Client: World Health Organization (WHO)
Project: A social network analysis of health centres and support structures in Lebanon
Date: September 2021
WHO approached Ripple Research to provide them with a social network analysis of health centres and service providers in Lebanon. This was in order to detect vulnerabilities in the healthcare network and strengthen the resilience of the Ministry of Public Health’s approach to collaborative governance.
As a response to the challenges arising from the chaotic and highly politicized environment, failing government policy implementation, and the predictable impasses of adversarial or command-and-control approaches, Lebanon’s Ministry of Public Health (MoPH) has developed its homegrown version of “collaborative governance”. A study has been commissioned by World Health Organization (WHO) Country Office Lebanon to carry out the first analysis of the Primary Health Care (PHC) Network.
In collaboration with Connecting Research to Development (CRD), Ripple Research conducted an assessment with the aim to detect vulnerabilities in the National PHC Network, improve its performance and identify linkages that can be strengthened which should enhance the resilience of MoPH’s approach to collaborative governance.
Connecting Research to Development (CRD) is a non-profit that operates in the support, generation, and dissemination of evidence-based research from combined perspectives of public health and social sciences.
CRD approached Ripple Research to provide them with a social network analysis (SNA) of health centres and service providers in Lebanon. This was in order to detect vulnerabilities in the healthcare network and to strengthen the resilience of the Ministry of Public Health’s approach to collaborative governance.
Exploring the importance of collaborative governance for Lebanon’s healthcare system
Lebanon has experienced overlapping crises in recent times, in addition to infrastructural breakdown and political paralysis, the nation has also felt the tremors of the COVID-19 pandemic, whereby 8% of the population of 6.5 million contracted the novel coronavirus.
Despite these hurdles, the country’s healthcare ecosystem has shown resilience in the form of an encouraging health insurance market, successive reforms and evidence-based decision making when it comes to the efficient use of people’s private financial resources.
Overtime, The Ministry of Public Health (MoPH) in Lebanon has ebbed towards “collaborative governance” by creating a network of Primary Healthcare Centers (PHC) which has embedded other stakeholder groups to create a large network.
This includes networks of: hospital managers, professionals working in mental health, organisations involved in Human Resources for Health (HRH), staff working in pharmaceutical policy and regulation, Lebanese health system experts as well as those that work in emergency services and palliative care.
In this case study, we explore the nature of Lebanon’s healthcare system and understand the cross-sectional network of primary health centres by ascertaining the positioning and embeddedness of key primary health centres and the inter-linkages with their service providers. This is salient in order to detect vulnerabilities within the healthcare network and strengthen the resilience of the Ministry of Public Health’s approach to collaborative governance.
Our approach
In order to understand the embeddedness and hierarchical positioning of individual health centres in terms of access to material resources, funding and quality work force, we selected 83 primary health centres from a total of 1140 using a sampling method.
We mapped these 83 public health centres to ten specific service providers using sophisticated network visualization software to get both non-compounded ego network and composite network visualizations.
Our approach consisted of a 3-step process to draw relationship insights of different engagements across the primary health centre network. This involved cleaning and coding the data, conducting a network analysis and generating insights through hierarchical and divisional positioning.
Below is a snapshot of the network ecosystem accompanied with an analysis of the network density. This offers an insight into the complexity of the linkages that covered the diversity of engagement, tie strength, and centrality scores amongst other parameters of importance.
What we discovered
Through our social network analysis, Ripple Research revealed two main discoveries.
We determined the relative positions of every service provider linked to different primary health care centres in the network and revealed the strength and diversity of linkages. This helped in determining which primary health care centres enjoy the greatest level of immunity from network-caused vulnerabilities due to their advantageous (tightly coupled with fewer constraints) position in the network.
It also became clear that even the highly engaged primary health centres or service providers do not enjoy similar strength of ties across all verticals. This means that ties are also determined by strengths of actors involved and not solely dependent on their strategic positions. This emboldens the need of working towards ‘collaborative governance’ for optimal results.
These insights can be used by international aid agencies, government and civic bodies to better understand and analyse social cohesiveness and embeddedness of actors involved in a given context. Moreover, this custom-built framework can be applied across other sectors and geographies.
Our research acts as a preliminary filter and guide for policymakers to build inclusive policies that ensure fair resource allocation at a grass-roots level across social networks.