A twinning network can produce significant improvements in organizational, managerial, and clinical performance across a diverse range of indicators.

A twinning network can provide positive empowerment and motivational effects but requires the right combination of senior leadership involvement, preexisting capacity within the twinning network, and opportunities for sharing knowledge.

The twinning partnership network approach, particularly in the context of Rwanda, exemplifies how such networks can be effectively used to strengthen health systems and drive sustainable development.

In settings with organizational and clinical capacity that varies across similar types of institutions, policymakers should consider using twinning networks to unlock capacity and skills that already exist and place peer institutions in teaching roles rather than using external technical “experts.”

For twinning networks to be successful, donors and program implementers should focus on several key factors, such as institutions having the ability to set their own learning goals that are relevant and tailored to their specific needs, having high-performing peer institutions that can serve as effective mentors and models, and having participating institutions that can dedicate adequate time and resources to improving key performance indicators.

We describe the development, implementation, and evaluation of a novel twinning approach: the Twinning Partnership Network (TPN). Twinning is a well-known approach to peer learning that has been used in a variety of settings to build organizational capacity. Although twinning takes many forms, the heart of the approach is that institutions with shared characteristics collaborate via sharing information and experiences to achieve a specific goal. We adapted a twinning partnership strategy developed by the World Health Organization to create a network of like-minded health institutions. The key innovation of the TPN is the network, which ensures that an institution always has a high-performing peer with whom to partner on a specific topic area of interest. We identified 10 hospitals and 30 districts in Rwanda to participate in the TPN. These districts and hospitals participated in a kickoff workshop in which they identified capacity gaps, clarified goals, and selected twinning partners. After the workshop, districts and hospitals participated in exchange visits, coaching visits, and virtual and in-person learning events. We found that districts and hospitals that selected specific areas and worked on them throughout the duration of the TPN with their peers improved their performance significantly when compared with those that selected and worked on other areas. Accreditation scores improved by 5.6% more in hospitals selecting accreditation than those that did not. Districts that selected improving community-based health insurance coverage improved by 4.8% more than districts that did not select this topic area. We hypothesize that these results are due to senior management’s interest and motivation to improve in these specific areas, the motivation gained by learning from high-performing peers with similar resources, and context-specific knowledge sharing from peer hospitals and districts.

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