The Logarithmic Spiral of Networks of Care for Expectant Families in Rural Nepal: A Descriptive Case Study

Health Syst Reform. 2020 Nov 20;6(2):e1824520. doi: 10.1080/23288604.2020.1824520.


This case study utilizes the four domains of effective Networks of Care (NOC) as a lens to describe the suite of interventions of a biosocial approach to maternal and neonatal health services in rural Nepal: The Network of Safety model, created by the non-governmental organization One Heart Worldwide (OHW) in collaboration with the government health system in Nepal. This approach provides essential guidance in the areas of health financing, governance, sustainability, reflection of user preference, and scalability. OHW addresses the reproductive health needs of women living in remote areas of Nepal in collaboration with local-level health and government workers by emphasizing clinical skill development and mentorship in management and leadership. With Nepal's shift to Federalism, the OHW approach proved flexible and able to deepen its support to leaders in new local-level government structures. The results on the ground were remarkable: using analytic skills gained from their OHW partnership, municipality leaders and health workers demonstrated effective communication and proactive responses to challenges, while maintaining fidelity to the Network of Safety model. The six-year commitment made by OHW to partner municipalities promoted active learning and adaptation and is a clear contributor to the scalability of the OHW Network of Safety. Observing the Network of Safety work through the domains of NOC highlights the interdisciplinary effort required to successfully transform Maternal and Neonatal Health (MNH) services in rural Nepal.

Keywords: Networks of Care; biosocial maternal and newborn care; decentralization; federalism; rural Nepal.

MeSH terms

  • Community Networks*
  • Humans
  • Learning
  • Maternal Health Services / organization & administration
  • Maternal Health Services / trends*
  • Nepal
  • Rural Population / trends
  • Workforce