School of Public Health, Makerere University, Uganda Mulago Hospital Complex, Mulago Hill Road, P.O. Box 7072, Kampala, Uganda.
Institute for International Health and Development, Queen Margaret University, Edinburgh, UK.
Health Policy Plan. 2017 Oct 1;32(8):1193-1202. doi: 10.1093/heapol/czx071.
In post-conflict settings, service coverage indices are unlikely to be sustained if health systems are built on weak and unstable inter-organization networks-here referred to as infrastructure. The objective of this study was to assess the inter-organization infrastructure that supports the provision of selected health services in the reconstruction phase after conflict in northern Uganda. Applied social network analysis was used to establish the structure, size and function among organizations supporting the provision of (1) HIV treatment, (2) maternal delivery services and (3) workforce strengthening. Overall, 87 organizations were identified from 48 respondent organizations in the three post-conflict districts in northern Uganda. A two-stage snowball approach was used starting with service provider organizations in each district. Data included a list of organizations and their key attributes related to the provision of each service for the year 2012-13. The findings show that inter-organization networks are mostly focused on HIV treatment and least for workforce strengthening. The networks for HIV treatment and maternal services were about 3-4 times denser relative to the network for workforce strengthening. The network for HIV treatment accounted for 69-81% of the aggregated network in Gulu and Kitgum districts. In contrast, the network for workforce strengthening contributed the least (6% and 10%) in these two districts. Likewise, the networks supporting a young district (Amuru) was under invested with few organizations and sparse connections. Overall, organizations exhibited a broad range of functional roles in supporting HIV treatment compared to other services in the study. Basic information about the inter-organization setup (infrastructure)-can contribute to knowledge for building organization networks in more equitable ways. More connected organizations can be leveraged for faster communication and resource flow to boost the delivery of health services.
在冲突后环境中，如果卫生系统建立在脆弱和不稳定的组织间网络（即基础设施）上，服务覆盖指数不太可能持续。本研究旨在评估在乌干达北部冲突后重建阶段支持提供选定卫生服务的组织间基础设施。应用社会网络分析来确定支持提供（1）艾滋病毒治疗、（2）产妇分娩服务和（3）劳动力加强的组织之间的结构、规模和功能。总体而言，从乌干达北部三个冲突后地区的 48 个应答组织中确定了 87 个组织。采用两阶段滚雪球方法，从每个地区的服务提供组织开始。数据包括 2012-13 年提供每项服务的组织名单及其与提供每项服务相关的主要属性。调查结果表明，组织间网络主要集中在艾滋病毒治疗方面，而在劳动力加强方面的网络最少。艾滋病毒治疗和产妇服务网络相对于劳动力加强网络密集度约为 3-4 倍。艾滋病毒治疗网络在古卢和基特古姆地区分别占总网络的 69-81%。相比之下，劳动力加强网络在这两个地区的贡献最小（分别为 6%和 10%）。同样，支持年轻地区（阿穆鲁）的网络投资不足，组织较少，连接稀疏。总体而言，与研究中的其他服务相比，组织在支持艾滋病毒治疗方面表现出广泛的功能角色。组织间设置（基础设施）的基本信息可以为以更公平的方式建立组织网络提供知识。更多的联网组织可以利用更快的沟通和资源流动来促进卫生服务的提供。
