A five-step methodology for South-South Learning Exchanges to scale up family planning services to achieve 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.