save the children – saving newborn organizational … · 2019. 5. 8. · save the children...

Study Team: Ashley Strahley (Team Leader), Lynne Franco, Sarya Sok, Jonathan Jones, Lyn Messner and Beeta Tahmassebi

SAVE THE CHILDREN – SAVING NEWBORN LIVES Organizational Network Analysis of the Communities of Organizations Working on Newborn Health and Survival: Bangladesh, Malawi, Nepal, Uganda and at the Global Level

September 2014

Point of Contact:

Lynne Franco Vice President, Technical Assistance and Evaluation EnCompass LLC 11426 Rockville Pike, Suite 229 Rockville, MD 20852 Tel: +1-301-287-8700 Email: [email protected]

mailto:[email protected]

Save the Children September 2014

Newborn Organizational Network Analysis ii

TABLE OF CONTENTS Acronyms .................................................................................................................................................. iii

Executive Summary ....................................................................................................................................iv

Purpose of the Organizational Network Analysis ......................................................................................... 1

Methods ..................................................................................................................................................... 2

Findings ...................................................................................................................................................... 4

Reflections on the Way Forward ............................................................................................................... 18

References ............................................................................................................................................... 20

Appendix A: Participating Organizations .................................................................................................... 21

Appendix B: Types of Organizations Represented ...................................................................................... 25

Appendix C: Limitations of the Organizational Network Analyses ............................................................... 26

Appendix D: Organizations Playing Key Network Functions ........................................................................ 27

Appendix E: Summaries of Each ONA’s Results .......................................................................................... 30 Bangladesh ONA Summary ............................................................................................................................... 31 Malawi ONA Summary ..................................................................................................................................... 32 Nepal ONA Summary ........................................................................................................................................ 33 Uganda ONA Summary ..................................................................................................................................... 34 Global ONA Summary ....................................................................................................................................... 35

TABLE OF EXHIBITS FIGURE 1: ONA RESPONSE RATES ................................................................................................................................................... 3 FIGURE 2: NETWORK DENSITY ......................................................................................................................................................... 4 FIGURE 3: LEVELS OF INTERACTION ................................................................................................................................................... 4 FIGURE 4: LEVELS OF INTERACTION IN COUNTRY AND GLOBAL LEVEL NEWBORN COMMUNITIES ................................................................... 5 FIGURE 5: EVOLUTION OF A NETWORK .............................................................................................................................................. 6 FIGURE 6: KEY FEATURES OF A NETWORK PLOT ................................................................................................................................... 6 FIGURE 7: BANGLADESH NEWBORN NETWORK - LEVEL OF INTERACTION AS REPORTED BY OTHER ORGANIZATIONS.......................................... 8 FIGURE 8: MALAWI NEWBORN NETWORK - LEVEL OF INTERACTION AS REPORTED BY OTHER ORGANIZATIONS ................................................ 9 FIGURE 9: NEPAL NEWBORN NETWORK - LEVEL OF INTERACTION AS REPORTED BY OTHER ORGANIZATIONS ................................................. 10 FIGURE 10: UGANDA NEWBORN NETWORK - LEVEL OF INTERACTION AS REPORTED BY OTHER ORGANIZATIONS ........................................... 11 FIGURE 11: FREQUENCY OF INTERACTION IN COUNTRY LEVEL NEWBORN COMMUNITIES .......................................................................... 12 FIGURE 12: GLOBAL NEWBORN NETWORK - LEVEL OF INTERACTION AS REPORTED BY OTHER ORGANIZATIONS ............................................. 13 FIGURE 13: HIGHEST CENTRALITY SCORING ORGANIZATIONS FOR TECHNICAL AREAS OF INTERACTION AT THE GLOBAL LEVEL ........................... 14 FIGURE 14: AREAS OF INTERACTION IN THE GLOBAL LEVEL NEWBORN COMMUNITY ................................................................................ 14 FIGURE 15: TOP THREE ORGANIZATIONS PLAYING KEY NETWORK FUNCTIONS ........................................................................................ 15 FIGURE 16: COMPLETE LIST OF ORGANIZATIONS (AND ACRONYMS) INCLUDED IN EACH ORGANIZATIONAL NETWORK ANALYSIS ......................... 21 FIGURE 17: TYPES OF ORGANIZATIONS REPRESENTED IN EACH ORGANIZATIONAL NETWORK ANALYSIS ......................................................... 25 FIGURE 18: ORGANIZATIONS PLAYING A KEY NETWORK ROLE IN PROVIDING TECHNICAL EXPERTISE ............................................................... 27 FIGURE 19: ORGANIZATIONS PLAYING A KEY NETWORK ROLE OF KNOWLEDGE MANAGEMENT ..................................................................... 28 FIGURE 20: ORGANIZATIONS PLAYING A KEY NETWORK ROLE IN CONVENING FOR THE COMMUNITY ............................................................. 28 FIGURE 21: ORGANIZATIONS PLAYING A KEY NETWORK ROLE IN PROVIDING LEADERSHIP ............................................................................ 29

file:///C:/Users/Lynne%20Franco/Dropbox/SNL3%20ONA/ONA/Synthesis%20Report/Organizational%20Network%20Analysis%20of%20Newborn%20Communities%20-%20Synthesis%20Report_1Oct2014.docx%23_Toc399926287


Newborn Organizational Network Analysis iii

ACRONYMS

BMGF Bill & Melinda Gates Foundation

CSO Civil Society Organization

ENAP Every Newborn Action Plan

icrrd.b International Centre for Diarrhoeal Disease Research, Bangladesh

LSHTM London School of Hygiene and Tropical Medicine

M&E Monitoring and Evaluation

MDG Millennium Development Goals

MNCH Maternal, Newborn and Child Health

MOH Ministry of Health

MoHP Ministry of Health and Population

NNSC National Newborn Steering Committee

ONA Organizational Network Analysis

PMNCH The Partnership for Maternal, Newborn & Child Health

Save Save the Children

SNL Saving Newborn Lives

UNICEF The United Nations Children’s Fund

USAID United States International Development Agency

WHO World Health Organization


Newborn Organizational Network Analysis iv

EXECUTIVE SUMMARY

Introduction: Over the last 15 years, newborn health has garnered increased attention, and individuals, organizations, and communities of organizations have emerged to work on newborn health and survival at both global and country levels. Save the Children’s Saving Newborn Lives (SNL) program commissioned EnCompass LLC to conduct a series of five organizational network analyses (ONA) to gain insight into the current functioning of newborn communities in Bangladesh, Malawi, Nepal, Uganda, and at the global level. ONA is a technique that maps interactions between organizations and identifies relationship structures and patterns. The five ONAs included in this study are intended to encourage reflection and guide the charting of a pathway to maintain momentum for newborn health and survival by identifying appropriate actions to enhance future sustainability and specific organizations that could play key roles in sustaining the momentum over time.

Methods: The five ONAs assessed connectedness of individual organizations; identified which organizations play a central role in the network; appraised how cross-connected the newborn community is; and gauged the role SNL is currently playing in the network. Each ONA used a mixed methods approach, collecting quantitative data on characteristics of interaction between organizations, as well as qualitative data on strengths, challenges, and goals for the network. A total of 25 organizations at country level and 40 for the global level ONA were sampled. The sample included government agencies, research/academic institutions, professional associations, development partners, nongovernmental implementing organizations, and other organizations. The study team collected data through phone and Skype interviews, and used UCINET and NetDraw to create the network plots. The study’s limitations include the limited and pre-determined sample size and difficulties in differentiation between entities in the sample or between individuals and the organizations they represented.

Findings: ONA provides a number of quantitative measures to describe the interactions in a network. Network density, a measure of the overall connectedness of the organizations, was high in all five ONAs, ranging from 59% for the global newborn community to 79% in Bangladesh. Some similarities and differences were found across the five newborn communities, and SNL was among the most connected organizations in all five ONAs:

Bangladesh: Bangladesh’s newborn network has the highest overall density and the largest percentage of interactions rated as “high.” Bangladesh’s network plot indicates a wide diversity among the most central/connected organizations: government, research/academic organizations, development partners, nongovernmental implementing organizations, professional associations, and other organizations. Bangladesh was the only ONA revealing such diversity.

Malawi: In Malawi, the most frequently mentioned level of interaction was “high”. The most central organizations in Malawi’s newborn network included development partners, nongovernmental implementing partners, one government agency, and a research/academic organization. Development partners dominated the most central group.

Nepal: Nepal’s newborn network plot revealed a strong government presence in the network, with three government entities with the highest centrality measures. When looking at the top


Newborn Organizational Network Analysis v

two groups, government, development partners, and nongovernmental implementing partners were represented, which is somewhat less diverse than the most central group in other country networks. “High” levels of interaction were the most frequent.

Uganda: Organizations in the top two centrality groups in Uganda’s network plot included government, development partners, nongovernmental implementing partners, professional associations, and the National Newborn Steering Committee (NNSC). Government and nongovernmental implementing partners were the most central organizations. In Uganda, “middle” and “high” levels of interactions were similar in frequency.

Global: The group of most central organizations was dominated by development partners with only one other organization – SNL. The most frequently cited levels of interaction were: “high” and “low,” followed by “middle.” In terms of areas of interaction, organizations connected mostly on advocacy, followed by knowledge management, evidence generations, programmatic/technical support, and finally on measurement/M&E.

Within every network, certain organizations take on specific responsibilities, or key network functions, critical to overall network functionality and sustainability: knowledge management, technical expertise, convening, and opinion leadership. Spontaneous responses indicated that these network functions, at country level, were predominately filled by Save the Children/ SNL, development partners, and the government. At the global level, development partners and Save the Children/SNL played the largest role.

Qualitative data indicated a desire for better coordination, communication, synergy of efforts, and cross-learning and sharing within the communities of organizations working on newborn issues.

Reflections: Communities can use the findings from ONAs included in this study to consider the current state of their network and to inform discussions about their long-term goals and how to maintain momentum around newborn health and survival in the future. Areas for reflection include: how to foster emerging leaders and champions to keep the momentum over time; how to work more efficiently and effectively (resource use, information sharing, and reduction of duplication); what kind of expansion would strengthen the network and its ability to reach its goals; and what kinds of organizations will need to fill key network roles to ensure sustainability and institutionalization of newborn efforts.


Newborn Organizational Network Analysis 1

Organizational Network Analysis of the Community of Organizations Working on Newborn Health and Survival PURPOSE OF THE ORGANIZATIONAL NETWORK ANALYSIS

Over the last 15 years, newborn health has garnered increased attention and support at both global and country levels. Newborn survival has historically been seen as too challenging to address in low-income countries. The establishment of the Millennium Development Goals (MDG) in 2000 provided a context in which newborn health and survival is prioritized, as it became clear that reducing under-5 mortality cannot be achieved without addressing newborn survival. In the same year, a proposal to support countries in accelerating achievement of MDG 4 was developed through an iterative process between the Bill & Melinda Gates Foundation (BMGF) and Save the Children. The resulting Saving Newborn Lives (SNL) program, in collaboration with an informal network of technical experts, worked to raise awareness of newborn mortality, acquire attention for successful interventions and gather support for newborn health from a range of organizations (Shiffman 2010).

How has the newborn community developed?

Individuals, organizations, and communities of organizations have emerged over the last decade to work on newborn health and survival at both global and country levels. Shiffman & Sultana (2013) report on the changing perceptions of newborn health in Bangladesh: in 2000, many health care providers believed that reducing newborn mortality was not possible without high-cost interventions; by 2011, a strong community of individuals and organizations had worked to establish the National Neonatal Health Strategy and prioritize neonatal mortality in national health plans and in new government- and donor-led newborn programs. Smith and Neupane (2010) describe a similar trajectory in Nepal: newborn health was a neglected issue before 2000, the first national strategy for neonatal health was published in 2004, and a community-based Newborn Care Package was piloted by the Government of Nepal in 2009. At the global level, in May 2014, the Every Newborn Action Plan (ENAP) was endorsed at the World Health Assembly, marking a major achievement by both global and country level newborn actors.

“We are all focusing in the same direction…There is movement that involves everyone, so that everyone can contribute. But what is more important is that this is based on the newborn need. We

have developed guidelines that can be strong and sustained.” – Country level Research/Academic Organization

SNL, now in its third grant from the BMGF, has over the last 15 years collaborated with global and national partners to support evidence generation, consensus building, policy formulation and guidance, program implementation, and to develop newborn communities. The focus of the third SNL grant (2013-2017) is the transition from building the evidence and policy to facilitating achievement of coverage of high-impact newborn services at scale in low-income countries. SNL is committed to ensuring the energy and cooperation of newborn partners is sustained beyond the life of SNL’s current grant. Consequently, SNL commissioned EnCompass LLC to implement a series of five organizational network analyses (ONA) to gain insight into the current functioning of newborn



communities in order to help maintain and grow these newborn networks. The five ONAs were conducted in Bangladesh, Malawi, Nepal, Uganda, and at the global level.

What is an organizational network analysis and how can it inform the newborn community?

Inter-organizational cooperation is critical to keeping newborn health and survival on country and global health agendas. Understanding the dynamics and characteristics of organizational relationships can help predict whether relationships will be sustained over time and how changes in membership or roles may affect the network. Organizational network analysis is a technique that maps interactions between organizations and identifies relationship structures and patterns (Tichy et al. 1979).

The five ONAs included in this report:

Assessed connectedness of individual organizations Identified which organizations play a central role in the network Gauged the role SNL is currently playing in the network Appraised how cross-connected the newborn community is.

These ONAs are intended to encourage reflection and guide the charting of a pathway to maintain momentum for newborn health and survival by identifying appropriate actions to enhance future sustainability and specific organizations that could play key roles to sustain the momentum over time. The ultimate goal is to mainstream practice of newborn care and institutionalize newborn-related efforts beyond 2017.

METHODS

How were the organizational network analyses conducted?

This study of newborn communities used a mixed quantitative and qualitative approach for all five individual ONAs. The mixed methodology provided both the quantitative network analysis to establish the existing relationships between organizations, and a qualitative component for deeper level of understanding and context of respondents’ answers. Each ONA collected data on characteristics of interaction between organizations, as well as strengths, challenges, and goals for the network. At country level, frequency of interaction was also captured. For the global level, frequency of interaction was dropped and areas of interaction added: advocacy, knowledge management, evidence generation, measurement/ M&E, and programmatic/technical support.1

1 Frequency was replaced with areas of interaction because no differences in patterns between level of interaction and

frequency of interaction were found in the country level ONAs.

“Working together to have a common voice…everyone seems to be excited to have newborn care as a priority.” – Country level Development Partner



Sample: A total of 25 organizations at country level and 40 for the global level ONA were identified for the sample, with response rates shown in Figure 1. Each of the four SNL country offices worked collaboratively with SNL Home Office staff to select the specific organizations for inclusion in the country ONAs. For the global level ONA, SNL Home Office staff selected the sample with the input of the SNL Strategic Advisory Group. A majority of the organizations included in each sample were selected based on their current level of activity in newborn health. However, with an eye to the future, several organizations were included in each sample that are currently less active, but could be expected to play key roles in the future. In some cases, the sample included multiple programs/units within a single organization to account for situations where individual units each played an important and unique role in the network. For example, at the global level, USAID had representatives from several divisions active in newborn care; and at country level representatives from both Save the Children International as an overall organization and SNL as a specific unit, were included. Appendix A contains a complete list of participating organizations for each ONA.

Overall, the ONA samples included government agencies, research/academic institutions, professional associations, development partners, nongovernmental implementing organizations, and other organizations. See Appendix B for a complete breakdown of types of organizations represented in each country and at the global level.

Data collection: The study team collected data through phone and Skype interviews, using a series of structured and semi-structured questions. Structured questions asked the respondents (each representing an organization or organizational unit) whether they had interacted on newborn issues with each of the other organizations in the sample.2 The study team entered and analyzed the quantitative data in Excel, and used UCINET and NetDraw to create the network plots. Qualitative data were coded and analyzed in Dedoose, a cross-platform application for quantitative and qualitative analysis.

Dissemination to date: Results from the individual ONAs have been shared with the respective newborn communities and SNL has used the results as part of their Year 2 Internal Review process and transition planning.

Limitations: While these ONAs provide rich information, there are a few limitations that must be considered in interpreting the results. The five ONAs included a limited number of organizations and may not have included all organizations working in newborn health in the individual country contexts and at the global level. Additionally, some respondents found it difficult to differentiate between

2 For the global level ONA, given the larger sample, the structured questions on interactions with each of the other

organizations were not asked directly during the interviews. Respondents were asked to complete a self-administered table (excel file) in which they described their organization’s interactions with the other 39 organizations

ONA Sample Response Rate

Bangladesh 25 100%

Malawi 25 96%

Nepal 25 91%

Uganda 25 88%

Global 40 85 %

Figure 1: ONA Response Rates



entities in the sample, particularly when the entities were sub-units within the same larger organization (i.e., SNL, EveryOne Campaign and Save the Children). In a few cases, respondents also had difficulty distinguishing between individuals and the organizations they represented. It should be noted that the ONAs were conducted at a single point in time and did not capture changes or growth in the newborn community. More details on these limitations can be found in Appendix C.

FINDINGS

Organizational network analysis provides a number of quantitative measures to describe the interactions in a network. Network density, as a composite, measures the overall connectedness of the organizations, or the number of possible connections that are realized. Network density is calculated by adding the total number of organizations that report being connected to each other and then dividing that by the total number of possible connections that could exist in the network. As shown in Figure 2, the five ONAs displayed a high level of connectedness, with most organizations being connected to a large number of other organizations in the network.

What levels of interaction occurred in the networks?

Respondents were asked to categorize their interactions with each of the other organizations in the network as low, medium, and high (see Figure 3 for more details on definitions of these levels).

Figure 3: Levels of Interaction

Interaction Level

Description

Low Organizations provide information and communicate via formal communication channels, but do not make shared decisions or commitments. This level of interaction is also referred to as cooperation.

Medium Organizations share information, resources, communicate frequently, engage in some shared decision making and have mutual commitments. This level of interaction is also referred to as coordination.

High Organizations share information, ideas, and decisions. Communication is frequent and prioritized, and organizations engage in shared decision making, make mutual commitments and have a high level of trust. This level of interaction is also referred to as collaboration.

Figure 2: Network Density



Figure 4 below shows the density of each level of interaction for the five ONAs3.

Figure 4: Levels of Interaction in Country and Global Level Newborn Communities

High-level interactions were the most frequently reported interactions across all networks. In all four countries, there were more medium-level interactions reported than low-level interactions. At country level, there is a general trend of increasing percentages as interaction levels increase. This reflects networks that are not only highly connected, but have strong interactions. Only the global level network had a larger share of low-level interactions than those at medium-level, which may indicate more formal sharing of information unaccompanied by shared decision making or commitments. The Bangladesh network exhibited the highest frequency of high-level interactions, reflecting a network with particularly high levels of shared decision making and trust.

Which organizations are most connected?

Interactions can be plotted to provide a picture of each network and show which organizations are central to the network. Figure 5, on the next page, shares information on the evolution of networks and Figure 6 provides tips on how to interpret network plots. While the network plots provide a visual picture of the network, they are a reflection of the network measure in-degree centrality4, which represents the weighted connections as reported by other organizations.

3 Density of each level of interaction is calculated as the observed number of interactions at each level (low, medium,

high) divided by the total number of observed interactions across all levels. It is also a combination of an organization’s perspective on its interactions and those from other organizations. Calculations were adjusted to control for interaction between programs/units in the same organization, but this showed no perceptible difference from unadjusted measures.

4 In degree centrality refers to interactions reported about one organization by the other organizations in the network.

Out degree centrality refers to interactions reported by one organization about its interactions with other organizations.



The following sections include the network plots for level of interaction from each ONA. Centrality measures tended to cluster in groups. Thus, each network plot shows organizations with the highest centrality measures circled in solid black and those in the second highest centrality position circled in a dotted blue line. Appendix A provides a full listing of acronyms represented in the plots.

Figure 5: Evolution of a Network

Networks, like an organism, develop and evolve over time. Each phase of development increases the resiliency of the community. There are 4 commonly referenced phases of network development (Krebs and Holley 2006). Phase 1 – Scattered Fragments: Communities generally start as emerging and isolated clusters of organizations. At this phase the overall network is very weak. Phase 2 – Hub-and-Spoke Network: If left alone, connections between organization clusters will develop slowly or they will not develop at all. The presence of a leading organization or hub represents the next phase in community building because this leader connects the subgroups/clusters and often brings in external resources. While having a hub is good for network development, having just one connecting organization is not sustainable over time, and the network at this phase is still relatively weak. Phase 3 – Multi-Hub Small World Network: As a network develops and the hub connects different clusters, other organizations naturally start developing connections and the number of hubs will grow. At this stage, stronger and weaker ties/relationships will emerge in the network. Phase 4 – Core/Periphery Network: This is a stable structure that usually takes many years to develop. The network core contains key community members, including a number of hubs or connectors with many strong ties between them. The periphery contains organizations that are new to the network, represent other communities with some overlap (i.e., maternal health groups), or have unique resources, but are not part of one particular community. *Note: The core is comprised of blue nodes. The periphery is made up of the green nodes.

Figure 6: Key Features of a Network Plot

There are several features of a network plot that help its interpretation: Each organization is represented by a single geometric symbol whose color and shape represent the

type of organization. The size of each geometric symbol is based on how other organizations reported their level of

interaction – the largest symbols represent the most connected organizations (i.e., those with the highest centrality measures).

The mapping software generates placement of organizations within the plots automatically to accommodate which organizations are connected to which other organizations. Therefore, while generally the more connected organizations are in the center and less connected organizations will appear on the periphery; in highly connected networks the actual placement of organizations in the plots will be less meaningful because numerous organizations are highly central in the network.



COUNTRY LEVEL RESULTS

All country network plots reflect the density measures shown in Figure 2 and Figure 4, and each reveals a densely connected core of organizations. Figures 7-10 present the country level ONA plots.

Bangladesh: Bangladesh’s newborn network has the highest overall density and the largest percentage of interactions rated as “high.” Bangladesh’s network plot (Figure 7) indicates a wide diversity among the most central/connected organizations: government, research/academic organizations, development partners, nongovernmental implementing organizations, professional associations, and other organizations. Bangladesh was the only ONA revealing such diversity, and was the only network in which there was only a single development partner in the most central group.

Malawi: The most central organizations in Malawi’s newborn network (Figure 8) included development partners, nongovernmental implementing partners, one government agency, and a research/academic organization. There were a large number of development partners in the most central group.

Nepal: Nepal’s newborn network plot (Figure 9) revealed a strong government presence in the network, with three government entities with the highest centrality measures. When looking at the top two groups, government, development partners, and nongovernmental implementing partners were represented, which is somewhat less diverse than the most central group in other country networks.

Uganda: Organizations in the top two centrality groups in Uganda’s network plot (Figure 10) included government, development partners, nongovernmental implementing partners, professional associations, and the National Newborn Steering Committee. Government and nongovernmental implementing partners were the most central organizations.



Figure 7: Bangladesh Newborn Network - Level of Interaction as Reported by Other Organizations N.B. In Bangladesh, the levels of interactions were measured as cooperation (low), coordination (medium) and collaboration (high)

Bangladesh Newborn Network - Level of Interactionas reported by other organizations

1

Lines:CooperationCoordinationCollaboration

Government Research/ Professional Development Nongov. OtherAcademic Association Partner Implement.

Partner

SNL

icddr,b

OGSB

NTWC

BSMMU

Save

IMCI

MNCAH

UNICEF

Most Central

Next Most Central



Figure 8: Malawi Newborn Network - Level of Interaction as Reported by Other Organizations

Malawi Newborn Network - Level of Interaction as reported by other organizations

2

Lines:LowMediumHigh


Partner

RHDUNICEF

WHO

Save

USAID

SNL

UNFPA

KCN

Most Central

Next Most Central



Figure 9: Nepal Newborn Network - Level of Interaction as Reported by Other Organizations

Nepal Newborn Network - Level of Interaction as reported by other organizations

3

Lines:LowMediumHigh

Government Professional Development Nongov. OtherAssociation Partner Implement.

Partner

MoHPUNICEFSNL

FHDCHD

CNCP/JSI USAID

Most Central

Next Most Central



Figure 10: Uganda Newborn Network - Level of Interaction as Reported by Other Organizations

Uganda Newborn Network - Level of Interaction as reported by other organizations

4

Lines:LowMediumHigh


Partner

RHD_CH

Save

CHD_CHSNL

CH_MOH`

NNSC AOGU

WHO

UNICEF

UNFPA

Most Central

Next Most Central



How often are organizations interacting?

Country level respondents were asked to categorize the frequency of their interactions over the last year with each of the other organizations in the network: annually, quarterly, monthly, or weekly (Figure 11).5,6 In all countries, the most common frequency of interaction was quarterly. Bangladesh’s network showed a more intense pattern of interaction, with weekly (or more frequent) interactions being almost equal to monthly and quarterly interactions. In Malawi, Nepal, and Uganda the majority of organizations interacted on a quarterly or monthly basis, with few interacting on a weekly basis.

Figure 11: Frequency of Interaction in Country Level Newborn Communities

GLOBAL LEVEL RESULTS The global level network plot (Figure 12) showed that the group of most central organizations was dominated by development partners with only one other organization, a nongovernmental implementing partner. The second most central group of organizations was also limited to representatives of these same two categories. Unlike the country network plots, the gap between this group and the highest scoring group was much wider.

5 In Bangladesh (the first ONA), respondents were asked to report frequency as annually, quarterly, monthly, weekly, or

daily. In the subsequent country level ONAs, daily participation was dropped. In Figure 11, results for weekly and daily were combined to create weekly or more for Bangladesh. 6 Respondents were asked to report averages for the year. These numbers do not capture fluctuation of interaction

throughout the year. Several respondents reported that they interact daily/weekly with other organization during certain periods of the year and then have long periods without communication.



Figure 12: Global Newborn Network - Level of Interaction as Reported by Other Organizations

Global Newborn Network - Level of Interaction as reported by other organizations

5

Lines:LowMediumHigh

SNL

USAID NH

BMGF MNCH

UNICEF

MCHIP

WHO-MNCH

Research/ Professional Development Nongov. OtherAcademic Association Partner Implement Partner

Most Central

Next Most Central



At the global level, respondents were asked about their interactions with each of the other organizations in the network for each of the following areas: advocacy; evidence generation; knowledge management; measurement, monitoring and evaluation; and programmatic and technical support. Figure 13 presents the top three organizations in rank order of their in degree centrality measures for each area. Again, development partners predominated across all areas.

Figure 13: Highest Centrality Scoring Organizations for Technical Areas of Interaction at the Global Level

Advocacy Evidence Generation

Knowledge Management

Measurement/M&E Programmatic and Technical Support

UNICEF SNL SNL SNL USAID/NB BMGF MNCH USAID/NB

USAID/NB USAID/NB BMGF MNCH USAID/NB UNICEF

PMNCH BMGF MNCH UNICEF SNL BMGF MNCH SNL

Development Partner

Nongovernmental Implementing Partner

Other

Figure 14Error! Not a valid bookmark self-reference. summarizes the relative importance of each area as the point of interaction. Most interactions within the global newborn network were related to advocacy and knowledge management, while a smaller group of organizations were interacting on measurement and M&E.

Figure 14: Areas of Interaction in the Global Level Newborn Community

Network functions: What are the roles of organizations within the network? Within every network, certain organizations take on specific responsibilities critical to overall network functionality and sustainability. The five ONAs examined which organizations were perceived as providing four key network functions crucial for maintaining a robust network: knowledge management, technical expertise, convening, and opinion leadership. Respondents were asked to spontaneously state whom they turned to in the network for each of these functions. As seen in



Figure 15, respondents sometimes referred to an overall organization (rather than specific units within an organization, such as Ministry of Health (MOH) or Save/SNL) or discussed groups of organizations collectively (i.e., professional associations).

Figure 15: Top Three Organizations Playing Key Network Functions

Technical Expertise

Knowledge Management Convening Leadership

Bangladesh

Save/SNL Save/SNL Save/SNL Save/SNL

UNICEF UNICEF MOH UNICEF

icrrd,b icrrd,b UNICEF MOH

Malawi

Save/SNL Save/SNL MOH MOH

WHO MOH SAVE/SNL SAVE/SNL

UNICEF PACHI UNICEF UNICEF UNICEF

Nepal

Save/SNL Save/SNL Save/SNL UNICEF

UNICEF UNICEF UNICEF Save/SNL

Prof. Assn WHO MOH MOH

Uganda

Save/SNL Save/SNL MOH MOH

MOH UNICEF Save/SNL Save/SNL

UNICEF MOH UNICEF UNICEF

Global

Save/SNL Save/SNL WHO BMGF

LSHTM WHO USAID WHO

WHO PMNCH Save/SNL Save/SNL

Government

Research/ Academic

Professional Association

Development Partner

Nongovernmental Implementing Partner

Other

Access to technical expertise: In order for a network to function well, members need access to technical expertise, advice, and assistance from others in the community regarding specific topics related to newborn health and survival. A few organizations stood out for bringing technical knowledge and assistance to the newborn communities, across all four countries and at the global level. In particular, Save the Children/SNL, UNICEF, and the WHO consistently were recognized for their technical expertise. If one considers all organizations for which at least 20% of respondents mention the organization as playing a key network role (data available in Appendix D), in Bangladesh, Uganda and at the global level, research/academic organizations figured prominently in providing technical expertise, though not necessarily in the top three positions. In Nepal and Uganda respondents also viewed the government as a source of technical expertise. In Bangladesh, Nepal, and Uganda, professional associations were noted as playing a key role, although not always in one of the top three positions.



“WHO, UNICEF – you cannot do anything without them. Their technical guidance and leadership of WHO is really important.” – Global level Research/Academic Organization

Knowledge management, ensuring dissemination of timely and relevant information about newborn care and survival to others in the community is necessary to foster sharing and learning across the community. In the interviews, all newborn communities mentioned Save the Children/SNL, UNICEF, and WHO as playing an important role in knowledge management. In the four countries, governmental offices were also seen as playing a critical role in knowledge management. Across all communities, only in Malawi did a local organization, Parent and Child Health Initiative (PACHI), emerge as fulfilling the knowledge management role. In Bangladesh and Uganda, research/academic organizations stood out for their contribution to knowledge management, reflecting the prominence of the icddr,b and Makerere University.

“UNICEF creates a forum for knowledge management and supports others in knowledge management. In the last 6-7 years they have managed several large MNCH programs and they try

to share all of these things.” – Country level Nongovernmental Implementing Partner

“[A nongovernmental organization] is now running [a program] on maternal health information issues by email and on the website they’ve developed. They conduct monthly meetings to go with

the dissemination…[and to] host research findings.” – Country Government

Convening, another key function contributing to network performance, refers to actions that bring the community together, such as coordination of meetings and encouraging participation within the community. Respondents remarked that organizations with access to resources (i.e., funding) and technical expertise are natural conveners. Across the newborn communities studied at country level, government (MOH) was viewed as a key convener, as well as Save the Children/SNL and UNICEF. USAID was also frequently mentioned as playing this role in Nepal, Malawi, and at the global level, and the WHO was the top convener at the global level. The NNSC in Uganda and the PMNCH in the global newborn community were also seen as conveners in newborn health in these networks due to their composition and mandate.

“[With respect to convening, it is] SNL, but the government may be in the front sometimes. The

government plays a front role, but in the back it is primarily SNL.” – Country level Research/Academic Organization

“WHO - the capacity they have at national levels, convening and leadership at national levels with the

MOH… if they are looking to go to scale at national level, [it] has to be within WHO guidelines.” – Global level Nongovernmental Implementing Partner

Opinion leadership, referring to organizations with the capacity to leverage resources, reputation, and technical expertise to influence the work, directions, and decisions within the newborn community, is important for a robust network. In the four countries, the top three partners who emerged as the newborn community leaders were Save the Children/SNL, UNICEF, and government (MOH). The NNSC in Uganda and the PMNCH in the global newborn community were recognized as leaders in newborn health in the same way that they were seen as key conveners.



Research/academic organizations stood out only in Bangladesh (icddr,b) and at the global level, and several specific individuals also emerged as key leaders.

“Ministry of Health is the overall leader. We call them the strategic and credible leader of the community. The main [purpose] of the community is to make sure that the activities of the CSO’s are

in line with the Ministry…so they are the leader of the CSO’s. They are the leader in terms of providing technical guidance.” – Country level Nongovernmental Implementing Partner

What did organizations say about the network? Across all five ONAs, respondents spoke about a sense of growing coordination and collaboration. Respondents in each community discussed how exchanging findings, evidence, and lessons across the network enabled a sense of community and common purpose. Within each newborn community, respondents remarked on the rich technical capacity and a range of perspectives operating in their network. Overall, responses reflected communities that are strong and connected by an exchange of knowledge and information. All networks were firmly centered on the goal of increasing coverage of effective newborn interventions. “It’s about newborn care of Nepal. Putting the issue on the front instead of the organization... They all

came together to work together.” – Country level Nongovernmental Implementing Partner Despite overarching similarities, some differences emerged between countries. In both Malawi and Nepal, respondents attributed increased coordination to the government and the key role it was playing. The Ministry of Health and Population served as the central coordinating body in Nepal and was well placed to harmonize newborn interventions. In Malawi, the Reproductive Health Directorate convened the quarterly Safe Motherhood Meetings, which regularly brought together key members in the network. Ugandan respondents highlighted their focus on learning and the community’s commitment to generating evidence, exchanging information, and employing monitoring and evaluation so that they may improve newborn outcomes. For Bangladesh, Nepal and the Global newborn networks, their crowning achievement for the prior year was related to development of a formal policy document focused on advancing newborn-related issues.

What wishes did newborn network members express to address challenges they face?

While recognizing progress to date in coordination and knowledge management, respondents in all newborn communities studied also expressed the need for improvements in these areas. Respondents spoke about the importance of sharing information and regular communication as critical in moving their work forward and sustaining the network.

In Bangladesh, respondents called for improved collaboration, sharing, and learning with the maternal health community. In both Malawi and Uganda, organizations cited duplication in roles due to a lack of coordination and communication between partners, and that organizations’ need to claim attribution for successes hindered the existing partnerships and forming of potential partnerships. In Nepal comments reflected tensions between the different organizations in the network and respondents expressed a wish for long-term coordination and knowledge management.



At the global level, respondents discussed the need for a more seamless connection in how newborn stakeholders interact around the formulation of policy, programs, training and other interventions with stakeholders representing maternal health and the reproductive, maternal, newborn and child health continuum of care. Partners discussed specific examples of where the linkages are lacking (connections between pre-term birth, stillbirths, and health care workers in obstetrics, gynecology, and pediatrics). Respondents also spoke about the need to procure resources and secure funding to implement the ENAP. Partners discussed how they would like to maintain the momentum created by the ENAP and quickly move work forward; however, they cited challenges with competition for resources and country level ownership. “Information is not being shared as much as it should be. We need information and we don’t have it.

Sharing information has not been done well and I am more likely to go and shout and take petitions to the speaker, but I do not have the information that WHO or UNICEF has. We do not have good and

quick information to use.” – Country level Nongovernmental Implementing Partner

“There are times when the newborn focus is artificially divided by the maternal health. You shouldn’t separate the mother from the baby… [newborn corners] could be an opportunity for integrating the needs of newborns and maternal health.” – Global level Nongovernmental Implementing Partner

Summaries of each ONA can be found in Appendix E.

REFLECTIONS ON THE WAY FORWARD

How can the ONAs be used to inform future planning?

Communities can use the findings from ONAs included in this study to consider the current state of their network and to inform discussions about their long-term goals and how to maintain momentum around newborn health and survival going forward. A few key areas of reflection are highlighted below.

How well is the network fostering emerging leaders and champions? Some networks rely heavily on a few key individuals within organizations, with the potential risk of loss of institutional capacity in the form of knowledge, information, and connections to the community should these individuals depart the organizations. Networks might consider how to mitigate this risk by both strengthening linkages within organizations so that the loss of a key individual does not mean the loss of the organization to the network, and by expanding the leadership pool of the network. All communities can strategize how to strengthen linkages, foster the next generation of leaders, and identify current or emerging newborn champions in order to ensure continued momentum around newborn survival.

How can the network meet its goals efficiently and effectively? Critical reflection on how communities are meeting goals is important to ensure that duplication in the network is minimized and coordination and synergy of action are maximized. Improved coordination and collaboration emerged as a priority across all networks. All communities can evaluate resources used, information sharing and coordination of activities, and map stakeholder roles to see where duplication is occurring and where organizations are adding value in order to maximize network efficiency.



Developing and maintaining high levels of collaboration with other organizations is important for achieving network goals. However, it requires an investment of time and energy that can detract from organizations’ ability to meet their own objectives. Some communities find that appointing a designated network coordinator, or secretariat, is helpful in reducing the burden of collaboration on individual members. Communities should reflect on the costs and benefits of members’ current time and energy investments and devise a plan for network management that maximizes network achievements and averts stakeholder exhaustion.

How inclusive does the network need to be to be effective? In Bangladesh and at the global level, respondents expressed a desire to strengthen collaboration with the maternal health community. In Malawi, there was an interest in expanding linkages to professional associations, district-level stakeholders, and community leaders. All networks can reflect on their inclusivity and strategize ways to reach out to potential new members that can bring in resources, expertise, and access to key new stakeholders and other aspects necessary for long-term effectiveness and sustainability of newborn programming.

For sustainability and institutionalization, how diverse are the organizations fulfilling key network functions? The number and types of organizations that were highly connected or fulfilled key roles varied across the studied communities. In some cases, for example, networks had a heavy presence of development partners. While there is no ”ideal” configuration, all networks should reflect on what their distribution of “key” organizations means for their sustainability and chart a way forward that aims to build leadership from organizations across local and global level network partners.



REFERENCES

Krebs, V., and J. Holley. 2006. Building Smart Communities through Network Weaving. OH: Appalachian Center for Economic Networks. Accessed at http://community-wealth.org/content/building-smart-communities-through-network-weaving (September 8, 2014).

Shiffman J. 2010. Issue attention in global health: the case of newborn survival. Lancet. Vol. 375, p. 2045–49.

Shiffman J., and S. Sultana. 2013. Generating Political Priority for Neonatal Mortality Reduction in Bangladesh. American Journal of Public Health. Vol. 103, No. 4:623-31.

Smith S., and S. Neupane.2010. Factors in health initiative success: Learning from Nepal’s newborn survival initiative. Social Science and Medicine. Vol. 72, Issue 4: 568-75

Tichy, Tushman, and Fombrun. 1979. Social Network Analysis for Organizations. The Academy of Management Review. Vol. 4, No. 4:507-19

http://community-wealth.org/content/building-smart-communities-through-network-weavinghttp://community-wealth.org/content/building-smart-communities-through-network-weaving



APPENDIX A: PARTICIPATING ORGANIZATIONS

Organizations in italics were included in the list of organizations asked about, but did not participate in the interviews themselves.

Figure 16: Complete list of organizations (and acronyms) included in each Organizational Network Analysis

Type Bangladesh Malawi Nepal Uganda Global

Government

Directorate General of Health Services - Maternal Neonatal Child and Adolescent Health (MNCAH)

Directorate General of Health Services - Integrated Management of Childhood Illnesses (IMCI)

Directorate General of Family Planning – Director General office (DGFP)

Directorate General of Family Planning –Maternal Child Reproductive and Adolescent Health (MCRAH)

Ministry of Health -Planning Wing (Pwing)

Reproductive Health Directorate, Ministry of Health (RHD)

Integrated Management of Childhood Illnesses Unit, Ministry of Health (IMCI)

Central Monitoring and Evaluation Department, Ministry of Health (CMED)

Child Health Division, Ministry of Health and Population (CHD)

Ministry of Health and Population (MoPH)

Family Health Division, Ministry of Health and Population (FHD)

Health Management Information System, Ministry of Health and Population (HMIS)

Community Health Department, Ministry of Health (CH-MOH)

Child Health Division, Community Health Department, Ministry of Health (CHD-CH)

Reproductive Health Division, Community Health Department, Ministry of Health (RHD-CH)

Not applicable at global level

Research/ Academic

Bangladesh Institute of Child Health (BICH)

Bangabandhu Sheikh Mujib Medical University (BSMMU)

College of Medicine, Univ. Malawi (CoM)

Bwaila Hospital (BH)

Kamuzu College of Nursing (KCN)

Makerere University School of Public Health (MUSPH)

Pediatrics Department, School of Medicine,

Johns Hopkins University-CHERG/MCHEE (JHU_CHERG)

Johns Hopkins University – Neonatal Research (JHU_NR)

London School of Hygiene and Tropical




International Centre for Diarrhoeal Diseases Research (icddr,b)

National Institute of Population Research and Training (NIPORT)

Makerere University (PD_MU)

Jinja School of Nursing (JSN)

Medicine Informed Decisions for Actions in Maternal and Newborn Health (IDEAS)

London School of Hygiene and Tropical Medicine Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH)

University College London Institute of Child Health (UCL)

National Institute of Child Health and Human Development Global Network (NICHD)

Professional Association

Bangladesh Neonatal Forum (BNF)

Bangladesh Perinatal Society (BPS)

Bangladesh Paediatrics Association (BPA)

Obstetrical and Gynecological Society of Bangladesh (OGSB)

Association of Malawian Midwives (AMAMI)

Medical Association of Malawi (MAM)

Medical Council of Malawi (MCM)

Nurses’ and Midwives’ Council of Malawi (NMCM)

Nepal Pediatric Society (NEPAS)

Perinatal Society of Nepal (PESON)

Society of Public Health Physicians (SOPHYN)

Uganda Paediatric Association (UPA)

Association of Obstetricians and Gynecologists (AOGU)

American Academy of Pediatrics (AAP)

International Federation of Gynecology and Obstetrics (FIGO)

Development Partner

United Nations Children’s Fund (UNICEF)

United States Agency for International Development (USAID)

Japan International Cooperation Agency (JICA)

World Health Organization (WHO)

United Nations Population Fund (UNFPA)


United States Agency for International

Department for International Development (DFID)

United States Agency for International Development (USAID)


World Health


World Health Organization (WHO)


United States Agency for

Bill & Melinda Gates Foundation- Maternal Newborn and Child Health (BMGF_MNCH)

Bill & Melinda Gates Foundation – Advocacy (BMGF_A)

World Health Organization - Research (WHO_R)

World Health Organization - Maternal Newborn and Child Health (WHO_MNCH)




Development (USAID)

Norwegian Church Aid (NCA)

Organization (WHO) International Development (USAID)


USAID- Maternal Health (USAID_MH)

Laerdal Foundation (LF)

USAID- Newborn Health (USAID_NH)

USAID- MNCH Research (USAID_MNCHR)

Department for International Development, UK (DFID)

Children's Investment Fund Foundation (CIFF)


Canadian International Development Agency/ Department of Foreign Affairs and Trade (DFATD)

Johnson & Johnson (JJ)

Norwegian Agency for Development Cooperation (NORAD)

Nongovern-mental Implementating Partner

NGO Health Service Delivery Project (NHSDP)

BRAC

Social Marketing Company (SMC)

MaMoni

Saving Newborn Lives (SNL)

Save the Children (Save)

Christian Health Association of Malawi (CHAM)

The University of North Carolina Project (UNCP)

The Parent and Child Health Initiative (PACHI)

Support for Service Delivery Integration

Nepal Health Sector Support Program (NHSSP)

Health for Life Project (H4L)

Chlorhexidine Navi Care Program (CNCP/JSI)

Integrated Rural Health Development Training Centre

Uganda Women’s Health Initiative (UWHI)

Applying Science to Strengthen and Improve Systems Project, University Research Co. (ASSIST)

STRIDES Project ,Management Sciences for Health

Maternal and Newborn Integrated Program (MCHIP)

Save the Children U.S. (SCUS)

Save the Children International (SCI)

Program for Appropriate Technology in Health (PATH)

Cooperative for Assistance and Relief Everywhere (CARE)

World Vision (WV)

John Snow, Inc. (JSI)




EveryOne

(SSDI)

Maikhanda Trust (MT)

Development Communications Trust (DCT)



(IRHDTC)

Suahaara Project (Suahaara)

Plan International (Plan)

One Heart Worldwide (OneHeart)

CARE



(STRIDES)

SAMASHA Medical (SAMASHA)

Uganda National Health Consumers’ Organization (UNHCO)

PACE

EveryOne Campaign, Save the Children (EveryOne)



Family Care International (FCI)

Elizabeth Glaser Pediatric AIDS Foundation (EGPAF)

Save the Children - Saving Newborn Lives (SNL)

Other

National Technical Working Committee (NTWC) - Newborn

White Ribbon Alliance (WRA)

Nations Publications Limited Media (MPL)

Media Institute of Southern Africa (MISA)

Safe Motherhood Network (SMN)

Institute of Medicine (IOM)

White Ribbon Alliance (WRA)

National Newborn Steering Committee (NNSC)

Millennium Development Goals Health Alliance (MDGHA)

World Health Organization (WHO) – The Partnership for Maternal, Newborn and Child Health (PMNCH)

CORE Group (CORE)

Global Alliance to Prevent Prematurity and Stillbirth (GAPPS)

African Union (AU)

Maternal Health Task Force (MHTF)

Countdown to 2015 (CT2015)



APPENDIX B: TYPES OF ORGANIZATIONS REPRESENTED

Figure 17: Types of organizations represented in each Organizational Network Analysis

Bangladesh Malawi Nepal Uganda Global

Ministry of Health

20% 13% 10% 9% 0%

Research and Academic Organizations

16% 13% 0% 14% 14%

Professional Associations 16% 17% 14% 9% 6%

Development Partners 12% 21% 14% 14% 37%

Nongovernmental Implementing Organizations

28% 33% 52% 45% 26%

Other

9% 4% 10% 9% 17%



APPENDIX C: LIMITATIONS OF THE ORGANIZATIONAL NETWORK ANALYSES

The information provided in this report can serve as a starting point for communities to discuss the current state of their network, but the data do not provide comprehensive information. Several limitations to the study that should be considered when interpreting results include: limited sample size, oversampling of key organizations, lack of clearly defined roles/affiliations for a few key individuals, and inability of the ONA to capture changes over time.

Sample Size: Although the individual ONA samples were selected carefully to represent key newborn players and key organizational categories, time and resource constraints meant that it was not possible to include all organizations currently working on newborn issues, nor all those with future potential.

Oversampling: Because some organizations have multiple units interacting on newborn issues, in some cases, multiple programs/units were sampled from the same organization. As a result, some organizations were represented multiple times in an ONA. The centrality analyses were adjusted for overrepresentation of intra-organizational interaction (although there was little or no difference after adjustment). However, during the open-ended semi-structured questions respondents sometimes conflated different departments and projects as the same entity. For example, a number of participants did not differentiate between SNL and Save the Children.

Role/Affiliation: A few key individuals were associated with multiple organizations in the network and there may have been confusion among respondents as to which organization the individual was representing. For example, at least one individual in a country level network was actively involved with a professional association, participated in the national steering committee, and was formally employed by a third organization in the network. In this and other instances, some respondents had difficulty distinguishing which organization the individual represented. The study team controlled for this by citing individuals and organizations separately, where appropriate.

Timing: Interviews were conducted at a single point in time and did not capture changes or growth in the newborn community. Additionally, the ONAs were conducted at the same time the ENAP was being developed. The ENAP – which aims to establish a plan to end preventable newborn mortality – was seeking consultation from countries on the development of the initiative, and countries’ relationship with the ENAP differed, based on location. In Bangladesh and Nepal the communities had a strong presence before this process began and were probably not influenced by the ENAP. In Malawi, Uganda, and at the global-level, respondents reported that the ENAP served as a way to bring the communities together to address issues in the newborn community. Therefore, the ENAP may have influenced some of the ONAs and the ONAs may have looked differently if they were conducted at a different point in time.



APPENDIX D: ORGANIZATIONS PLAYING KEY NETWORK FUNCTIONS

The tables below present the list of organizations mentioned by at least 20% of respondents as playing a key network function.

Figure 18: Organizations playing a key network role in providing technical expertise

TYPE OF ORGANIZATION Bangladesh Malawi Nepal Uganda Global

Ministry of Health X X X X N/A

Save the Children/SNL X X X X X

UNICEF X X X X X

USAID X

WHO X X X X

Professional Associations X X X

Research and Academic Organizations X X X

Newborn Steering Committee N/A N/A X

Other Nongovernmental Implementing Organizations X X

Other Development Partners X X



Figure 19: Organizations playing a key network role of knowledge management




UNICEF X X X X X

USAID X X

WHO X X X X X

Professional Associations X

Research and Academic Organizations X X

Newborn Steering Committee N/A N/A

Other Nongovernmental Implementing Organizations X X X

Other Development Partners X

Figure 20: Organizations playing a key network role in convening for the community




UNICEF X X X X X

USAID X X X

WHO X

Professional Associations

Research and Academic Organizations X


Other Nongovernmental Implementing Organizations




Figure 21: Organizations playing a key network role in providing leadership




UNICEF X X X X

USAID X X X

WHO X X

Professional Associations X X

Research and Academic Organizations X X


Other Nongovernmental Implementing Organizations




APPENDIX E: SUMMARIES OF EACH ONA’S RESULTS

This appendix presents a one-page summary of each ONA, including a summary of the newborn community, selected community voices, data on frequency of interaction and level of interaction, summary of the most central organizations and those playing key network roles, and areas newborn community members felt needed improvement.

The table, at the bottom of each page, recaps the three most connected organizations from the network plots for level of interaction (and frequency for the four country ONA), and the top three organizations mentioned for each of the four key network functions.



BANGLADESH ONA SUMMARY“It is not just a group of people who have formed a club and discussing fancy things which [are] not being accepted by government…when we discuss about any particular issue or intervention, we are all brought to the table. People may have a different opinion, but then after discussion, we come to a consensus which we take to the government.”– Research/Academic Organization

Community Summary Bangladesh’s newborn community is diverse, comprising technical experts, implementers, and resource/network mobilizers. The community described itself as cohesive and members praised one another. Members acknowledged the flexibility and commitment to work together, and at times they work very intensively together. Ultimately, their greatest success, the government’s policy on newborn interventions, was rooted in the community’s deep commitment and passion for newborn health. Areas for Improvement Bangladesh’s newborn community highlighted the following challenges:

Some inherent competition between organizations for resources and influence

Each organization has its own rules, priorities, and agendas

Intensity of working together sometimes takes up internal resources (money, time) to work toward the community’s newborn health goals.

Respondents also expressed the desire for:

More collaboration, sharing, and learning with the maternal health community

Further exploration of the role of other organizations in the network.

“One of the challenges is to get everyone together under one [government] umbrella. It is difficult in Bangladesh to coordinate with [the two directorates] - both are separate and very strong and it is a challenge. They have different systems and different administrations. One is implementing in their own way - and the other in a different way.” – Research/Academic Organization

19%26%

55%

0%

10%

20%

30%

40%

50%

60%

Cooperation Coordination Collaboration

Bangladesh - Level of Interaction

10%

25% 23% 21%

0%

10%

20%

30%

40%

50%

Annually Quarterly Monthly Weekly ormore

Bangaldesh - Frequency of Interaction

Bangladesh’s Most Central Organizations -- Network Plots

Bangladesh’s Most Frequently Mentioned Organizations - Qualitative Data on Network Functions

Level of Interaction

Frequency of Interaction

Technical Expertise


Convening Leadership

SNL SNL Save/ SNL Save/ SNL Save/SNL Save/ SNL icddr,b icddr,b UNICEF UNICEF MOH UNICEF

Save OGSB Save icddr,b icddr,b UNICEF MOH



MALAWI ONA SUMMARY “Our collaboration on the projects is what I can recall as a success. What we’ve done together, field visits, strong institutions working together, to learn how we mobilize care for newborn.” – Research/Academic Organization

“We don’t have the data to really say how we are doing. We did not think we could collect data on the quality of [our intervention]. We would like to strengthen this in the coming year.” – Development Partner

Community Summary Malawi’s community acknowledged growth in collaborations and partnerships largely due to the prominent role of the Reproductive Health Directorate and its quarterly Safe Motherhood Meetings. Coordinating their efforts with one another amplified their overall impact while mitigating duplication and competition. They value standardization and guidelines. This environment fosters learning, which helps enforce guidelines they established together and view as a priority. These successes stem from a common understanding. Areas for Improvement Malawi’s stakeholders are pleased with the progress of the network to date, but spoke freely of challenges and areas for improvement within the community, including:

Mobilizing additional resources for newborn health, given the limitations of the government’s budget and resources

Improved coordination and communication between partners to minimize duplication of roles and competition for accolades

Better information flow and sharing of results across the community

Promoting evidence-based decision making Expansion of linkages to potential new

partners, including professional associations, district-level stakeholders, and community leaders.

24%

35%

42%

0%

10%

20%

30%

40%

50%

60%

Low Medium High

Malawi - Level of Interaction

18%

44%

26%

11%

0%

10%

20%

30%

40%

50%

Annual Quarterly Monthly Weekly

Malawi - Frequency of Interaction

Malawi’s Most Central Organizations -- Network Plots

Malawi’s Most Frequently Mentioned Organizations - Qualitative Data on Network Functions



Technical Expertise



RHD RHD Save/SNL Save/SNL MOH MOH WHO WHO Save WHO MOH Save/SNL Save/SNL Save UNICEF UNICEF PACHI UNICEF UNICEF UNICEF



NEPAL ONA SUMMARY “Nepal is fortunate that, for major interventions, there are many partners that come together and work closely…from a distance, looks like overlap, that is complementary, it takes a lot of energy to collaborate. Ultimately there is good concentration of help.” – Nongovernmental Implementing Partner

Community Summary Nepal’s newborn community recognizes growing cohesion, and better coordination and harmonized implementation through leadership of the Ministry of Health and Population. In addition, newborn partners remarked on their development of a succinct voice based on open dialogue and resolving different opinions. The community consists of members who contribute their skills in local and global practices, services and implementation, technical expertise, resources, data, and ability to communicate across multiple audiences, particularly for implementing community-based newborn care package. Areas for Improvement The newborn community’s wishes for the future included:

Strengthening coordination and further reducing duplication as a way to more efficiently channel resources and strengthen cohesion

Expanding sharing of evidence and learning about effective practice from each other.

“We need regular sharing, regular learning where one or two [organizations] share their project, their strengths and challenges…Have that vibrant learning. We wish we could be doing it this way.” – Nongovernmental Implementing Partner

Nepal’s Most Central Organizations -- Network Plots

Nepal’s Most Frequently Mentioned Organizations - Qualitative Data on Network Functions



Technical Expertise



CHD CHD Save/SNL Save/SNL Save/SNL UNICEF FHD UNICEF FHD UNICEF UNICEF UNICEF UNICEF Save/SNL

MOHP MOHP Prof. Assn WHO MOH MOH

26%

33%

41%

0%

10%

20%

30%

40%

50%

60%

Low Medium High

Nepal - Level of Interaction

18%

35% 34%

13%

0%

10%

20%

30%

40%

50%

Annually Quarterly Monthly Weekly

Nepal - Frequency of Interaction



UGANDA ONA SUMMARY “We are all focusing in the same

direction…There is movement that involves

everyone, so that everyone can contribute. But

what is more important is that this is based on

the newborn need. We have developed

guidelines that can be strong and sustained.”

– Research/Academic Organization

Community Summary Uganda’s community members highlighted their increasing coordination and efficiency in newborn interventions. Learning is a priority and members are committed to evidence generation, exchanging information, monitoring and evaluation so that they can improve newborn outcomes. Members of the community valued the range of passionate partners that include health care providers, civil society leaders, government decision makers and global level actors. Areas for Improvement The biggest areas for improvement identified in Uganda’s network were the need for:

Improved coordination and guidance (with the Ministry of Health emerging to lead this)

Improved knowledge management through centralization and sharing of information.

Respondents acknowledged the progress they have made so far in these areas, but also recognized that there is more work to be done.

“Most implementation partners depend on donor demands - they have to report back to the donors, but they do not report back to the MOH, and the MOH doesn’t know what is happening and this limits program coverage…that has been a big challenge. Right now we are realigning, to make sure government is overseeing programs and that [programs] are reporting back…we need them to follow the same policies and procedures during implementation.” – Government

Uganda’s Most Central Organizations -- Network Plots

Uganda’s Most Frequently Mentioned Organizations - Qualitative Data on Network Functions



Technical Expertise



RHD RHD Save/SNL Save/SNL MOH MOH SNL CHD SNL MOH UNICEF Save/SNL Save/SNL CHD Save UNICEF MOH UNICEF UNICEF

24%

38% 38%

0%

10%

20%

30%

40%

50%

60%

Low Medium High

Uganda - Level of Interaction

14%

43%

31%

12%

0%

10%

20%

30%

40%

50%

Annually Quarterly Monthly Weekly

Uganda - Frequency of Interaction



GLOBAL ONA SUMMARY “The newborn group has actually felt like several organizations becoming one. The organizations have done this because we have a group of great leaders at each of the institutions - they are a group of individuals who know each other well and are deeply committed to success.” – Other

Community Summary The global newborn community highlighted a sense of community and common purpose through building consensus and collaborative consultations. With rich technical capacity in the community, they value sharing of information and using evidence generation to shape advocacy, policy, and program implementation. While members acknowledged their cohesiveness around the newborn, many explicitly stated the need for stronger links, particularly with maternal care.

Areas for Improvement Newborn partners expressed a desire for a more seamless connection in how stakeholders interact to formulate policy, programs, training and other interventions to maternal health and other Reproductive, Maternal, Newborn and Child Health areas.

Many partners recognized a need for procuring resources and securing funding to actually implement the ENAP. Partners discussed how they would like to sustain the momentum and quickly move forward; but they also discussed complicating factors, such as competition for resources and the need for country level ownership.

Partners also point to the next phase where results from country/context-specific implementation are a priority, along with building ownership for implementation of ENAP at country level. Partners would like to see continued and improved coordination and collaboration, based on the unique contributions each one brings to the table. The newborn community would like to continue to strengthen the linkages of programming and evidence – improving metrics, sharing lessons, and real-time information flow.

“The challenges at an organizational level are competition for resources. When you are working towards a plan, you are working towards an ideal and not implementation. When it comes down to it and the question of implementation arises, then the issue of where the resources are coming from comes up.”– Development Partner

Global - Most Central Organizations -- Network

Plot on Level of Interaction

Global - Most Frequently Mentioned Organizations - Qualitative Data on Network Functions

Technical Expertise



SNL Save/SNL Save/SNL WHO BMGF UNICEF LSHTM WHO USAID WHO

BMGF MNCH WHO PMNCH Save/SNL Save/SNL

35%

28%

38%

0%

10%

20%

30%

40%

50%

60%

Low Medium High

Global - Level of Interaction

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