Network Integration
Defining Network Integration
Network integration means systematically strengthened links between referral hospital staff and peripheral facility staff, and between peripheral facility staff and community health workers.
Thus:
hospital care ⇔ care at health center ⇔ community awareness/care
A very common situation in many countries is when there is no regular communication between staff at the health center level (primary health care level, PHC) and the hospital in the area. Midwives at health centers may feel isolated and neglected; in the community there is little awareness of the prevention and treatment of common maternal and newborn conditions. At worst, there is disrespect between staff at various levels, including community health workers or volunteers. 
The result is a district where referrals are suboptimal, and worse, there is no joint learning in the district. Even under very resource-poor conditions, limited efforts to link these health workers by systematic interventions can be expected to significantly improve outcomes.
The Current Challenge and How To Address It
Saving more mothers from PPH requires long-term collaboration, where a few dedicated staff at the referral hospital regularly confer with the relevant staff (midwives) at the health center, gradually building mutual confidence and respect, together learning to apply new clinical methods.
This can take many forms, like regular meetings, staff auscultation, inviting in peripheral care providers when arriving with a medical emergency, etc. E-based tools such as WhatsApp groups tend to reinforce the dialogue, but face to face contact also appears fundamental. When busy colleagues at referral hospitals realize that they can receive bleeding mothers in better condition than previously, and even sleep better at night, this is usually an impetus to strengthen links to health centers; and to inspire health center staff to regularly communicate with the village health workers/volunteers in their respective catchment area.
“Network integration” is a significant component of the successes of PPH programs described in all the country case studies on this website (India, Niger, Nigeria). Staff at health centers learn not only from referral hospital staff, but also from colleagues at other health centers; as such a joint review of results, along with local troubleshooting, are also very important.
A strengthened collaboration between hospitals, health centers, and communities has led to impressive results in the realm of PPH control. This improvement appears critical for other parts of MNCH care, both in emergency and non-emergency situations.
