Johnson-Peretz Jason, Christian Canice, Akatukwasa Cecilia, Atwine Fred, Kamya Moses R, Havlir Diane V, Chamie Gabriel, Camlin Carol S, Kakande Elijah
University of California, San Francisco.
Infectious Diseases Research Collaboration.
Res Sq. 2025 Jul 31:rs.3.rs-5046392. doi: 10.21203/rs.3.rs-5046392/v1.
Decentralisation policies that devolve certain administrative and decision-making powers to local levels can pose challenges for public health and healthcare systems. For a decentralised health system to function optimally, mid-level systems must rely on tightly clustered, so-called "small-world" networks to efficiently scale-up national health campaigns and share best practices. Few studies have qualitatively tackled the mechanisms of small-world creation and their potential effects on public health promotion during centralized national campaigns in a decentralised, mid-level healthcare system tier.
We performed a thematic analysis using a rigorous and accelerated data reduction (RADaR) technique on 23 in-depth interviews and six focus group discussions with mid-level healthcare managers in a cluster-randomised trial from 2019 to 2021, whose intervention component aimed to increase isoniazid preventive therapy (IPT) uptake to prevent tuberculosis among people living with HIV in Uganda.
Training mid-level managers on management and leadership skills fostered the creation of small-world networks within a decentralised healthcare context and promoted mid-level manager agency to address several drawbacks associated with the decentralisation of healthcare systems. Through improved communication, intervention groups encouraged teamwork within their districts, building a denser cluster of networks. This in turn fostered small world ties that paired transparency with a sense of reciprocal accountability moving in multiple directions, upwards to the Ministry of Health (MoH), downwards towards local communities, and horizontally towards peers.
Increased collaboration demonstrably strengthened the clustering of small-world network ties at a horizontal level to disseminate knowledge of best practices more quickly and efficiently in promoting the uptake of IPT while ensuring accountability to peers, the MoH, and local communities, sustaining these levels after a centralized national campaign ended.
NCT03315962. Registered 20 October, 2017.
将某些行政和决策权下放至地方层面的分权政策可能给公共卫生和医疗系统带来挑战。对于一个分权的卫生系统而言，要实现最佳运作，中层系统必须依赖紧密聚集的所谓“小世界”网络，以有效扩大全国性卫生运动的规模并分享最佳实践经验。在分权的中层医疗系统层级开展集中式全国运动期间，很少有研究定性探讨小世界形成的机制及其对公共卫生促进的潜在影响。
我们在2019年至2021年的一项整群随机试验中，对23次深度访谈和6次与中层医疗管理人员的焦点小组讨论进行了主题分析，该试验的干预部分旨在提高异烟肼预防性治疗（IPT）的使用率，以预防乌干达艾滋病毒感染者中的结核病。
对中层管理人员进行管理和领导技能培训，有助于在分权的医疗环境中创建小世界网络，并提升中层管理人员应对与医疗系统分权相关的若干弊端的能力。通过改善沟通，干预组鼓励其所在地区内的团队合作，构建了更密集的网络集群。这反过来又促进了小世界联系，将透明度与多向的相互问责意识相结合，向上至卫生部（MoH），向下至当地社区，横向至同行。
加强合作显著增强了小世界网络联系在横向层面的聚集，从而在推广IPT的过程中更快、更有效地传播最佳实践知识，同时确保对同行、卫生部和当地社区负责，并在集中式全国运动结束后维持这些水平。
NCT03315962。于2017年10月20日注册。
