mechanisms, both formal and informal, that enable collective action to achieve common goals.

Lola Adedokun – a funder’s perspective on building and sustaining multi-level learning platforms

Dr Adedokun will offer the perspective of an engaged funder and reflect on approaches to building and sustaining multi-level learning platforms coordinated and led by academic, practitioners and national health system leaders in sub-Saharan Africa (e.g. Ghana, Ethiopia, Mozambique, Rwanda, Zambia and Tanzania). She will discuss essential elements to building and reinforcing a culture of learning that include capacity building for research and clinical skills, leadership development and succession planning, financing, and documentation and diffusion of knowledge.

Back to HSR 2020

hsr 2020 sixth global symposium on health systems research