using network-mapping to examine
TRANSCRIPT
Using Network-Mapping to Examine Information
Dissemination and Implementation Within Ethiopia’s Family
Planning and Reproductive Health System
Presenter: Sarah V. Harlan
Co-authors: Tara M. Sullivan, Samson Estifanos,
Sisay Wagnew, Gashaw Mengistu
Outline
• Context & background
• Methods
• Results
– Net-Map
– Needs assessment
• Summary & recommendations
Context: Ethiopia
• Population: 83 million
• Fertility rate: 4.8 children per
woman
• Maternal mortality ratio:
673/100,000 live births
• Infant mortality rate:
68/1,000 live births
• Use of modern
contraception: 27.3%
• Unmet need for
contraception: 25.3%
Context: Ethiopia
• Opportunities to improve
family planning and
reproductive health
(FP/RH)
– Government support
– Development partnerships
– Donor support
Context: Lack of Heath
Information
Many health professionals
and health policy makers in
Africa lack access to the
information needed to make
evidence-based decisions
and provide effective care.
Source: Neil Pakenham-Walsh and Frederick Bukachi. Information needs
of health care workers in developing countries: a literature review with a
focus on Africa. Human Resources for Health 2009, 7:30.
© 2001 Hugh Rigby, Courtesy of Photoshare
Study objectives
1. Explore the current family
planning/reproductive health (FP/RH)
knowledge management system in Ethiopia
2. Examine information flows, barriers, and
opportunities at different levels of the health
system
3. Identify areas to strengthen health information
sharing and use
Study Population
• Program officers
• Information officers
• Senior advisors
• Health care providers
© 2007 Bonnie Gillespie, Courtesy of Photoshare
© 2005 Virginia Lamprecht, Courtesy of Photoshare
Methods
• Part of multi-country qualitative study
– India, Malawi, Senegal, Ethiopia, Peru
• Examined multiple levels of the health system
– National level (Addis Ababa)
– Regional and zonal/woreda levels
• 3 of the 9 regions (Amhara, Oromia,
and Afar) and their respective zones
• Methodology
– 17 key informant interviews
– 4 group interviews, 2 focus groups
– 3 Net-Map exercises (national, regional, zonal)
Interviews and Focus Groups
National Regional/Zonal Total
Addis Ababa Amhara Oromia Afar
TYPE National Regional Zonal/Woreda Regional Zonal/Woreda Regional/Woreda
Individual
interview
11 3 1 2 17
Focus
group
1 1 2
Group
interview
1 1 1 1 4
TOTAL 11 4 1 2 1 4 23
Network Mapping (Net-Map)
• Participatory social mapping tool
• Individuals/groups address a key question and
create a network map of actors
Source: Schiffer, E., Hauck, J. (August 2010) Net-Map: Collecting Social Network Data and
Facilitating Network Learning through Participatory Influence Network Mapping. Field Methods
22(3).
Net-Map: Methods
• Individual/groups:
– Listed FP/RH actors, drew links
between them
– Added wooden “influence
towers”
– Discussed the goals of each
actor
• Researchers entered data into
Visualizer software
© 2011, Natalie Campbell, Courtesy of MSH
Net-Map: Methods
Net-Map: Overall Results
• Number of FP/RH actors:
103 (46 most influential)
• Information flow: Ministry
of Health (MOH) at center
• Influence: MOH received
highest ranking
• Funding: USAID is main
source; MOH is main
recipient
Net-Map: National Level Results
• Information flow:
MOH at center
• Influence: MOH seen
as most influential
• Funding: Mostly
provided by U.S.-based
donors
Net-Map: National Level Results
“…Many actors are focusing in their own
area of engagement, rather than seeing the
comprehensive package and the national
situation, the big picture... information
management system on the topic is weak
and needs urgent fix.”
–Respondent, CORHA (The Consortium of
Reproductive Health Associations)
Net-Map: Regional Level Results
• Information flow:
Regional MOH plays
central role
• Influence: Government
and international NGOs
most influential
• Funding: Mostly USAID
and other international
donors/bilaterals
Net-Map: Regional Level Results
“…though there are different international
and local NGOs, only a few are
working on FP/RH programs in Afar.” – Respondent, ROHA WEDDU (Ethiopian NGO)
Net-Map: Zonal/Woreda Level
Results
• Information flow: Zonal
MOH at the center
• Influence: Governmental
orgs, local NGOs,
international NGOs are
most influential
• Funding: U.S.-based
donors/bilateral, channeled
through international NGOs
Net-Map: Zonal/Woreda Level
Results
“Most NGOs and donor/bilateral
engagements...will be phasing out at
some point in time. But the government-
based programs will remain so far as the
constitutional order is there. Therefore,
empowering the government line offices
at different levels ensures sustainability.”
– Director, ROHA WEDDU (Ethiopian NGO)
Information Needs: Overall Results
• Timely, regular access to FP/RH information
• Central information repository
• Diverse types of materials
• Additional training and improved ICT
(information and communication technology)
• Stronger professional networks
Information Needs: Overall Results
“FP/RH-related information is not well
communicated and good practices are not shared
among the different actors.”
– Program Officer, FHI 360
“…integration is highly needed in such areas to avoid
unnecessary duplication and resource wastage.
Despite limited actors in the region, program/
resource coordination and integration is very
weak.”
– Respondent, Afar focus group
Information Needs: Results by Level
Level Main information needs Quotes
National Up-to-date, high-quality, contextualized information for making high-level FP/RH decisions (policy, etc.)
“…the government policies/strategies are not well communicated, even to the NGOs operating on the topic.”
Regional Policy and strategy from national level; information on practical challenges from the community level; consistent and up-to-date information
“…[we have] diverse and uncontrolled sources of information on FP/RH, which creates confusion in some areas.”
Zonal Easy-to-understand information packaged appropriately (in local language and adapted for local context)
“…[there is] no easy access of information to updates and best practices. “
Preferred Communication Methods:
Results
• Mobile phones are widely
used at all levels
• Internet is preferred at the
national level
© 2007 Andrew Heavens
Preferred Communication Methods:
Results
• Meetings are highly
valued, especially at
regional and zonal
levels
• Print materials are
requested at the
regional/zonal levels
© 2005 Virginia Lamprecht, Courtesy of Photoshare
Preferred Communication Methods:
Results
“We use ‘Dagu’ as an opportunity to
disseminate information. As a tradition, when
two Afars meet, whether know each other or
not, they sit and exchange information clearly…
We use different health issues to be raised
in ‘Dagu’ chat, so that it is disseminated
easily.”
– Respondent, local NGO, Afar Region
Summary of Findings
• Large number of actors working on FP/RH in
Ethiopia, but not distributed evenly
• MOH lies at the center of the information
system, and information can be slow to diffuse
• Health professionals need:
– FP/RH information that is up-to-date,
understandable, and contextualized
– more coordination among organizations
– a central repository for information on FP/RH
Key Recommendations
• Communicate governmental
policies regularly to ensure
high-quality FP/RH programs
& services
• Set up programs for
learning and sharing FP/RH
information at all levels of the
health system
• Strengthen systems – ICT
infrastructure, KM system, and
RH/FP networks
© 2009 Mengistu Asnake, Courtesy of Photoshare
For More Information
Sarah V. Harlan
Tara M. Sullivan
Samson Estifanos
Sisay Wagnew
Gashaw Mengistu
Visit:
http://www.k4health.org/needs-assessments
© 2005 Virginia Lamprecht, Courtesy of Photoshare
Thank You