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.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2021
2021
Historique:
received:
27
11
2020
accepted:
27
04
2021
entrez:
12
5
2021
pubmed:
13
5
2021
medline:
21
10
2021
Statut:
epublish
Résumé
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. 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. 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. 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 33979415
doi: 10.1371/journal.pone.0251472
pii: PONE-D-20-37351
pmc: PMC8115818
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0251472Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Afr J AIDS Res. 2018 Dec;17(4):301-312
pubmed: 30466345
Health Policy Plan. 2013 Mar;28(2):143-56
pubmed: 22411882
J Epidemiol Community Health. 2004 Dec;58(12):971-5
pubmed: 15547054
BMC Health Serv Res. 2014 Oct 04;14:479
pubmed: 25280467
S Afr Med J. 2013 Jan 23;103(3):156-8
pubmed: 23472691
Glob Health Action. 2013 Jan 24;6:19289
pubmed: 23364085
BMC Public Health. 2017 Feb 15;17(1):200
pubmed: 28202001
Soc Sci Med. 2015 Jun;135:1-14
pubmed: 25931377
PLoS One. 2015 Jun 25;10(6):e0131712
pubmed: 26110842
Health Policy. 2014 May;116(1):61-70
pubmed: 24513175
Health Policy Plan. 2012 May;27 Suppl 2:ii27-38
pubmed: 22513730
Health Policy. 2014 May;116(1):51-60
pubmed: 24508181
Glob Health Action. 2014 Dec 22;7:25327
pubmed: 25537938
Health Policy Plan. 2020 Apr 1;35(3):302-312
pubmed: 31872256
Health Res Policy Syst. 2020 Jun 3;18(1):55
pubmed: 32493349
Health Policy Plan. 2007 May;22(3):186-92
pubmed: 17485420
Int J Health Policy Manag. 2017 Nov 25;7(7):603-613
pubmed: 29996580
Health Policy Plan. 2018 Jul 1;33(suppl_2):ii65-ii74
pubmed: 30053037
Global Health. 2020 Jan 9;16(1):5
pubmed: 31918730
J Health Polit Policy Law. 2015 Apr;40(2):281-323
pubmed: 25646388
Health Res Policy Syst. 2019 Apr 16;17(1):42
pubmed: 30992014
Implement Sci. 2013 Oct 01;8:116
pubmed: 24083343