A five-step methodology for South-South Learning Exchanges to scale up family planning services to achieve Sustainable Development Goals and universal health coverage

Summary box

The WHO has curated a detailed guide for intercountry South-South Learning Exchange (SSLE). This guide outlines a five-step methodology for planning, conducting and evaluating SSLEs. Key principles for an effective SSLE include:

• Learning objectives should be identified in/by countries validated by the wider community in the country and not imposed by an external partner.

• Partnership with an in-country implementing partner could support the implementation of the knowledge gained.

• A systematic, well-structured approach with in-built mechanisms to track progress, document experiences and assess the implementation of the learnings will support the scaling up of family planning services and promote sexual and reproductive health programmes, contributing to achieving the Sustainable Development Goals and universal health coverage.

Introduction

Among 1.64 billion women of reproductive age (15–49 years) living in low- and middle-income countries (LMICs), 923 million wish to avoid pregnancy, yet 24% face an unmet need for family planning (FP), endangering their health and well-being and impacting their families.¹ 49% of pregnancies in LMICs—equivalent to 111 million annually—are unintended.² Addressing this unmet need and providing care to all women at the standards recommended by the WHO could reduce unintended pregnancies by 68%, unsafe abortions by 72% and maternal deaths by 62%, as advised by the Guttmacher Institute.¹

Ensuring universal access to sexual and reproductive health (SRH) care services, including FP, information and education, and the integration of SRH services into national strategies and programmes, in line with Sustainable Development Goals (SDGs) targets 3.7 and 5.6, is outlined in WHO’s Fourteenth General Programme of Work 2025–2028.³

To address these challenges, improve access to quality, rights-based FP services and accelerate the scale-up of high-impact FP practices, the WHO launched the FP Accelerator Project in 2019 to address unmet FP needs using four main approaches.⁴ One of the approaches is to facilitate South-South Learning Exchange (SSLE) between countries. Defined by WHO as ‘an interactive process where stakeholder teams exchange knowledge and experiences to help one or both teams work towards change’. As a form of South-South Cooperation (SSC), SSLE is an important channel for capacity building through shared learning and equitable partnerships. UN agencies, including WHO and other international organisations, have recognised SSC as an effective form of development cooperation to achieve the SDGs.^{5 6}

SSLE differs from other forms of international cooperation. For example, triangular cooperation involves partnerships between two or more developing countries that are supported by a developed country or multilateral organisation to implement development programmes and projects.⁷ Technical assistance, by contrast, typically involves the provision of external expertise to strengthen the design, quality or efficiency of specific programmes, research, services, products or systems.⁸ While these approaches are complementary, SSLEs focus on learning between countries with common challenges and context-specific problem-solving.

Previous studies highlight the potential of SSLE in generating new ideas and knowledge about approaches that work, inspiring leaders to implement reforms, avoiding pitfalls, exchanging practical solutions, fostering collaboration and building the capacity of participants to advocate for the larger change process or the best practice. Use of SSLE has been reported across several domains of health; however, many of these initiatives were small-scale or nested in larger cooperation programmes or lacked documentation.⁹ The approaches employed were not standardised, suggesting the need for a more structured and systematic methodology.¹⁰ Recognising these limitations, WHO and the United Nations Population Fund have developed comprehensive guidance, ‘A step-by-step guide to SSLE’. This standardised, five-step methodology for conducting SSLE,¹¹ with in-built monitoring, ensures that learning exchanges between countries are country-driven, inclusive of all stakeholders and focused on specific outputs/outcomes and learnings. The guide is developed to support the implementation and scale-up of evidence-based practices by sharing new knowledge, skills or approaches between programme managers and policymakers from geographically distinct locations with similar contexts. The targeted audience is learning exchange facilitators, planning committees and participants engaged in the exchange process, though it can be used by donors, academia and other implementing partners interested in the subject.

A step-by-step guide to SSLE

The SSLE guide was developed through a rigorous consultative process conducted in three stages from 2019 to 2023 as part of the WHO FP Accelerator project. The first stage involved a thorough review of published and grey literature to draft a standard operating procedure (SOP) guide. This draft SOP was piloted in two districts of West Bengal, India, to refine its structure and usability. Subsequently, the revised SOP was applied to facilitate SSLEs between three country pairs: Sri Lanka-Nepal, Nigeria-Uganda and Guinea-Côte d’Ivoire. An external evaluation of the SSLE between Nepal and Sri Lanka was conducted to assess its implementation and outcomes, providing critical insights for further refinement.¹² The second stage included conducting a scoping review to map evidence on the process, outcomes, enablers and barriers of SSLE in FP,¹³ holding stakeholder interviews to capture diverse perspectives,¹⁴ consulting with a wide range of global experts and partners, organising webinars and a panel discussion at the 2022 International Conference of Family Planning to gather feedback and share initial findings. In the third stage, a WHO steering committee and an expert working group were convened to review the evidence and lessons learnt from stages 1 and 2 and to finalise the SSLE guidance document. To ensure inclusivity and transparency, the revised guide was presented at a virtual public consultation organised in collaboration with the WHO IBP Network. Feedback from this consultation, as well as insights from learning exchanges in six countries, a scoping review, webinars and consultations, were incorporated into the guidance document. Online supplemental figure 1 depicts the SOP and the final SSLE guide.

Five steps for conducting an SSLE

The step-by-step guide outlines a structured five-step methodology for planning, conducting and evaluating an SSLE (see online supplemental figure 2). For each step, the guide provides a clear and detailed explanation for implementation.

Step 1: define the need for and purpose of the learning exchange

This foundational step involves a needs assessment to identify gaps in FP programming and establish clear objectives for the learning exchange. WHO, the Ministry of Health (MoH) and implementing partners (country teams) collaboratively review the implementation gaps in FP programming interventions based on country plans, specify the objectives and expected outcomes, and identify human and financial resources to support the learning exchange. They determine the in-country partners who will support the exchange and select the country from which to draw knowledge, ensuring the knowledge-providing country has the capacity to meet the learning objectives. This critical step not only defines the purpose of the exchange but also sets a baseline for evaluation.

Step 2: plan the SSLE

In this step, the knowledge-seeking and knowledge-providing teams design the components of the exchange. Together, they decide on the type of exchange: a study tour, reciprocal exchange, virtual or expert visit. They identify participants and leadership for the exchange and appoint a facilitator (preferably a local partner) to work between the two teams in planning, implementing and evaluating the exchange. They will develop a comprehensive plan with an agenda, timeline, logistics and a monitoring, evaluation and documentation strategy.

Step 3: facilitate the learning exchange

The learning exchange is conducted with support from a facilitator implementing partner. During the exchange, evidence and experiences are presented to support the identified practices. Tools and resources used for successful implementation are shared, and successes, challenges and solutions are discussed. The country teams spend a significant time engaging in learning, seeking clarifications and outlining practical applications for their FP programmes. The teams develop a concrete action plan, detailing the next steps that are achievable within an agreed timeframe. Throughout this process, the facilitator provides support and guidance to the teams.

Step 4: support implementation of the action plan

After the learning exchange, the country team implements the learnings based on the action plan. The facilitator plays a crucial role in supporting implementation, addressing challenges and monitoring progress. Tools such as roadmaps and monitoring trackers are used to maintain focus on the desired outcomes, assess achievements and analyse delays. Regular monthly reports, feedback surveys and after-action review meetings are conducted to ensure continuous improvement. This step emphasises the importance of monitoring and documentation to achieve the intended objectives.

Step 5: follow-up after the learning exchange

This final step involves sharing the results and ensuring sustained impact. Each team prepares a comprehensive report detailing the learning exchange process, experiences and lessons learnt. Within six to twelve months, participants may hold a state-level dissemination meeting to share outcomes. Further evaluations are conducted at 24 months to assess the long-term outcomes of the exchange. The knowledge-providing team and the implementing partners continue to offer supportive supervision to the knowledge-seeking team for local problem-solving.

Recommendations

Table 1 outlines key recommendations for funders, planners and implementers to enhance the effectiveness of future SSLEs.

Table 1. Principles for conducting a South-South Learning Exchange (SSLE).

Steps in SSLE	Recommendations to conduct SSLE
Define the need for and purpose	Ensure the purpose of the SSLE is country-driven and aligned with national priorities. Obtain approval for the SSLE purpose from the country’s technical working group. Clearly design the SSLE to address a specific and well-defined need. Maintain flexibility to adapt to evolving needs and emerging issues.
Plan the SSLE	Follow a structured and systematic process for conducting the SSLE. Engage participants who are influential, knowledgeable, passionate, and respected (FP Champions). Involve the MoH from the start of the SSLE to ensure ownership and alignment with national strategies. Develop a comprehensive monitoring and evaluation (M&E) plan to track progress and outcomes.
Facilitate the learning exchange	Encourage reciprocal exchange of knowledge, where both countries contribute and benefit. Consider conducting the SSLE virtually to enhance wider collaboration and reduce logistical and financial barriers. Use a monitoring tracker and conduct after-action reviews to monitor progress and refine processes. Focus on achieving results and outcomes from the beginning.
Support implementation of action plan	Provide ongoing support to implement the learnings derived from the SSLE. Prioritise documentation, monitor and use data to guide actions and decision-making.
Follow-up after the learning exchange	Strengthen M&E to enhance accountability and measure the impact of the exchange. Document and disseminate key outcomes, lessons learnt, successes and challenges.

FP, family planning; MoH, Ministry of Health.

Outcomes and lessons learnt from SSLE

Table 2 summarises the key outcomes and lessons learnt from two SSLEs conducted using the WHO SSLE guide.

Table 2. Key outcomes and lessons learnt from two learning exchanges implemented using the WHO SSLE guide.

Learning exchange country learning needs	Key outcomes	Lessons learnt
Nigeria-Uganda15 Nigeria: improve quality of care (QoC) in FP across the life course and integrate FP in the RMNCAH Quality, Equity and Dignity network. Uganda: Strengthen leadership, coordination and monitoring for quality, rights-based FP, with emphasis on postpartum FP (PPFP)/postabortion FP.	Nigeria: Developed national level implementation guideline for improving QoC in FP; conducted a partner landscape analysis to align QoC in FP initiatives; revised national FP training manual for physicians and midwives to include QoC. Uganda: Developed an operational plan to strengthen QoC in FP with indicators; integrated a human rights-based approach into overall FP quality indicators; developed an FP counselling and education package and delivered at daily education sessions during antenatal, postnatal and young child health visits.	Strong national ownership and commitment from leadership were critical to success. A standardised systematic five-step approach ensured consistency and uniformity. Ministry of Health leadership, supported by a coordinating implementing partner, facilitated effective implementation.
Nepal- Sri Lanka12 Nepal: Improve organisation of clinical services to strengthen PPFP integration, with focus on provincial-level ownership and practical service delivery across the life course Sri Lanka: Transition from a paper-based logistic management information system (LMIS) to an electronic LMIS to improve district and central levels contraceptive commodity security.	Nepal: Developed national PPFP guidelines; integrated FP counselling across the continuum of care; developed advocacy tools in local language; trained subnational managers and providers; institutionalised PPFP in provincial hospitals; established demonstration site for scaling PPFP services at the Civil Services hospital; revised training curricula for skilled health personnel and skilled birth attendants; integrated three PPFP indicators into Nepal Family Health Survey, Nepal Demographic and Health Survey and Health Management Information System. Sri Lanka: Converted paper-based LMIS into eLMIS; scaled up nationally to all health districts and divisional levels; integrated PPFP into supervisory tools; added 2 PPFP indicators to the M&E system with routine monitoring from district and divisional managers.	Clear, specific, country-driven learning objectives aligned with national priorities are essential. Ministry of Health leadership ensures ownership and sustainability. Built-in monitoring mechanisms from the outset support accountability and progress tracking. Countries with common challenges and seeking to achieve common goals can make faster progress through shared learning and experiences.

FP, family planning; M&E, monitoring and evaluation; SSLE, South-South Learning Exchange.

Conclusions

The step-by-step guide to conduct SSLE offers a structured and standardised approach to conduct an inclusive and sustainable knowledge exchange. By following this methodology, stakeholders can effectively share experiences and best practices to address common challenges. The recommendations provided in the guide aim to assist donors, organisers and implementers in designing and executing an impactful learning exchange that aligns with their objectives. This process, if followed, will support the scaling up of FP services and promote SRH, contributing to achieving the SDGs and universal health coverage.

The author is a staff member of the World Health Organization. The author alone is responsible for the views expressed in this publication and they do not necessarily represent the views, decisions or policies of the World Health Organization.

Data availability statement

All data generated or analysed during this study are included in this published article.