To our knowledge, this study represents the first network analysis of assistive technology organizations at a national level, and therefore provides a model for other researchers and policy developers wishing to understand the nature and strength of their national networks.
Our results suggest there is no single organization in Malawi which is central to the provision of assistive technology. In fact, there is a high degree of interconnectedness within and across the network, which spans different ministries and sectors. This is seen in both the network metrics and the graphical representation. Across the three ministries, and one coordinating body represented by the ministries, it is clear there is no single ministry which is seen as being central to assistive technology in Malawi.
This lack of a single point of centrality poses particular challenges, but also opportunities, for the development of policy. In many countries, including Malawi, it is conventional to have a single ministry responsible for leadership and delivery of programs and services in a particular area. For example, policy development guidance published by the Government of Malawi suggests the need to identify a single line ministry, who holds responsibility for policy development, implementation, and review.15
Whilst recognizing the administrative value of a core or managing ministry, this is not incompatible with an opportunity to cultivate a distributed or collective leadership approach, where the responsibility for leadership and implementation is shared across ministries, reflecting the differing and legitimate interests of different sectors regarding assistive technology. Collective leadership has been documented to be effective at achieving meaningful change at the healthcare provision level and in developing policies where there are multiple stakeholders.16,17
Our research also highlights the role of differing types of organizations, and their centrality to the delivery of assistive technology. We were interested to see that International NGOs, while playing a critical role in the funding and delivery of assistive technology, are not as central to the network as those organizations which represent people with disabilities, service delivery organizations, and ministries. This may mean that these organizations have more of a supportive than implementing role to play, at least in the case of Malawi. Furthermore, International NGOs appear to have fewer outward connections, than inward connections; suggesting there may be a high level of awareness of these organizations by national organizations, but the international NGOs do not have the same level of awareness of these national organizations. For more effective service delivery, international NGOs may therefore be better at providing funding to existing service delivery organizations and OPDs who have greater strength within the network, than seeking to provide services themselves.
Limitations
We were unable to capture all relevant organizations working in Malawi in assistive technology, however our respondents do include those organizations which are the most engaged in the area. Furthermore, this represents only a cross-sectional view of the network, and existing relationships at the time of data collection. Finally, there may be response bias in the survey, where some organizations may have reported a higher degree of connection with other organizations to appear favorable in terms of being ‘better-connected’.