Health Law Platform

The Problem

Each country is governed by a collection of laws. Whether modern, customary or blend of both. When these laws are poorly designed, or the law making process is poorly navigated, a domino effect occurs causing broader society to miss out. With Bills often only passed every ten years on a particular topic, ensuring legislation is navigated well can impact an entire generation.

Some developing countries are particularly susceptible to weak legislation. This may be because they lack knowledge, are overwhelmed with other priorities, or lack necessary systems to support legislative development, passage, implementation, monitoring and enforcement. Developing countries also face strong external pressures from powerful multinational companies and larger countries trying to influence the writing of legislation that benefits them. On top of this, global initiatives such as the International Health Regulations (IHR) can place an additional legislative burden on already overburdened countries to comply to global priorities. Even when this is not the case, developing nations can often spend too much effort copying the laws of other countries rather than exploring how they might best legislate to maximise their unique cultural strengths, values and resources.

Over the years, various bodies have tried different things to address this issue. Two of the primary interventions have been to:

1. Train locals in better law and policy skills to increase a countries competency and capacity. The problem with this has been as individuals become more skilled, they have often left the public service or country to pursue opportunities more beneficial to them and their family. Training a large enough cohort to weather this churn is also expensive and time consuming.
2. Countries have also been provided access to experts that can help them navigate key legislative topics. Whilst experts bring strong knowledge in their area of expertise, they often don't bring the political, cultural or local contextual knowledge crucial for producing quality and sustainable legislation. There are also a large variety of technical domains for them to cover, and not enough experts trained in legislation in a development context. Because of these challenges, as well as further cost and time constraints, experts are often only given a few weeks of consultation from which to provide assistance on complex topics. This forces experts to restrict the scope of their work and/or make educated guesses about what will suit the country best. This often results in cobbling together existing templates from other jurisdictions which may not form a sustainable solution.

Whilst both of these initiatives are positive steps forward, I have long believed more can be done.

The Solution

Aware of these issues, Luke Elich and I began to have conversations about a potential technology solutions to travel alongside these current interventions. Luke was a lawyer who had worked for DFAT, PNG Government and was leading the Health Law and Ethics unit at WHO WPRO. Our conversation began over lunch in Manila under the watchful eye of the Jolibee mascot. Luke sparked the discussion with a lengthy monologue summarising the challenges he'd seen over his career along with thoughts on systems level solutions. Picking up on his thoughts, I built out some ideas and we began to discuss further. At the same time Dr Genevieve Howse was also keen to see this area evolve. She had done her PhD on a similar area, (helping Pacific Island nations better navigate legislation and its processes), and had worked extensively applying this in PNG. Whilst she had created some great published work, she had a vision for something more accessible, interactive and useful.

From these initial discussions, a few keys became clear to me. Any solution we developed had to:

• Suit any country in the world. Whether using common, civil or customary law,
• Cause users of our solution to implicitly, not explicitly, explore approaches other than legislation, (legislation is often seen as a silver bullet to social issues, but a good legislative process shouldn't always result in legislation. Instead the process should reveal if a more effective intervention would work),
• The solution couldn't 'tell' countries what to d0 - it shouldn't be prescriptive or directive, instead it should resource countries and empower them to better self-determine their own path.
• The solution should also meet countries where they are at, even if they don't know how to contextualise this them self.

What this revealed to me was that a principle-based approach would be required. Take for example, Health Workforce Regulation. It would not be useful to tell countries how they should specifically regulate a health workforce because countries are far too diverse to adequately design one law that would magically suit every culture or health system. Yet whilst over-specificity wouldn't work, neither would over-generalisation. General advice on various topics is useful but what countries ultimately seek is meaty content that gets in to the weeds on issues in a useful and practical sense. So how could we get specific whilst also remaining scalable across different cultures and legislative systems? An answer was 'Principles'. In our Health Workforce Regulation example, a principle-based approach would break this area down into core practical principles to doing Health Workforce Regulation well. For example you probably want to think about:

• Creating and maintaining some sort of workforce registrar,
• Having some sort of accountability mechanism, and
• Defining the scope of practice for what it means to be a 'doctor' or 'nurse' etc.

Building on these principles, a country can then bring knowledge of their own context. This may result in their doctors being accountable to a government department, a newly established health association or a local tribal chief. The solution doesn't matter so much as that the principle is being met in the best possible way based on their unique structures, history, resources etc.

Whilst it was important to identify Principles as a key ingredient in the solution design, this wasn't enough. Principles around a topic are powerful for policy design, but they can still be too abstract and we wanted to go deeper to help countries more tangibly build better quality legislation. Whilst each topic had its own principles unique to them, Luke felt legislation itself, independant of any topic, could be broken into its own definable components of which each would have their own principles. For example, whilst a principle of navigating Health Workforce Regulation well is to consider Accountability - Accountability is not unique to Health Workforce Regulation. And in fact, the principles of doing Accountability well, and the legislative instruments used to establish and maintain quality Accountability structures, are topic agnostic. This idea suggested that a library of common legislative 'building blocks' could be developed to allow policy makers to 'Lego together' their own quality legislation. If possible, this would provide a powerful balance of legislative focus and resource whilst empowering them to lead the process and marry in their own local knowledge.

The Key Challenge

What arose from all these discussions was the idea that all topics contain principles. And all principles rely on a library of legislative tools, mechanisms and strategies. Helping countries effectively could therefore mean simply helping them identify the principles relevant to their area of interest. And for each legislative component they wished to use, helping them understand how to do this well.

The key question arising from this was:

Is it even possible to taxonomise the legislative universe? And if so what would that look like?

Professor Vivian Lin, who was the WHO WPRO Director of Health Systems at the time, caught wind of our work and established an initial R&D project to explore the concepts viability. Taking over many of the meeting rooms and white boards at the WHO regional office in Manila for two weeks, Luke and I brainstormed this key question. Could we make the legislative world definable yet also not overly restrictive? Specific, yet scalable? Sophisticated, yet accessible to people without legal training? Drawing on academia, our experience and a variety of stakeholders, we explored all sorts of taxonomies and structures landing on an initial solution.

Concept Review

Whilst our initial concept made sense to us and passed our own internal tests, we had gone far down the intellectual rabbit hole and needed external critique. To make our work more accessible, I mocked up a basic prototype and then presented the project on behalf of WHO at an International Health Law Symposium hosted by Yonsei University in South Korea 2017.

The format for the event was for each expert to present a challenge they were facing and then allow the rest of the group to provide feedback, ideas or other support. Listening throughout the day, it interested me that every challenge discussed could theoretically be addressed by the solution Luke and I had developed. As the last person to present, Luke introduced the concept and I shared this observation along with an invitation to pick holes in our concept to see where this may not be the case.

The discussion that followed was overwhelmingly positive and hugely helpful. The experts validated our concept whilst at the same time identifying a number of improvements and follow up questions.

Alpha Version

Following this meeting, the project received increased support and we found other parts of the world became keen to collaborate with us on the concepts development. Whilst the initial R&D work had focused on the anatomy of the solution, the project now needed content to further validate its structure. To this end, WHO commissioned a number of legal and policy experts to start drafting content whilst I engaged with my team at Lantern to move the basic prototype into a more robust Alpha version of the platform.

As WHO produced the content, my team would then import this into the platform. As the content grew, we were able to further test and refine our theories on the original structural design. Eventually, we had completed enough content and refinement to give a strong enough representation of the concept and I suggested we review the alpha site with a range of external stakeholders to get further insights on how we were progressing.

We presented the Alpha version of the tool in two ways:

1. The first was at an international ministerial meeting on Health Profession Education Reforms held in Shanghai 2019. With the ministers and staff of 8 countries, I presented the tool and ran a workshop where they each had the opportunity to use the tool on a laptop at their table. Following this experience, they were then asked to submit feedback via survey.
2. Additionally, I worked with WHO to email ~20 health law experts around the world, asked them to review our work, and then spent 1-2 hours interviewing each of them to unpack their thoughts.

This feedback was incredibly useful to both validate our work as well as polish it further.

Beta Version

After synthesising all our learnings from the Prototype and Alpha iterations, I settled down to design a more comprehensive Beta evolution of the tool. Whereas the previous rounds had been focused on testing, validating, learning, listening and engaging key stakeholders. The Beta version was to be a fully functioning tool with a rich feature set and built in a way that could be accessible to remote and rural locations.

As WHO focused on producing more content, my team built out features such as Glossary and Reference engines, a user log in and bookmarking system, and custom illustration to help impute subconscious messages and associations we wanted users to adopt.

The solution went live February 2021 with the plan to re-evaluate after 12 months.