Developing a Common Understanding of Networks of Care through a Scoping Study

Abstract

The phrase "Networks of Care" seems familiar but remains poorly defined. A health system that exemplifies effective Networks of Care (NOC) purposefully and effectively interconnects service delivery touch points within a catchment area to fill critical service gaps and create continuity in patient care. To more fully elaborate the concept of Networks of Care, we conducted a multimethod scoping study that included a literature review, stakeholder interviews, and descriptive case studies from five low-and middle-income countries. Our extended definition of a Network of Care features four overlapping and interdependent domains of activity at multiple levels of health systems, characterized by: 1) Agreement and Enabling Environment, 2) Operational Standards, 3) Quality, Efficiency and Responsibility, and 4) Learning and Adaptation. There are a series of key interrelated themes within each domain. Creating a common understanding of what characterizes and fosters an effective Network of Care can drive the evolution and strengthening of national health programs, especially those incorporating universal health coverage and promoting comprehensive care and integrated services. An understanding of the Networks of Care model can help guide efforts to move health service delivery toward goals that can benefit a diversity of stakeholders, including a variety of health system actors, such as health care workers, users of health systems, and the wider community at large. It can also contribute to improving poor health outcomes and reducing waste originating from fragmented services and lack of access.

Averting Maternal Death and Disability in an Urban Network of Care in Dar es Salaam, Tanzania: A Descriptive Case Study

“…2 NOC is defined as "a group of … health service delivery sites deliberately interconnected through an administrative and clinical management model which promotes a structure and culture that prioritizes client-centered, effective, efficient operation and collaborative learning, enabling providers across all levels of care, not excluding the community, to work in teams and share responsibility for health outcomes." 11 The new NOC of CCBRT was comprised of government hospitals and catchment facilities operating across Dar es Salaam, originally started in 2010 with 8 facilities: 3 hospitals that were later upgraded to regional referral hospitals, and 5 health centers. In 2011 and again in 2013, additional health centers and 12 dispensaries, which are primary care sites with a limited scope of services (the level of facility down from health center in the Tanzanian health service delivery organizational structure), were added, to reach a total of 22 networked facilities.…”

Applying a Client-centered Approach to Maternal and Neonatal Networks of Care: Case Studies from Urban and Rural Nigeria

“…A NOC is defined as "a group of public and/or private sector service delivery sites deliberately interconnected through an administrative and clinical management model which promotes a structure and culture that prioritizes client-centered, effective, efficient operation and collaborative learning, enabling providers across all levels of care, not excluding the community, to work in teams and share responsibility for outcomes." 11 The NOC Framework proposes that the success of a NOC-as demonstrated by improved patient health outcomes in the targeted clinical areasis accomplished by attention to four interconnected domains: 1) Agreement and Enabling Environment, 2) Operational Standards, 3) Quality, Efficiency and Responsibility and 4) Learning and Adaptation. These case studies from Northern Nigeria and Lagos State use routinely reported data, program operational manuals, standard operating procedures (SOPs), and interviews with NOC stakeholders to retrospectively document the two NOC according to the NOC definition and framework.…”

Harnessing the Power of Networks of Care for Universal Health Coverage

“…12 The NOC approach, a style of integrated health delivery, is described in a multi-method scoping study and case studies from six diverse implementation settings. [1][2][3][4][5][6] The articles provide a set of practicable, measurable means to bridge Networks of Care and Universal Health Coverage.…”

“…The NOC approach offers the possibility to learn from and improve subnational health management, financing and governance, including direct contracting to fill gaps in the public sector offerings. 1 The NOC approach is well suited to translating policies and guidelines into local-level implementation, managing delivery of essential health benefits packages, and providing accountable, trusted systems. 3,5 The use of NOC could improve quality, access, and equity while informing and advancing national pursuit of UHC goals, providing additional efficiencies in implementation, and strengthening the positions of Ministries of Health to leverage additional resources.…”