Abstract
Accountability for maternal, newborn and child health (MNCH) is a collaborative endeavour and documenting collaboration dynamics may be key to understanding variations in the performance of MNCH services. This study explored the dynamics of collaboration among frontline health professionals participating in two MNCH coordination structures in a rural South African district. It examined the role and position of actors, the nature of their relationships, and the overall structure of the collaborative network in two sub-districts. Cross-sectional survey using a social network analysis (SNA) methodology of 42 district and sub district actors involved in MNCH coordination structures. Different domains of collaboration (eg, communication, professional support, innovation) were surveyed at key interfaces (district-sub-district, across service delivery levels, and within teams). The overall network structure reflected a predominantly hierarchical mode of clustering of organisational relationships around hospitals and their referring primary healthcare (PHC) facilities. Clusters were linked through (and dependent on) a combination of district MNCH programme and line managers, identified as central connectors or boundary spanners. Overall network density remained low suggesting potential for strengthening collaborative relationships. Within cluster collaborative patterns (inter-professional and across levels) varied, highlighting the significance of small units in district functioning. SNA provides a mechanism to uncover the nature of relationships and key actors in collaborative dynamics which could point to system strengths and weaknesses. It offers insights on the level of fragmentation within and across small units, and the need to strengthen cohesion and improve collaborative relationships, and ultimately, the delivery of health services.
Highlights
Health systems are social systems that are determined by people who interact through various forms of collaboration or conflict expressed through the sharing of ideas, interests, values, norms, affinities and power
This study aimed to assess the dynamics of collaboration on maternal, newborn and child health (MNCH) within a rural South African district, by exploring and quantifying the structure of the collaborative network as well as the role and position of actors involved in two key district MNCH coordination mechanisms
Characteristics of Study Respondents The total network size consisted of 143 nodes distributed as follows: Cluster 1 (n = 23), 18 names provided in the survey and 5 names added by respondents; Cluster 2 (n = 26), all 26 names included with no additions from respondents; Cluster 3 (n = 41), 37 included in the questionnaire, 4 names added by respondents; Cluster 4 (n = 53), 51 names from attendance registers included in the survey and 2 names added by respondents
Summary
Health systems are social systems that are determined by people who interact through various forms of collaboration or conflict expressed through the sharing of ideas, interests, values, norms, affinities and power. This can be considered the ‘software’ of the health system, a guiding force underpinning the relationships among health system actors and performance.[1]. Collaboration can be viewed as a key attribute of effective governance, enabling knowledge sharing, service coordination and joint problem-solving.[3] Successful collaboration is built on the recognition of all actors being part of the solution to problems identified, and requires the following: communication skills, trust-building, capabilities for coaching and mentoring, promotion of collective and inclusive decision-making processes that sustain accountability, and equitable practices.[3,4]. Collaborative relationships are enabled by or embedded in formal and informal social networks in the work setting[6,7] and can be affected by differences in professional power, level of expertise and professional and organizational culture.[8]
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