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Professional advice networks present an opportunity to change health provider practice as healthcare workers are oftentimes likely to be convinced by trusted colleagues. Moreover, making use of such advice networks can be particularly relevant in resource constrained settings where funding for and feasibility of training everyone does not exist.

This study, authored by Kate Sabot et al and published in BMC Health Services Research, compares professional advice networks of healthcare workers in eight primary healthcare units across four regions of Ethiopia.

One hundred sixty staff at eight primary healthcare units were interviewed using a structured tool. Quantitative data captured the frequency of healthcare worker advice seeking and giving on providing antenatal, childbirth, postnatal and newborn care.

This study provides foundational information regarding professional advice networks of PHCU healthcare workers in Ethiopia. This study establishes that PHCU staff involved in delivery of maternal and newborn health services have informal advice networks outside of supervisory structures.

Findings point to the importance of focusing future training on cadres more central to advice networks, such as midwives. One possibility could be training an individual or two per PHCU to be the “knowledge sharing focal persons”, who attend trainings and are responsible for sharing learnings. Another could be cadre-based in service trainings with the same mandate for sharing learnings. Further studies would be needed to pilot such approaches to ensure achievement of equivalent learning and patient outcomes. A simple policy implication of this work could be providing guidelines and reference material in local languages.

This study demonstrates the feasibility of using social network analysis methods in rural Ethiopia, which has implications for other low or middle-income countries. This study also shows the value of combining quantitative network methods with qualitative research to lend a greater understanding of network properties. Mixed SNA method studies should be used more widely in these contexts as they provide a different lens and understanding of professional advice networks in settings where resources for health are increasingly constrained and as such networks may be an efficient and effective way to change practice.


Kate Sabot

IDEAS Research Assistant and DrPH student 2013-2016

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Dr Della Berhanu

Assistant Professor

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Dr Neil Spicer

Associate Professor

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Professor Joanna Schellenberg

IDEAS Co-Principal Investigator and Professor