Measuring coordination between women's self-help groups and local health systems in rural India: a social network analysis

Objectives To assess how the health coordination and emergency referral networks between women's self-help groups (SHGs) and local health systems have changed over the course of a 2-year learning phase of the Uttar Pradesh Community Mobilization Project, India. Design A pretest, post-test programme evaluation using social network survey to analyse changes in network structure and connectivity between key individuals and groups. Setting The study was conducted in 18 villages located in three districts in Uttar Pradesh, India. Intervention To improve linkages and coordination between SHGs and government health providers by building capacity in leadership, management and community mobilisation skills of the SHG federation. Participants A purposeful sampling that met inclusion criteria. 316 respondents at baseline and 280 respondents at endline, including SHG members, village-level and block-level government health workers, and other key members of the community (traditional birth attendants, drug sellers, unqualified rural medical providers, pradhans or elected village heads, and religious leaders). Main outcome measures Social network analysis measured degree centrality, density and centralisation to assess changes in health services coordination networks at the village and block levels. Results The health services coordination and emergency referral networks increased in density and the number of connections between respondents as measured by average degree centrality have increased, along with more diversity of interaction between groups. The network expanded relationships at the village and block levels, reflecting the rise of bridging social capital. The accredited social health activist, a village health worker, occupied the central position in the network, and her role expanded to sharing information and coordinating services with the SHG members. Conclusions The creation of new partnerships between traditionally under-represented communities and local government can serve as vehicle for building social capital that can lead to a more accountable and accessible community health delivery system.