Using social network analysis to examine inter-governmental relations in the implementation of the Ideal Clinic Realisation and Maintenance programme in two South African provinces

Abstract

Background Within the context of universal health coverage (UHC), South Africa has embarked on a series of health sector reforms. The implementation of the Ideal Clinic Realisation and Maintenance (ICRM) programme is a major UHC reform. Cooperative governance is enshrined in South Africa’s Constitution, with health a concurrent competency of national and provincial government. Hence, effective inter-governmental relations (IGR) are essential for the ICRM programme implementation. Aim The aim of the study was to measure the cohesion of IGR, specifically consultation, support and information sharing, across national, provincial and local government health departments in the ICRM programme implementation. Materials and methods Using Provan and Milward’s theory on network effectiveness, this study was a whole network design social network analysis (SNA). The study was conducted in two districts in Gauteng (GP) and Mpumalanga (MP) provinces of South Africa. Following informed consent, we used both an interview schedule and a network matrix to collect the social network data from health policy actors in national, provincial and local government. We used UCINET version 6.619 to analyse the SNA data for the overall network cohesion and cohesion within and between the government spheres. Results The social network analysis revealed non-cohesive relationships between the different spheres of government. In both provinces, there was poor consultation in the ICRM programme implementation, illustrated by the low densities of seeking advice (GP = 15.6%; MP = 24.4%) and providing advice (GP = 14.1%; MP = 25.1%). The most cohesive relationships existed within the National Department of Health (density = 66.7%), suggesting that national policy actors sought advice from one another, rather than from the provincial health departments. A density of 2.1% in GP, and 12.5% in MP illustrated the latter. Conclusion The non-cohesive relationships amongst policy actors across government spheres should be addressed in order to realise the benefits of cooperative governance in implementing the ICRM programme.

Decentralization and resource contributions within local governance networks: Evidence from health sector reform in Honduras

“…With respect to network environment, the major finding coming from this work is the close relationship between communication and resource contributions; unsurprisingly, communication appears to be a prerequisite or at least a facilitator of resource exchange as organizations in networks with greater densities of communication tend to contribute more resource ties than those where communication is sparse. This result also speaks to the growing body of research striving to more clearly identify different types of relationships or ties among actors within governance networks (Bodin et al, 2020; Morrison et al, 2023) and consider network dynamics as potential mechanisms linking policy reforms to system‐level performance (Muthathi et al, 2021; Zhou & Dai, 2023). Alongside prior work considering ties based on information‐sharing or participation in common venues, our findings emphasize resource contributions as an important type of network relationship and highlight the factors shaping this relatively strong form of collective action.…”

Social Network Analysis of the Schistosomiasis control program in two local government areas in Oyo state, Nigeria: Insights for NTD elimination plans

“…Low network density can affect the effectiveness and efficiency of the stakeholders in meeting their goals, in this case, schistosomiasis elimination because of the sparsity of connections between stakeholders. Some studies have highlighted the importance of network density on network efficiency and effectiveness [24,26]. However, other studies argue that low density does not necessarily mean low efficiency since a network of strong and highly active stakeholders is not very effective [27][28][29][30].…”

“…There are several studies including systematic reviews on social network analysis among healthcare organizations in developed countries [15][16][17][18][19][20][21], and a few studies on organizational SNA from a developing country setting [22][23][24][25]. Within the African context, there are no known studies exploring the relationships between the stakeholders within the local NTD network generally, the stakeholder network of the schistosomiasis control program specifically, and how the state of these relationships can affect disease control and elimination.…”