Strengths and weaknesses of the South-South Learning Exchange: a qualitative analysis of experts’ perspectives

Introduction

The South-South learning exchange or peer-peer learning exchange refers to an interactive learning process where peers exchange knowledge and experience to work towards a beneficial change (WHO, 2018a). These exchanges are often referred as south-to-south cooperation (SSC) or knowledge exchange. The WHO’s thirteenth “General Programme of Work (2019–2023)” (World Health Organization, 2018b) integrated south-to-south cooperation as a strategy to develop and scale up innovative solutions for building capacities through shared learning and equitable partnerships, thereby contributing to the achievement of the Sustainable Development Goals. Some authors argued that the concept of SSC lacks a universally accepted definition. This absence of consensus is driven by the ongoing discussion around the nuances of "southern" identity, the multifaceted nature of "development", and the dynamics of "cooperation" — whether it occurs among equals or otherwise (Avis, 2022; Besharati & MacFeely, 2019; Caixeta & dos Santos, 2022). This complexity underscores the challenge in creating one definition of SSC and SSLE, reflecting the diverse experiences and expectations of the actors involved in south-to-south cooperation.

Although the debate on common definitions is ongoing, SSLEs have some key aspects in common. The exchanges allow participants to “learn firsthand from the experience of their peers how a challenge was solved or solution implemented” (Kumar & Watkins, 2017). The SSLE can inspire peers, create new ideas, implement reforms, share practical problem-solving ‘how-to’ knowledge, and foster collaboration and advocacy (The World Bank, 2019a) – all key factors for social learning processes (Reed et al., 2010). They require coordination with two peer teams (knowledge seeker and knowledge provider), a facilitator (broker) who brings the two teams together, and various stakeholders that support the work towards a change, or have an interest in the outcomes of the SSLE (World Health Organization, 2018b). Organizers are usually international agencies, non-governmental organizations (NGOs) and governments (e.g. India, South Africa, China, Brazil) and the SSLE can be bilateral, multilateral, intraregional or interregional. There isn't a universally set duration, and flexibility allows adaptation to specific needs.

Governments, agencies and institutions have increased over time the opportunity to run SSLE programs to share practices and experiences in various ways (i.e. visit tours, platforms) (Food and Agriculture Organization of the United Nations (FAO), 2021) and areas, such as development, climate change, conservation management, and reproductive health and rights (Partners In Population And Development, 2021; The World Bank, 2019a). Previous peer-reviewed literature reporting SSLE experiences is limited to specific topics such as conservation management (Bretos et al., 2017; Gardner et al., 2017; Heyman & Stronza, 2011), information system in health (Were et al., 2019), human capacity on HIV/AIDS services (Ivers et al., 2010), disease outbreak and health system strengthening (Olu et al., 2017). Grey literature illustrated results of SSLEs conducted by several agencies, such as the World Bank (The World Bank, 2019b), the United Nations Development Programme (United Nations Development Programme, 2017), the United Nations Office for South-South Cooperation (United Nations Office for South-South Cooperation, 2019; United Nations Office for South-South Cooperation, 2020), and the United Nations Population Fund (United Nations Population Fund (UNFPA), 2018; United Nations Population Fund (UNFPA), 2021). The increasing adoption of SSLE programs by various entities reflects a growing recognition of its value across diverse fields, and positions SSC as a critical means for the Global South to innovate and decolonize south-south cooperation and development, as well as fostering a new identity within the realm of international politics (Caixeta & dos Santos, 2022; Waisbich, 2022). Despite scholars pointing out the challenges faced in SSC, discussing the need for defining and whether or how to measure SSC (Besharati & MacFeely, 2019; Waisbich, 2022), the peer-reviewed literature on SSLE initiatives remains scarce. This highlights the need for academia to have access to information on SSLE to conduct more in-depth analyses to inform, support, and evaluate policy-making.

The WHO embarked on the Family Planning (FP) Accelerator project in 2019 (World Health Organization, 2020) with the objective to improve access to quality and rights-based FP services. Under this project, ten (five bilateral SSLE) low-income countries have participated in SSLE. These exchanges follow a five-step approach using the preliminary version of “A step-by-step Guide to South–South learning exchanges” guide (World Health Organization, 2018a), which allows the planning, conducting and evaluation of an SSLE to plan, conduct, and evaluate a SSLE. The steps include defining the need for and the purpose of the learning exchange; planning and facilitating the learning exchange; supporting implementation of the action plan and following-up after the learning exchange. An example is the SSLE between the Nepalese and Sri Lankan ministries of health, in which respective teams shared their best practices and learnings. This resulted in the implementation of a web-based system for logistics management of FP commodities in Sri Lanka and Nepal. They started the implementation of integrated family planning services in a decentralized environment, using a lifecycle approach to improve the uptake of postpartum FP (Kabra et al., 2022). The strengths of the WHO approach laid on the strong emphasis on the preparation phase and prioritization of the learning question before the exchange begins. This methodology gives considerable attention to the phases following the exchange. This includes post-exchange implementation, follow-up, and comprehensive documentation of the outcomes and lessons learned.

The authors of this study conducted a scoping review of both published and grey literature on SSLE that included 29 articles, where 27 were reports, case studies or press releases and only two peer-reviewed publications (Allagh et al., 2023). This review captures four types of approaches adopted for conducting SSLEs: study tours (reciprocal, non-reciprocal), virtual exchanges, expert visits, and mixed method exchanges (study tour and expert visits; virtual reciprocal exchange), where a study tour is the most common approach. Policy dialogue was identified as the primary output of these SSLEs and improved contraceptive prevalence, which is the most frequently reported outcome. Ambiguity remains regarding the extent to which SSLEs have contributed to FP outcomes due to the limited reported evidence and consistent documentations (i.e., information on implementation of learnings, documentation of lessons learnt, information on selection of participants), and their scarce quality (i.e., evaluation of SSLE and documentation of results). Hence, it is evident that there is a compelling need to systematize the SSLE approach.

By conducting this qualitative analysis of experts' perspectives, this paper aims to shed light on the strengths and weaknesses of the South-South Learning Exchange approach. The insights gained from this study will contribute to the existing knowledge and inform future efforts to enhance the impact of SSLEs.

Methods

Results

Strengths

We identified three main strengths associated with the SSLE process: empowerment of participants, positive peer-to-peer “mind change” and convincing and powerful hands-on learning (Figure 1).

Figure 1. Strengths and weakness of SSLE.

Weaknesses

We identified three main weaknesses associated with SSLEs: demanding and time-consuming process (human resources, working days, costs, logistics); participants initial reluctance to SSLE approaches; absence of a systematized and internationally recognized methodology.

Discussion

This study sheds light on some strengths and weaknesses of South-South learning exchanges by examining the perspective of a range of experts from different disciplines. Empowerment of participants, positive peer-to-peer “mind change” and powerful knowhow are the main strengths of the SSLE approach. Resource heavy, reluctancy of participants and absence of a validated guide methodology emerged as main weaknesses of SSLE, which could impair the effectiveness of this approach. This study illustrated that SSLE is a promising and valuable tool to pass on knowledge and information from a grass-roots approach.

The SSLEs’ strengths derived from two main processes previously described in the management, educational and psychological literature: experiential learning and social learning.

SSLE provides participants with hands-on, personal experiences, that are key to experimental learning. As described in the Kolb’s experimental learning model (Kolb, 2015) and its subsequent revision (Morris, 2019), learning consists of a four-stage cycle that includes a concrete experience, a reflective observation on the experience, conceptualization, and an active experimentation of what you have learnt. “Learning by doing” has been highlighted as a funding concept of this approach by Morrison et al. (Morris, 2019). Learners are immersed in this learning experience that contains context-specific information, and this “hands-on” process makes learners active and empowered. In fact, participants’ reflection on the acquired knowledge or experience and the internalization and application of the knowhow are the strengths of the South-South model. This approach leads to an understanding that is different from that acquired through research, observation, books, and lessons (Borkman, 2007). Moreover, this “hands-on” process enhances ownership, empowerment, enthusiasm and leadership among participants.

During the exchange, participants are involved in the process of social learning (Schusler et al., 2003). The social learning theory postulated that “social behaviour is learned by observing and imitating the behaviour of others” and suggested that “behaviour change is more likely when modelling is provided by peers than non-peers” (Bandura & RH, 1977). Interactions with peers who are successfully coping with their experiences are more likely to result in positive behaviour change and peers are more credible role models for others. Personal interactions created a common understanding and may encourage the continuous sharing of best practices after the exchange event (Jenkins et al., 2017). This study showed that participants from countries with similarities exchange knowledge and expertise in a convincing way, such as the exchange run among Indonesian and Chadian Muslim religious leaders on family planning. The peer model is a key strength of the SSLE.

South-South Learning Exchanges can be resource-intensive, and necessitates substantial commitment from participants and organizers. The major cost factors include expenses for human resources, travel, accommodation, and conference facilities - essential for conducting these exchanges. Adequate funding enables the increase of dedicated personnel and the enhancement of existing staff capabilities through training. More skilled personnel can help diversifying roles and responsibilities among participants, enhancing the quality of the process. SSLE financing sources are varied, influenced by the level of involvement and engagement of organizations and governments, and varied across different regions and countries, as well as thematic areas. Funding often comes from United Nations agencies (e.g. UNFPA, FAO, IFAD, PAHO), the World Bank, governments, non-governmental organizations (NGOs) and bilateral/multilateral aid entities. Some offices allocate specific portions of their core budget, while others rely on programmatic funds. Comprehensive data on the resources invested in and leveraged by SSLEs remains elusive, underscoring the need for more transparent and detailed reporting mechanisms. Although traditional learning exchanges are known to be costly and time-consuming (Gardner et al., 2017; Jenkins et al., 2017), recent initiatives conducted by the co-authors show that SSLE can be successfully conducted online at reduced costs (Kabra et al., 2022). However, the participants reported that that virtual formats lack the impact of in-person interactions, which offer direct, hands-on learning experiences. Achieving the desired outcomes of SSLEs thus requires significant investment, underscoring the importance of sustained national and international commitment, as well as partnerships with international bodies and the private sector for funding.

The reluctance of participants and donors to engage with SSLEs can be attributed to several challenges inherent in the implementation of SSLE initiatives. These challenges include a lack of standardized approaches, frameworks, and evaluation methods, as well as limited evidence demonstrating the impact of these exchanges (Olu et al., 2017; UNFPA Evaluation Office, 2020). Frequently, SSLE programs are characterized by their small scale, informal nature, or integration within broader cooperation programs (WHO & World Health Organization, 2014), with the documentation and dissemination of outcomes often being overlooked. Our analysis indicates that diverse approaches and frameworks are implemented across different agencies and organizations, leading to monitoring, evaluation, and follow-up processes often seen as inadequate and variegated across different sectors. This inadequacy is underscored in the “Formative evaluation of UNFPA approach to South-South and triangular cooperation” (UNFPA Evaluation Office, 2020) and by other scholars, such as Jenkins et al. and Thompson et al. (Jenkins et al., 2017; Thompson et al., 2017). However, exceptions illustrate the potential for success through rigorous methodologies. For instance, the Korean Development Institute and the World Bank Institute have showcased the effectiveness of a results-focused approach in assessing knowledge exchange programs through three detailed case studies (Chun & Kim, 2011). Similarly, collaborative efforts between Nepal and Sri Lanka, under WHO’s facilitation, have led to the development of a monitoring tracker and framework to effectively implement action plans during SSLE (Kabra et al., 2022). These examples demonstrate that employing a thorough methodology, including a strong emphasis on the preparation phase (prioritization of the learning objectives) and on the post-exchange implementation (i.e. meticulous documentation and monitoring & evaluation), can significantly enhance the assessment and demonstration of SSLE impacts. Such robust methods increase the credibility and visibility of SSLE initiatives among participants, governments, and funders, ultimately leading to better access to and availability of learning resources through SSLE. Moreover, the development of a standardized and cross-sector methodology, frameworks and evaluation system allows to better measure and assess the contribution that a country or institution make in international development, as well as to reflect on pitfalls encountered during the SSLE. Countries from the Global South should lead the development of a methodology and ensure that these tools are tailored to their specific contexts and needs (Besharati & MacFeely, 2019). However, Waisbich LT highlights that the debate on measuring South-South Cooperation (SSC) unveils intricate and unresolved discussions between the Global North and South (or the South and the rising powers, such as Brazil, China, India) on "power, status, and responsibilities" within international development—a complexity that extends beyond the scope of this paper (Waisbich, 2022). While regular monitoring and evaluation are critical for enhancing SSLEs, the underlying tensions and disagreements between the North and South persist, suggesting these challenges may continue to influence the dialogue on SSC.

We note several limitations of this study. Firstly, participants were identified through reports and documents found in our scoping review (Allagh et al., 2023). Although we included a variety of publications, we might have overlooked individuals involved in SSLEs, potentially introducing a selection bias into our research. Additionally, participants were selected from available SSLE organizers or participants whom the authors could contact, leading to challenges in recruiting interviewees since we were solely able to contact them by email. Then, as most of interviewees were SSLE organizers or facilitators, we were unable to capture insights from the peer teams and stakeholders’ into the current study. This may have potential implications that should be emphasised in future studies. Conducting interviews exclusively in English may have been a potential limitation for our research, even if it's essential to note that all the participants were able to engage effectively. Future research should consider language diversity. Finally, recruitment was done by the authors of this study who work at the SRHR department, and several interviewees were SRHR experts; there may be some specific bias in recruitment.

To our knowledge, this is the first manuscript exploring the perspectives of a sample of experts on SSLE from different disciplines. The originality of this study lies in the collection of various personal and professional SSLE experiences: we sampled across various professional levels (government representatives, NGOs, communities) and captured the far-ranging capacities of SSLE application (from fishery management to family planning). An additional strength of this study stems in part from the interdisciplinary team. Co-authors of this study are from different disciplines such as healthcare management, public health, human reproduction and family planning.

This manuscript has highlighted the need for reaching a consensus on guidelines, framework and an evaluation system to conduct and assess the impact of SSLE. Despite several initiatives being conducted all over the world, they are not comparable in terms of adopted guidelines, documentation, frameworks and evaluation measures. By focusing research efforts on these areas (i.e. Delphi technique, consensus conferences), it will be possible to implement standardized approaches and metrics for evaluating both the short-term and long-term impacts of SSLEs, as well as their cost benefit. This will not only enhance our understanding of SSLEs but also ensure their benefits are maximized and efficiently realized. The initial version of the five-step methodology developed by the WHO mark a significant stride toward a unified approach, highlighting a strong focus on the defining the learning objectives and emphasizing the post-exchange implementation phase. Drawing on the insights from this paper and our accumulated experience in the field, we have compiled a set of key recommendations to guide and enhance future SSLEs.

Conclusion

This study has shed light on the multifaceted nature of South-South Learning Exchanges (SSLE), uncovering both strengths, such as participant empowerment, positive peer-to-peer mindset shifts, and the transfer of hands-on learning, and weaknesses, including the resource-intensive nature of these exchanges, participant reluctance, and the lack of a validated guiding methodology. The strengths of SSLEs are anchored in the theories of experiential and social learning, highlighting SSLE's potential to create an environment that significantly enhances knowledge exchange among participants. Despite these strengths, the study highlights the challenges SSLE initiatives face, particularly the limited funds and commitment to support them, stemming from limited evidence of impact, disparate approaches, and the absence of standardized guidelines, and evaluation practices., The development of a comprehensive set of guidelines, frameworks, and evaluation systems will not only enhance our understanding of SSLEs, but also extend their benefits and ensure their effective implementation.