Poster at Integration for Impact Conference in September of 2012.

1. Coordination and Integration of HIV and
Family Planning Services through
Organizational Network Analysis
Heidi REYNOLDS1; Jim THOMAS1,2; Ademe TSEGAYE3; Christine BEVC4
1MEASURE Evaluation, Carolina Population Center, University of North Carolina, Chapel Hill (UNC-CH), Email: heidi_reynolds@unc.edu
2Department of Epidemiology, Gillings School of Global Public Health, UNC-CH
3FHI360, Addis Ababa, Ethiopia
4Center for Public Health Preparedness, NC Institute for Public Health, Gillings School of Global Public Health, UNC-CH
Introduction
• People living with HIV may need care and treatment for their HIV
disease, counseling on skills to protect their partners, prevention or Map of Kolfe Keranyo and Kirkos sub-cities,
treatment for tuberculosis or other diseases, to prevent unintended Addis Ababa
pregnancies, training for jobs, or support for housing.
• Services for people with HIV are provided by a variety of
organizations that seldom coordinate with each other, leading to
service gaps and other inefficiencies.
• Organizational network analysis (ONA) is part of an approach that
has the potential to understand relationships among actors and
make better use of available resources to improve service
integration.
• Baseline study goal: To use the ONA approach to understand how
organizations work together (or not) to achieve program
objectives, meet clients’ needs, and reduce duplication or fill gaps.
Methods
• Enumeration period: Identified all organizations in 2 sub-cities in
Addis Ababa, Ethiopia providing HIV or family planning (FP)
services to women ages 18-49 (Kirkos n=25; Kolfe Keranyo n=26).
• Organizational representative interviews: Conducted in
May, 2011 to examine exchanges of information, resources, and
clients.
• Female client interviews: Also conducted in May 2011 with
female clients of one large home-based HIV care organization
(Kirkos n=234; Kolfe Keranyo n=225). Source: www.addisallaround.com
• Results interpretation meeting: In November, 2011, held
meetings with organizational representatives in both sub-cities to
share results and shape a response to improve networking.
Main Instrument for Collecting Data about the Organizational Network
The instrument lists all facilities, organizations, bureaus, and offices identified during the enumeration period and
involved in care and support services for people living with HIV and/or provide some family planning services. The
organizational representative is asked about the extent to which his/her organization is involved with, or linked
to, the others based on different types of in involvement (e.g., shared funding [money]; client referrals, etc.).
Scored as 0 = Never, 1= less than once a month, 2= 1-3 times a month, 3=4-8 times a month, or 4= more than 8 times a month
Organizational Results (preliminary) Client results (preliminary)
Kirkos Kofle
FP and HIV services* provided
N=234 N=225
by organizations Kirkos Kolfe Keranyo
Age (mean years) 33.9 32.1
HIV only 18 (72%) 5 (19%)
Average income of clients less than 83% 89%
FP only 0 1 (4%)
US$1/day
Both 7 (28%) 20 (77%)
< or = 30 min Travel time to nearest 79% 61%
*HIV services may include one or more of: HIV diagnostic testing; dispense government health facility
ART; preventative therapy for opportunistic infections (CTX); preventative
therapy for TB (INH); treatment of TB; treatment of STIs; provision of prophylaxis
Currently using a pregnancy prevention 30% 45%
for PMTCT; pediatric HIV/AIDS care; nutritional services; pharmacy services; method
home-based care for PLHA; social support for PHLA; or housing services. Client adherence to ARV regimen 59% 65%
General Quality of Life* 2.24 2.09
Organizational Referrals (for any *Scale of 1-5 where 1 is ‘very poor’ and 5 is ‘very good’
Kirkos Kolfe Keranyo
reason/service)
Number of ties 69 101
3 Network Strengthening Meetings
Density (the number of ties as a Held in March, June & August, 2012 with representatives from Kirkos
11.5% 15.5%
percent of all possible ties) using an adapted leadership development program (LDP) approach
to strengthen network.
Organizational Network Graph of Client Referral
Patterns
Discussion
• Baseline identified low levels of referral between organizations.
• Referrals were mainly to similar type organizations (e.g., NGOs
Kirkos Kolfe Keranyo referred to NGOs, etc.). The exception was in Kolfe where there
was the presence of a large major government referral hospital
that received referrals.
• Clients had needs for social services & services to improve ART
Graphic Summary of Client Referral Patterns adherence.
among Types of Organizations
Next Steps
• Collect follow-up data in October, 2012 to see if referrals are
strengthened and Kirkos goal is met (see pic).
• Ultimately to understand when organizational networks change over
time, how do clients’ outcomes change?
Potential applications of ONA
• To provide information to organizations and donors so that they can
improve coordination and collaboration.
• Programmatic assessment tool: to understand exchanges of
information, resources and referrals between organizations and use
this information to strengthen the network.
Kirkos Kolfe Keranyo • Evaluation tool: Quantitative assessment over time to understand
whether referrals and exchanges of information and resources
increase as a result of intervention.
For more information about organizational networks or
this study:
www.measureevaluation.org/networks/organizational-
networks