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Networks as systems: A case study of the World Health Organisation’s Global Health Workforce Alliance

Allan Best (InSource Research Group, Coquitlam, Canada) (School of Population and Public Health, University of British Columbia, Vancouver, Canada)
Alex Berland (InSource Research Group, Coquitlam, Canada) (School of Population and Public Health, University of British Columbia, Vancouver, Canada)
Trisha Greenhalgh (InSource Research Group, Coquitlam, Canada)
Ivy L. Bourgeault (Telfer School of Management, University of Ottawa, Ottawa, Canada)
Jessie E. Saul (North American Research and Analysis, InSource Research Group, Coquitlam, Canada)
Brittany Barker (InSource Research Group, Coquitlam, Canada)

Journal of Health Organization and Management

ISSN: 1477-7266

Article publication date: 2 January 2018

Issue publication date: 6 March 2018




The purpose of this paper is to present a case study of the World Health Organization’s Global Healthcare Workforce Alliance (GHWA). Based on a commissioned evaluation of GHWA, it applies network theory and key concepts from systems thinking to explore network emergence, effectiveness, and evolution to over a ten-year period. The research was designed to provide high-level strategic guidance for further evolution of global governance in human resources for health (HRH).


Methods included a review of published literature on HRH governance and current practice in the field and an in-depth case study whose main data sources were relevant GHWA background documents and key informant interviews with GHWA leaders, staff, and stakeholders. Sampling was purposive and at a senior level, focusing on board members, executive directors, funders, and academics. Data were analyzed thematically with reference to systems theory and Shiffman’s theory of network development.


Five key lessons emerged: effective management and leadership are critical; networks need to balance “tight” and “loose” approaches to their structure and processes; an active communication strategy is key to create and maintain support; the goals, priorities, and membership must be carefully focused; and the network needs to support shared measurement of progress on agreed-upon goals. Shiffman’s middle-range network theory is a useful tool when guided by the principles of complex systems that illuminate dynamic situations and shifting interests as global alliances evolve.

Research limitations/implications

This study was implemented at the end of the ten-year funding cycle. A more continuous evaluation throughout the term would have provided richer understanding of issues. Experience and perspectives at the country level were not assessed.

Practical implications

Design and management of large, complex networks requires ongoing attention to key issues like leadership, and flexible structures and processes to accommodate the dynamic reality of these networks.


This case study builds on growing interest in the role of networks to foster large-scale change. The particular value rests on the longitudinal perspective on the evolution of a large, complex global network, and the use of theory to guide understanding.



The Global Health Workforce Alliance (GHWA) funded the original study on which this paper is based. The GHWA Secretariat reviewed and approved the study design proposed by the research team; suggested a long list of the key informants from amongst its stakeholders; and commented on the penultimate draft of the report. Professor Greenhalgh is partly funded by a grant to the Oxford Biomedical Research Centre, NIHR BRC-1215-20008. The authors want to thank other members of the study team for their excellent contributions – Kevin Noel, Jennifer Bitz, Alexandra Wright, and Carol Herbert. The GHWA secretariat was not involved in final selection of key informants; nor in collection, analysis or interpretation of data; nor in approving or writing the final version of the study report; nor in contributing to or approving this paper; and nor in deciding to submit the paper for publication.


Best, A., Berland, A., Greenhalgh, T., Bourgeault, I.L., Saul, J.E. and Barker, B. (2018), "Networks as systems: A case study of the World Health Organisation’s Global Health Workforce Alliance", Journal of Health Organization and Management, Vol. 32 No. 1, pp. 9-24.



Emerald Publishing Limited

Copyright © 2018, Emerald Publishing Limited

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