The role of social networks in the governance of health systems : the case of eye care systems in Ghana

Blanchet, K; James, P

Abstract

Efforts have been increasingly invested to improve local health systems’capacities in developing countries. We describe the application of innovative methods based on a social network analysis approach. The findings presented
refer to a study carried out between July 2008 and January 2010 in the Brong Ahafo region of Ghana. Social network analysis methods were applied in five different districts using the software package Ucinet to calculate the various
properties of the social network of eye care providers. The study focused on the managerial decisions made by Ghanaian district hospital managers about the governance of the health system. The study showed that the health system
in the Brong Ahafo region experienced significant changes specifically after a key shock, the departure of an international organization. Several other actors at
different levels of the network disappeared, the positions of nurses and hospital managers changed, creating new relationships and power balances that resulted in a change in the general structure of the network. The system shifted from a centralized and dense hierarchical network towards an enclaved network composed of five sub-networks. The new structure was less able to respond to shocks, circulate information and knowledge across scales and implement
multi-scale solutions than that which it replaced. Although the network became less resilient, it responded better to the management needs of the hospital managers who now had better access to information, even if this information
was partial. The change of the network over time also showed the influence of the international organization on generating links and creating connections between actors from different levels. The findings of the study reveal the
importance of creating international health connections between actors working in different spatial scales of the health system.

Citation

Blanchet, K., & James, P. (2013). The role of social networks in the governance of health systems : the case of eye care systems in Ghana. Health Policy and Planning, 28(2), 143-156. https://doi.org/10.1093/heapol/czs031+1

• Journal Article Type: Article
• Acceptance Date: Dec 20, 2011
• Online Publication Date: Mar 12, 2012
• Publication Date: Mar 1, 2013
• Deposit Date: Mar 19, 2012
• Journal: Health Policy and Planning
• Print ISSN: 0268-1080
• Electronic ISSN: 1460-2237
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 28
• Issue: 2
• Pages: 143-156
• DOI: https://doi.org/10.1093/heapol/czs031+1
• Publisher URL: http://dx.doi.org/10.1093/heapol/czs031
• Related Public URLs: http://heapol.oxfordjournals.org/
• Additional Information: Additional Information : First published online March 12; Funders : Swiss Red Cross