Developing an understanding of networks with a focus on LMIC health systems: how and why clinical and programmatic networks form and function to be able to change practices: a realist review

Networks are an increasingly employed approach to improve quality of care, service delivery, and health systems performance, particularly in low-and-middle income country (LMIC) health systems. The literature shows that networks can improve the provision and quality of services and health system functioning but there is limited evidence explaining how and why networks are established and work to achieve their reported results. We undertook a realist review to explore this. The objective of this realist review was to develop a programme theory outlining the underlying mechanisms and interactions of contexts that explain how and why a network’s set-up and function enable high-quality care and services and improved clinical outcomes in LMIC health systems. We followed Pawson’s five steps for realist reviews. The search strategy was based on a previously published scoping review with additional searches. Literature was selected based on its relevance to the programme theory and rigour. Context-mechanism-outcome configurations were developed from the extracted data to refine the initial programme theory with causal explanations. Theories on social movements and organisations supported the identification of mechanism and brought additional explanatory power to the programme theory. The programme theory explains how networks are initiated, formed, and function in a way that sets them up for network leadership and committed, engaged, and motivated network members to emerge and to change practices, which may lead to improved quality of care, service delivery, and clinical outcomes through the following phases: identify a problem, developing a collective vision, taking action to solve the problem, forming purposeful relationships, linkages, and partnerships, building a network identity and culture, and the creation of a psychological safe space. This deeper understanding of networks formation and functioning can lead to a more considered planning and implementation of networks, thereby improving health system functioning and performance

Networks of care to strengthen primary healthcare in resource constrained settings

Networks of care are a promising way to provide support and resources for isolated primary care workers and deserve more research, argue Enoch Oti Agyekum and colleague

Networks of Care: An Approach to Improving Maternal and Newborn Health.

The Networks of Care approach has the potential to harmonize existing strategies and optimize health systems functions for maternal and newborn health, thereby strengthening the quality of care and ultimately improving outcomes

Understanding networks in low-and middle-income countries’ health systems: a scoping review

Networks are an often-employed approach to improve problems of poor service delivery and quality of care in sub-optimally functioning health systems. There are many types of health system networks reported in the literature and despite differences, there are identifiable common characteristics, uses, purposes, and stakeholders. This scoping review systematically searched the literature on networks in health systems to map the different types of networks to develop an understanding of what they are, when and what they are used for, and the purposes they intend to achieve. Peer-reviewed literature was systematically searched from six databases (Medline (Ovid), EMBASE (Ovid), Global Health (Ovid), the Cochrane Library, Web of Science Core Collection, Global Index Medicus’s Africa Index Medicus) and grey literature was purposively searched. Data from the selected literature on network definitions, characteristics, stakeholders, uses, and purposes were charted. Drawing on existing frameworks and refining with the selected literature, a five-component framework (form and structure, governance and leadership, mode of functioning, resources, and communication), broadly characterizing a network, is proposed. The framework and mapping of uses, purposes, and stakeholders is a first step towards further understanding what networks are, when and what they are used for, and the purposes they intend to achieve in health systems

Chapter 11 The Role of Surveillance Methods and Technologies in Plant Biosecurity

Countries design biosecurity systems to protect their animal, plant, and environmental resources from invasive alien species. Countries maintain biosecurity systems to safely manage trade and prevent the introduction of invasive pests (insects, diseases and weeds) through numerous pathways of entry. Plant biosecurity programmes seek to exclude exotic organisms from becoming established on agricultural crops, ornamental plants and “natural” areas. Without barriers for entry, invasive organisms can expand their range, colonize new territory and cause considerable economic and environmental damage (Magarey et al. 2009). Spatially, one country’s biosecurity efforts may be categorised as “pre-border”, “border” and “post-border” when describing that country’s attempts at minimising the movement of unwanted organisms. Countries collaborate internationally on a range of interrelated biosecurity activities to confront these exotic invasive species. Surveillance is a key component of that continuum. The International Plant Protection Convention (IPPC) defines surveillance as an official process which collects and records data on pest occurrence or absence by survey, monitoring or other procedures. The diverse purposes of surveillance include: • Promote early detection of pests to facilitate eradication or management; • Support trade by demonstrating areas of pest freedom or low pest prevalence; • Describe the distribution and prevalence of risk organisms already present; • Delimit the full extent of pest population following a detected incursion; • Measure the success of biosecurity systems; • Enable management and cost benefit decisions; • Develop a list of pests or hosts present in an area; • Monitor progress in a pest eradication campaign; • Enable reporting to other organisations. National Plant Protection Organisations (NPPO) and other regulatory agencies conduct different types of survey programmes to fulfil these needs. In addition, these Plant Protection agencies often rely on outreach to passively surveil partners who report pest detections. For example, in New Zealand most new pest detections are reported by industry, researchers, and the public via a toll-free telephone number (Froud et al. 2008). The success of plant protection programmes depends on the ability to detect pests. To conduct a survey, a large number of associated tools and technologies are required (Fig. 11.1). Some of the tools/technology involve statistics, GIS, data management and risk mapping, and will be discussed in this chapter. However, effective surveillance tools and technology are often lacking. When no effective insect trap or lure exists, officials must rely on visual surveys. Detecting plant diseases often presents an even greater challenge. The combination of high costs and inadequate technology leads to survey programmes that are less than optimal. As a result, pests frequently are introduced and become established before timely detection. With delay in discovery of invasive pests, the likelihood of eradication decreases while the cost of control/management/eradication increases dramatically. Figure 11.2 shows the hierarchy of surveillance activities and the flow of information. The flow of information starts at the point of collection in the field. From that point, the information is integrated and tailored to meet the needs of various end-users. For a fruit fly trapping example, regulatory officials collect, clean and compile survey data for managers to use to control fruit fly outbreaks (Chap. 15). For another application, industry collects survey data as part of the day-to-day commercial operations. This data is then used as a basis to run predictive models that can help industry understand the movement of emerging pests or pests of phytosanitary concern (Chap. 9). The same data might also be used by growers or regulatory officials to take action in support of surveillance or eradication. This chapter outlines types of survey operations and provides a review of survey design, information management, data integration, modelling, and GIS. Surveys may be structured around high-consequence target pests. Other surveys may focus on commodities and the survey of exotic pests that may be found associated with that commodity. Still other surveys may target high-risk areas. The USDA, APHIS PPQ Cooperative Agricultural Pest Survey (CAPS) serves as an example of a large surveillance programme that demonstrates various surveillance concepts in practise

Networks of Care in Rural Madagascar for Achieving Universal Health Coverage in Ifanadiana District

International audienceHealth care is most effective when a patient's basic primary care needs are met as close to home as possible, with advanced care accessible when needed. In Ifanadiana District, Madagascar, a collaboration between the Ministry of Public Health (MoPH) and PIVOT, a non-governmental organization (NGO), fosters Networks of Care (NOC) to support high-quality, patient-centered care. The district's health system has three levels of care: community, health center, district hospital; a regional hospital is available for tertiary care services. We explore the MoPH/PIVOT collaboration through a case study which focuses on noteworthy elements of the collaboration across the four NOC domains: (I) agreement and enabling environment, (II) operational standards, (III) quality, efficiency, and responsibility, (IV) learning and adaptation. Under Domain I, we describe formal agreements between the MoPH and PIVOT and the process for engaging communities in creating effective NOC. Domain II discusses patient referral across levels of the health system and improvements to facility readiness and service availability. Under Domain III the collaboration prioritizes communication and supervision to support clinical quality, and social support for patients. Domain IV focuses on evaluation, research, and the use of data to modify programs to better meet community needs. The case study, organized by the domains of the NOC framework, demonstrates that a collaboration between the MoPH and an NGO can create effective NOC in a remote district with limited accessibility and advance the country's agenda to achieve universal health coverage