Role of actor networks in primary health care implementation in low- and middle-income countries: a scoping review

ABSTRACT

Background

Primary health care (PHC) improvement is often undermined by implementation gaps in low- and middle-income countries (LMICs). The influence that actor networks might have on the implementation has received little attention up to this point.

Objective

This study sought to offer insights about actor networks and how they support PHC implementation in LMICs.

Methods

We reviewed primary studies that utilised social network analysis (SNA) to determine actor networks and their influence on aspects of PHC in LMICs following the five-stage scoping review methodological framework by Arksey and O’Malley. Narrative synthesis was applied to describe the included studies and the results.

Results

Thirteen primary studies were found eligible for this review. Ten network types were identified from the included papers across different contexts and actors: professional advice networks, peer networks, support/supervisory networks, friendship networks, referral networks, community health committee (CHC) networks, inter-sectoral collaboration networks, partnership networks, communications networks, and inter-organisational network. The networks were found to support PHC implementation at patient/household or community-level, health facility-level and multi-partner networks that work across levels. The study demonstrates that: (1) patient/household or community-level networks promote early health-seeking, continuity of care and inclusiveness by enabling network members (actors) the support that ensures access to PHC services, (2) health facility-level networks enable collaboration among PHC staff and also ensure the building of social capital that enhances accountability and access to community health services, and (3) multi-partner networks that work across levels promote implementation by facilitating information and resource sharing, high professional trust and effective communication among actors.

Conclusion

This body of literature reviewed suggests that, actor networks exist across different levels and that they make a difference in PHC implementation. Social Network Analysis may be a useful approach to health policy analysis (HPA) on implementation.

KEYWORDS:

• Policy implementation
• primary health care
• actor networks
• social network analysis
• health policy analysis

Responsible Editor Jennifer Stewart Williams

Responsible Editor Jennifer Stewart Williams

Acknowledgments

This paper has been partially funded and supported through the Health Policy Analysis Fellowship programme, by the Alliance for Health Policy and Systems Research, World Health Organisation, Switzerland, and in addition, the first author received mentorship and peer support as a Fellow of the 2020 cohort. We are grateful to Zubin Shroff for the critical comments and reviews of the manuscript.

Author contributions

Dominic Dormenyo Gadeka was responsible for the conceptualisation and design of the study, analysis and interpretation of the data, and writing and revising the manuscript. Lucy Gilson and Eleanor Whyle contributed to the validation of the research design, review and editing analysis and interpretation of the data. Patricia Akweongo, Genevieve Cecilia Aryeetey and Justice Moses Aheto reviewed the paper and provided relevant feedback. All authors have read and approved the final version of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Paper context

Primary health care improvement is often undermined by implementation gaps in low- and middle-income countries. Limited attention has been paid to the role actor networks could play over the implementation. This body of literature reviewed suggests that, actor networks exist across different levels and that they make a difference in primary health care implementation. Social Network Analysis may be a useful approach to health policy analysis on implementation.

Additional information

Funding

This paper has been partially funded and supported through the Health Policy Analysis Fellowship programme, by the Alliance for Health Policy and Systems Research, World Health Organisation, Switzerland.