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Aivalli P, Gilmore B, Srinivas PN, De Brún A. Navigating intersectoral collaboration in nutrition programming: implementors' perspectives from Assam, India. Arch Public Health 2024; 82:82. [PMID: 38849925 PMCID: PMC11157891 DOI: 10.1186/s13690-024-01312-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 05/29/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND There is a growing interest in the use of intersectoral collaborative (ISC) approaches to address complex health-related issues. However, relatively little empirical research exists on the challenges of implementing, fostering and sustaining these approaches. Our study explores the perceptions and experiences of programme implementers regarding the implementation of an ISC approach, focusing on a case study of nutrition programming in Assam, India. METHODS We conducted qualitative semi-structured face-to-face in-depth interviews with eleven programme implementers from two selected districts of Assam, India. These participants were purposefully sampled to provide a comprehensive understanding of the experiences of implementing intersectoral collaboration. Following the interviews, an inductive thematic analysis was performed on the collected data. RESULTS The study identified three main themes: operationalisation of ISC in daily practice, facilitators of ISC, and barriers to effective ISC. These were further broken down into six subthemes: defined sectoral mandates, leadership dynamics, interpersonal relationships and engagement, collective vision and oversight, resource allocation, and power dynamics. These findings highlight the complexity of ISC, focusing on the important structural and relational aspects at the macro, meso, and micro levels. Interpersonal relationships and power dynamics among stakeholders substantially influenced ISC formation in both the districts. CONCLUSION Despite challenges, there is ongoing interest in establishing ISC in nutrition programming, supported by political development agendas. Success relies on clarifying sectoral roles, addressing power dynamics, and engaging stakeholders systematically. Actionable plans with measurable targets are crucial for promoting and sustaining ISC, ensuring positive programme outcomes. The insights from our study provide valuable guidance for global health practitioners and policymakers dealing with similar challenges, emphasising the urgent need for comprehensive research given the lack of universally recognised policies in the realm of ISC in global health practice.
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Affiliation(s)
- Praveenkumar Aivalli
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems (UCD IRIS Centre), School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland.
- School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland.
- , Guwahati, India.
| | - Brynne Gilmore
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems (UCD IRIS Centre), School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland
- School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | | | - Aoife De Brún
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems (UCD IRIS Centre), School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland
- School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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El-Jardali F, Fadlallah R, Daher N. Multi-sectoral collaborations in selected countries of the Eastern Mediterranean region: assessment, enablers and missed opportunities from the COVID-19 pandemic response. Health Res Policy Syst 2024; 22:14. [PMID: 38267995 PMCID: PMC10807098 DOI: 10.1186/s12961-023-01098-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 12/21/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has emphasized the importance of multi-sectoral collaboration to respond effectively to public health emergencies. This study aims to generate evidence on the extent to which multi-sectoral collaborations have been employed in the macro-level responses to the COVID-19 pandemic in nine selected countries of the Eastern Mediterranean region (EMR). METHODS The study employed in-depth analytical research design and was conducted in two phases. In the first phase, data were collected using a comprehensive documentation review. In the second phase, key informant interviews were conducted to validate findings from the first phase and gain additional insights into key barriers and facilitators. We analysed the macro-level pandemic responses across the following seven components of the analytical framework for multi-sectoral collaborations: (1) context and trigger; (2) leadership, institutional mechanisms and processes; (3) actors; (4) administration, funding and evaluation; (5) degree of multi-sectoral engagement; (6) impact; and (7) enabling factors. RESULTS Governments in the EMR have responded differently to the pandemic, with variations in reaction speed and strictness of implementation. While inter-ministerial committees were identified as the primary mechanism through which multi-sectoral action was established and implemented in the selected countries, there was a lack of clarity on how they functioned, particularly regarding the closeness of the cooperation and the working methods. Coordination structures lacked a clear mandate, joint costed action plan, sufficient resources and regular reporting on commitments. Furthermore, there was no evidence of robust communication planning both internally, focused on promoting internal consensual decision-making and managing power dynamics, and externally, concerning communication with the public. Across the selected countries, there was strong representation of different ministries in the pandemic response. Conversely, the contribution of non-state actors, including non-governmental organizations, civil society organizations, the private sector, the media and citizens, was relatively modest. Their involvement was more ad hoc, fragmented and largely self-initiated, particularly within the selected middle- and low income- countries of the EMR. Moreover, none of the countries incorporated explicit accountability framework or included anti-corruption and counter-fraud measures as integral components of their multi-sectoral plans and coordination mechanisms. Key enablers for the adoption of multi-sectoral collaborations have been identified, paving the way for more efficient responses in the future. DISCUSSION Mirroring global efforts, this study demonstrates that the selected countries in the EMR are making efforts to integrate multi-sectoral action into their pandemic responses. Nevertheless, persistent challenges and gaps remain, presenting untapped opportunities that governments can leverage to enhance the efficiency of future public health emergency responses.
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Affiliation(s)
- Fadi El-Jardali
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada
| | - Racha Fadlallah
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
- Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon.
| | - Najla Daher
- Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
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Helldén D, Sok S, Chea T, Nordenstedt H, Kuruvilla S, Alvesson HM, Alfvén T. Sustainable development goals and multisectoral collaborations for child health in Cambodia: a qualitative interview study with key child health stakeholders. BMJ Open 2023; 13:e073853. [PMID: 37989366 PMCID: PMC10668300 DOI: 10.1136/bmjopen-2023-073853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 10/04/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVES Multisectoral collaboration highlighted as key in delivering on the Sustainable Development Goals (SDGs), but still little is known on how to move from rhetoric to action. Cambodia has made remarkable progress on child health over the last decades with multisectoral collaborations being a key success factor. However, it is not known how country stakeholders perceive child health in the context of the SDGs or multisectoral collaborations for child health in Cambodia. DESIGN, SETTINGS AND PARTICIPANTS Through purposive sampling, we conducted semistructured interviews with 29 key child health stakeholders from a range of government and non-governmental organisations in Cambodia. Guided by framework analysis, themes, subthemes and categories were derived. RESULTS We found that the adoption of the SDGs led to increased possibility for action and higher ambitions for child health in Cambodia, while simultaneously establishing child health as a multisectoral issue among key child stakeholders. There seems to be a discrepancy between the desired step-by-step theory of conducting multisectoral collaboration and the real-world complexities including funding and power dynamics that heavily influence the process of collaboration. Identified success factors for multisectoral collaborations included having clear responsibilities, leadership from all and trust among stakeholders while the major obstacle found was lack of sustainable funding. CONCLUSION The findings from this in-depth multistakeholder study can inform policy-makers and practitioners in other countries on the theoretical and practical process as well as influencing aspects that shape multisectoral collaborations in general and for child health specifically. This is vital if multisectoral collaborations are to be successfully leveraged to accelerate the work towards achieving better child health in the era of the SDGs.
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Affiliation(s)
- Daniel Helldén
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Serey Sok
- Research Office, Royal University of Phnom Penh, Phnom Penh, Cambodia
| | - Thy Chea
- Malaria Consortium, Phnom Penh, Cambodia
| | - Helena Nordenstedt
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | | | | | - Tobias Alfvén
- Global Public Health, Karolinska Institute, Stockholm, Sweden
- Sachs' Children and Youth Hospital, Stockholm, Sweden
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Nambiar D, Bestman A, Srivastava S, Marten R, Yangchen S, Buse K. How to Build Healthy Societies: A Thematic Analysis of Relevant Conceptual Frameworks. Int J Health Policy Manag 2023; 12:7451. [PMID: 38618791 PMCID: PMC10699821 DOI: 10.34172/ijhpm.2023.7451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/16/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND As the Sustainable Development Goals deadline of 2030 draws near, greater attention is being given to health beyond the health sector, in other words, to the creation of healthy societies. However, action and reform in this area has not kept pace, in part due to a focus on narrower interventions and the lack of upstream action on health inequity. With an aim to guide action and political engagement for reform, we conducted a thematic analysis of concepts seeking to arrive at healthy societies. METHODS This paper drew on a qualitative thematic analysis of a purposive sample of 68 documents including political declarations, reports, peer reviewed literature and guidance published since 1974. Three independent reviewers extracted data to identify, discuss and critique public policy levers and 'enablers' of healthy societies, the "how." RESULTS The first lever concerned regulatory and fiscal measures. The second was intersectoral action. The final lever a shift in the global consensus around what signifies societal transformation and outcomes. The three enablers covered political leadership and accountability, popular mobilization and the generation and use of knowledge. CONCLUSION Documents focused largely on technical rather than political solutions. Even as the importance of political leadership was recognized, analysis of power was limited. Rights-based approaches were generally neglected as was assessing what worked or did not work to pull the levers or invest in the enablers. Frameworks typically failed to acknowledge or challenge prevailing ideologies, and did not seek to identify ways to hold or governments or corporations accountable for failures. Finally, ideas and approaches seem to recur again over the decades, without adding further nuance or analysis. This suggests a need for more upstream, critical and radical approaches to achieve healthy societies.
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Affiliation(s)
- Devaki Nambiar
- The George Institute for Global Health, New Delhi, India
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Amy Bestman
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | | | - Robert Marten
- The Alliance for Health Policy and Systems Research, World Health Organization (WHO), Geneva, Switzerland
| | - Sonam Yangchen
- The Alliance for Health Policy and Systems Research, World Health Organization (WHO), Geneva, Switzerland
| | - Kent Buse
- The George Institute for Global Health, Imperial College London, London, UK
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Kwachi B, Njiri S, Mulyanga S, Choge I, Mwalimu R, Ontiri S. Implementation of a Multisectoral Approach to Address Adolescent Pregnancy: A Case Study of Subnational Advocacy Informing National Scale-Up in Kenya. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2200546. [PMID: 37903578 PMCID: PMC10615237 DOI: 10.9745/ghsp-d-22-00546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/15/2023] [Indexed: 11/01/2023]
Abstract
Adolescent pregnancy continues to be a major concern globally, especially in sub-Saharan Africa, where it contributes to high maternal mortality and morbidity and other non-health consequences, such as school dropouts. Addressing adolescent sexual and reproductive health requires an enabling environment that extends beyond an individual to community and society levels through concerted efforts by various sectors and agencies. From 2016 to 2022, we implemented an advocacy intervention in Kenya that catalyzed multisectoral collaboration to address adolescent sexual and reproductive health issues, specifically adolescent pregnancy, at subnational and national levels. In this article, we document our experiences implementing the intervention by presenting a case study of this initiative, including the processes and lessons learned. Our experience to date demonstrates that multisectoral initiatives can be rolled out to address adolescent pregnancies in countries that continue to have a high burden of adolescent pregnancy. Successful implementation requires inclusivity, commitment, and leadership to fully realize the potential that multisectoral actions have in preventing adolescent pregnancy.
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Affiliation(s)
| | - Sally Njiri
- Advance Family Planning, Jhpiego Kenya, Nairobi, Kenya
| | - Sam Mulyanga
- Advance Family Planning, Jhpiego Kenya, Nairobi, Kenya
| | - Irene Choge
- Advance Family Planning, Jhpiego Kenya, Nairobi, Kenya
| | | | - Susan Ontiri
- International Center for Reproductive Health-Kenya, Mombasa, Kenya.
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Scarr JP, Jagnoor J. Identifying strategic priorities for advancing global drowning prevention: a Delphi method. BMJ Glob Health 2023; 8:e013303. [PMID: 37709301 PMCID: PMC10503336 DOI: 10.1136/bmjgh-2023-013303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/20/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION The burden of drowning is gaining prominence on the global agenda. Two United Nations system resolutions in 3 years reflect rising political support, but priorities remain undefined, and the issue lacks a global strategy. We aimed to identify strategic priorities for advancing global drowning prevention using a modified Delphi method. METHODS An advisory group was formed, and participants recruited with diverse expertise and backgrounds. We used document review, and data extracted from global health partnerships to identify strategic domains and draft priorities for global drowning prevention. Participants rated the priorities in two Delphi rounds, guided by relevance, feasibility and impact on equity, and where consensus was ≥70% of participants rating the priority as critical. RESULTS We recruited 134 participants from research (40.2%), policy (26.9%), technical (25.4%) and community (7.5%) backgrounds, with 38.1% representing low- and middle-income countries. We drafted 75 priorities. Following two Delphi rounds, 50 priorities were selected across the seven domains of research and further contextualisation, best practice guidance, capacity building, engagement with other health and sustainable development agendas, high-level political advocacy, multisectoral action and strengthening inclusive global governance. Participants scored priorities based on relevance (43.2%), feasibility (29.4%) and impact on equity (27.4%). CONCLUSION Our study identifies global priorities for drowning prevention and provides evidence for advocacy of drowning prevention in all pertinent policies, and in all relevant agendas. The priorities can be applied by funders to guide investment, by researchers to frame study questions, by policymakers to contrast views of expert groups and by national coalitions to anchor national drowning prevention plans. We identify agendas including disaster risk reduction, sustainable development, child and adolescent health, and climate resilience, where drowning prevention might offer co-benefits. Finally, our findings offer a strategic blueprint as the field looks to accelerate action, and develop a global strategy for drowning prevention.
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Affiliation(s)
- Justin-Paul Scarr
- The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia
- Royal Life Saving Society - Australia, Broadway, New South Wales, Australia
| | - Jagnoor Jagnoor
- The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia
- Injury Division, The George Institute for Global Health, New Delhi, India
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Ezekannagha O, Adeyemi O, Ajieroh V, Onabolu A. Advancing a Multisectoral Platform for Nutrition-Sensitive Agriculture in Nigeria: Reflections on Effectiveness and Lessons Learned. Food Nutr Bull 2023; 44:S52-S60. [PMID: 37317523 DOI: 10.1177/03795721231179786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Inadequate coordination mechanisms and capacity to coordinate are limiting factors for maximizing the ability of agriculture to improve nutrition in Sub-Saharan Africa. Effective coordination requires the availability of a platform for stakeholder convening, planning, operationalization of ideas, communication, and accountability. Nigeria's Federal Ministry of Agriculture and Rural Development established one such platform to support the institutionalization of nutrition-sensitive agriculture. Platform members include several departments within the Ministry, other ministries, and development partners. While the platform achieved key milestones and fostered collaboration, some gaps remained. OBJECTIVE This study reports an assessment to understand the perspectives of members of the coordination platform and identify ways of increasing effectiveness. METHODS Desk reviews of relevant documents and 18 key informant interviews were conducted. Documents and interview notes were coded and analysed to identify recurring themes. Themes were appraised using a nutrition coordination framework. RESULTS Sufficiently understanding the nutrition role of representatives' own organization/department and the purpose of the coordination platform and its activities was important for success. The profile and seniority of representing officers also mattered. While the leadership of the Ministry was committed to advancing nutrition through agriculture, the coordination platform could improve its functionality through consistent leadership, increased seniority of member representatives, and appropriate communication. CONCLUSIONS Multisectoral coordination platforms are necessary but do not alone achieve nutrition coordination. Effective leadership and investments in time, strategic orientation, and training are critical to achieving a shared purpose, individual sector fulfilment of nutrition roles, and additional coordination success factors.
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Affiliation(s)
| | - Olutayo Adeyemi
- Department of Human Nutrition and Dietetics, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | | | - Adeyinka Onabolu
- Global Alliance for Improved Nutrition, Abuja, Nigeria
- Federal Ministry of Agriculture and Rural Development, Abuja, Nigeria
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Bhatnagar P, Whiting S, Wickramasinghe K. Recommendations for developing urban interventions to promote physical activity: interviews with key informants in Europe. CITIES & HEALTH 2023; 7:1002-1011. [PMID: 38013980 PMCID: PMC10591599 DOI: 10.1080/23748834.2023.2242090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/25/2023] [Indexed: 11/29/2023]
Abstract
Although there is growing evidence on what interventions can promote physical activity in urban environments, guidance on how to get these interventions implemented is lacking in a European context. To understand the process of developing urban interventions to promote physical activity, we conducted 13 key informant interviews with professionals working in urban development in five European countries, though some worked in more than one country. Participants described their experiences, challenges and recommendations across six European countries. The main challenges faced were political environments, unsupportive contexts, communication issues, working with other sectors, resource limitations and evaluations. We presented recommendations made by participants which can overcome these challenges when developing urban interventions to promote physical activity. Recommendations included obtaining cross-party political support for a project; working with local communities right from the beginning; involving all stakeholders and encouraging their commitment through identification of common goals; asking the market for solutions when faced with resource constraints, and using existing data to facilitate evaluations.
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Affiliation(s)
- Prachi Bhatnagar
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, UK
| | - Stephen Whiting
- World Health Organization European Office for the Prevention and Control of Non-Communicable Diseases, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Kremlin Wickramasinghe
- World Health Organization European Office for the Prevention and Control of Non-Communicable Diseases, WHO Regional Office for Europe, Copenhagen, Denmark
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Jones W, Sobers N, Brown-Perry A, Bristol L, Samuels TA. Revising primary and secondary school curricula in the Caribbean to enhance education on the risks for noncommunicable diseases. Rev Panam Salud Publica 2023; 47:e97. [PMID: 37405120 PMCID: PMC10317247 DOI: 10.26633/rpsp.2023.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/09/2023] [Indexed: 07/06/2023] Open
Abstract
In the English-speaking Caribbean, an estimated 46% of men and 61% of women are currently overweight or obese, and 8% of children younger than 5 years are also overweight. To combat this worsening epidemic, driven by unhealthy dietary patterns, the Heads of Government of the Caribbean Community (CARICOM) issued the 2007 Port-of-Spain Declaration, which included mandates on the provision of healthy school meals, promotion of healthy dietary patterns, and reintroduction of physical education in schools. These mandates are aligned with evidence-based approaches used in childhood obesity prevention programs. School-based interventions, including curriculum revisions, are part of a multipronged approach to improve nutrition in children and are designed to complement and reinforce other interventions in schools. However, formal evaluation of the Port-of-Spain Declaration showed that most CARICOM member countries had difficulty implementing the mandates related to schools and diet. The Improving Household Nutrition Security and Public Health in the CARICOM project, in collaboration with regional institutions, the CARICOM Secretariat, and the Caribbean Examinations Council, sought to enhance nutrition education through revision of region-wide primary and secondary school curricula to increase the focus on prevention of noncommunicable diseases. This paper describes the process of revising the Caribbean Examinations Council's Human and Social Biology syllabus for secondary schools and the CARICOM Health and Family Life Education Regional Curriculum Framework for primary schools, which was achieved through multisectoral collaboration. We used the Framework for Reporting Adaptations and Modifications-Enhanced model to describe the process through which the modifications were made.
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Affiliation(s)
- Waneisha Jones
- The Faculty of Medical SciencesThe University of the West IndiesCave Hill CampusBarbadosThe Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Barbados.
| | - Natasha Sobers
- The George Alleyne Chronic Disease Research Centrea unit of the Caribbean Institute for Health ResearchThe University of the West IndiesBridgetownBarbadosThe George Alleyne Chronic Disease Research Centre, a unit of the Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados.
| | - Alsian Brown-Perry
- Caribbean Examinations CouncilKingstonJamaicaCaribbean Examinations Council, Kingston, Jamaica (retired).
| | - Laurette Bristol
- Human Resource DevelopmentCARICOM SecretariatTurkeyenGeorgetownGuyanaHuman Resource Development, CARICOM Secretariat, Turkeyen, Georgetown, Guyana.
| | - T. Alafia Samuels
- Epidemiology Research UnitCaribbean Institute for Health ResearchThe University of the West IndiesKingstonJamaicaEpidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica.
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Mabetha D, Ojewola T, van der Merwe M, Mabika R, Goosen G, Sigudla J, Hove J, Witter S, D'Ambruoso L. Realising radical potential: building community power in primary health care through Participatory Action Research. Int J Equity Health 2023; 22:94. [PMID: 37198678 DOI: 10.1186/s12939-023-01894-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 04/14/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND While community participation is an established pro-equity approach in Primary Health Care (PHC), it can take many forms, and the central category of power is under-theorised. The objectives were to (a) conduct theory-informed analysis of community power-building in PHC in a setting of structural deprivation and (b) develop practical guidance to support participation as a sustainable PHC component. METHODS Stakeholders representing rural communities, government departments and non-governmental organisations engaged through a participatory action research (PAR) process in a rural sub-district in South Africa. Three reiterative cycles of evidence generation, analysis, action, and reflection were progressed. Local health concerns were raised and framed by community stakeholders, who generated new data and evidence with researchers. Dialogue was then initiated between communities and the authorities, with local action plans coproduced, implemented, and monitored. Throughout, efforts were made to shift and share power, and to adapt the process to improve practical, local relevance. We analysed participant and researcher reflections, project documents, and other project data using power-building and power-limiting frameworks. RESULTS Co-constructing evidence among community stakeholders in safe spaces for dialogue and cooperative action-learning built collective capabilities. The authorities embraced the platform as a space to safely engage with communities and the process was taken up in the district health system. Responding to COVID-19, the process was collectively re-designed to include a training package for community health workers (CHWs) in rapid PAR. New skills and competencies, new community and facility-based alliances and explicit recognition of CHW roles, value, and contribution at higher levels of the system were reported following the adaptations. The process was subsequently scaled across the sub-district. CONCLUSIONS Community power-building in rural PHC was multidimensional, non-linear, and deeply relational. Collective mindsets and capabilities for joint action and learning were built through a pragmatic, cooperative, adaptive process, creating spaces where people could produce and use evidence to make decisions. Impacts were seen in demand for implementation outside the study setting. We offer a practice framework to expand community power in PHC: (1) prioritising community capability-building, (2) navigating social and institutional contexts, and (3) developing and sustaining authentic learning spaces.
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Affiliation(s)
- Denny Mabetha
- Cochrane South Africa, South African Medical Research Council (MRC), Cape Town, South Africa
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Aberdeen Centre for Health Data Science, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, and Centre for Global Development, School of Education, University of Aberdeen, Aberdeen, Scotland, UK
| | - Temitope Ojewola
- Aberdeen Centre for Health Data Science, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, and Centre for Global Development, School of Education, University of Aberdeen, Aberdeen, Scotland, UK
- Health Education England, Northwest, Manchester, England, UK
| | - Maria van der Merwe
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Aberdeen Centre for Health Data Science, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, and Centre for Global Development, School of Education, University of Aberdeen, Aberdeen, Scotland, UK
- Maria Van Der Merwe Consulting, White River, South Africa
| | | | | | - Jerry Sigudla
- Mpumalanga Department of Health, Mbombela, South Africa
| | - Jennifer Hove
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Aberdeen Centre for Health Data Science, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, and Centre for Global Development, School of Education, University of Aberdeen, Aberdeen, Scotland, UK
| | - Sophie Witter
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, Scotland, UK
| | - Lucia D'Ambruoso
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
- Aberdeen Centre for Health Data Science, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, and Centre for Global Development, School of Education, University of Aberdeen, Aberdeen, Scotland, UK.
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, Scotland, UK.
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
- Public Health, National Health Service (NHS) Grampian, Aberdeen, Scotland, UK.
- Department of Global Health, Stellenbosch University, Stellenbosch, South Africa.
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Chiari APG, Senna MIB, Gomes VE, Freire MDSM, Soares ARDS, Alves CRL, Cury GC, Ferreira RC. Intersectoral Collaboration to Promote Child Development: The Contributions of the Actor-Network Theory. QUALITATIVE HEALTH RESEARCH 2023; 33:451-467. [PMID: 37010148 PMCID: PMC10126467 DOI: 10.1177/10497323231153534] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
An integrated intersectoral care model promises to meet complex needs to promote early child development and address health determinants and inequities. Nevertheless, there is a lack of understanding of actors' interactions in producing intersectoral collaboration networks. The present study aimed to analyze the intersectoral collaboration in the social protection network involved in promoting early child growth and development in Brazilian municipalities. Underpinned by the tenets of actor-network theory, a case study was conducted with data produced from an educational intervention, entitled "Projeto Nascente." Through document analysis (ecomaps), participant observation (in Projeto Nascente seminars), and interviews (with municipal management representatives), our study explored and captured links among actors; controversies and resolution mechanisms; the presence of mediators and intermediaries; and an alignment of actors, resources, and support. The qualitative analysis of these materials identified three main themes: (1) agency fragility for intersectoral collaboration, (2) attempt to form networks, and (3) incorporation of fields of possibilities. Our findings revealed that intersectoral collaboration for promoting child growth and development is virtually non-existent or fragile, and local potential is missed or underused. These results emphasized the scarcity of action by mediators and intermediaries to promote enrollment processes to intersectoral collaboration. Likewise, existing controversies were not used as a mechanism for triggering changes. Our research supports the need to mobilize actors, resources, management, and communication tools that promote processes of interessement and enrollment in favor of intersectoral collaboration policies and practices for child development.
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Affiliation(s)
- Antônio Paulo Gomes Chiari
- Universidade Federal de Minas
Gerais, Belo Horizonte, Brazil
- Antônio Paulo Gomes Chiari, Department of Social
and Preventive Dentistry, Universidade Federal de Minas Gerais, Av. Presidente Antônio
Carlos, 6627, Belo Horizonte 31270-901, Brazil.
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Soilemezi D, Palmar‐Santos A, Navarta‐Sánchez MV, Roberts HC, Pedraz‐Marcos A, Haahr A, Sørensen D, Bragstad LK, Hjelle EG, Haavaag SB, Portillo MC. Understanding support systems for Parkinson's disease management in community settings: A cross-national qualitative study. Health Expect 2023; 26:670-682. [PMID: 36573594 PMCID: PMC10010098 DOI: 10.1111/hex.13691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/27/2022] [Accepted: 12/09/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Health and social care systems face difficulties in managing multimorbidity, disease burden and complex needs in long-term conditions such as Parkinson's disease. OBJECTIVE This study aimed to develop a European understanding of how health and social care professionals can collaborate with stakeholders from different organizations and sectors to enhance the management of Parkinson's disease in a community setting by identifying the existing gaps in this process and how people with Parkinson's disease and their family carers could benefit from these partnerships. METHODS A mixed-methods sequential study was conducted in Denmark, Norway, Spain and the United Kingdom. The findings from the qualitative phase are presented. Individual semistructured interviews were analysed using Braun's and Clarke's thematic analysis. A meta-ethnography approach was used to analyse and synthesize cross-national findings. RESULTS A total of 41 healthcare professionals and 39 stakeholders from different disciplines and sectors were interviewed in the four countries. The participants acknowledged a lack of awareness of available resources and poor communication between the different support systems in the management of Parkinson's disease. To promote multiagency collaborations, the participants highlighted the need to organize services along the Parkinson's disease journey, patient involvement and strategic involvement of carers in organizing resources and Parkinson's disease care pathways. According to the participants, the benefits from multiagency partnerships could lead to an enhanced continuity of care and specialized knowledge, mobilization of resources in the community, personalized support and improved access to services. CONCLUSIONS Policymakers are called upon to create formal structures that facilitate multisectoral collaborations to promote an integrated system of care for the management of Parkinson's disease in the community. To address this challenge, we propose five strategies showing how organizations can work together to optimize the use of resources and enhance the management of Parkinson's disease throughout the illness trajectory. PATIENT OR PUBLIC CONTRIBUTION Patient and Public Involvement groups made up of stakeholders, healthcare professionals, patients with Parkinson's disease and family carers participated in the design of the study, the development of the interview guides and the validation of the findings.
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Affiliation(s)
- Dia Soilemezi
- Department of Psychology, Faculty of Science and HealthUniversity of PortsmouthPortsmouthUK
| | - Ana Palmar‐Santos
- Nursing Department, Faculty of MedicineUniversidad Autónoma de MadridMadridSpain
| | | | - Helen C. Roberts
- National Institute for Health Research Applied Research Collaboration Wessex, Long Term Conditions, SouthamptonUK
- Academic Geriatric Medicine, Faculty of MedicineUniversity of SouthamptonSouthamptonUK
| | - Azucena Pedraz‐Marcos
- Unidad de Investigación en Cuidados y Sistemas de SaludThe Carlos III Health Institute (ISCIII)MadridSpain
- Grupo de investigación ISCiiiResearch Network on Chronicity, Primary Care, and Health Promotion (RICAPPS)TenerifeSpain
| | - Anita Haahr
- Research Centre for Health and Welfare Technology, Programme for Rehabilitation, VIA University CollegeAarhusDenmark
- Nursing and Healthcare, Department of Public HealthAarhus UniversityAarhusDenmark
| | - Dorthe Sørensen
- Research Centre for Health and Welfare Technology, Programme for Rehabilitation, VIA University CollegeAarhusDenmark
| | - Line K. Bragstad
- Department of Nursing Science and Research Center for Habilitation and Rehabilitation Services and Models (CHARM)University of OsloOsloNorway
- Department of Occupational Therapy, Prosthetics and OrthoticsOslo Metropolitan UniversityOsloNorway
| | - Ellen G. Hjelle
- Department of Nursing Science and Research Center for Habilitation and Rehabilitation Services and Models (CHARM)University of OsloOsloNorway
- Department of Occupational Therapy, Prosthetics and OrthoticsOslo Metropolitan UniversityOsloNorway
| | | | - Mari Carmen Portillo
- National Institute for Health Research Applied Research Collaboration Wessex, Long Term Conditions, SouthamptonUK
- Faculty of Environmental and Life Sciences, School of Health SciencesUniversity of SouthamptonSouthamptonUK
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Kolodziej D, Wolkwitz P, Schön G, Siefert S, Pawils S. Evaluation of a Child-centred Psychosocial Healthcare Intervention (KIDPROTEKT) - Results of a Cluster Randomized Controlled Trial in Paediatric and Gynaecologic Practices. INTERVENCION PSICOSOCIAL 2023; 32:33-42. [PMID: 37361631 PMCID: PMC10268543 DOI: 10.5093/pi2023a2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 10/11/2022] [Indexed: 06/28/2023]
Abstract
KID-PROTEKT is a child-centred psychosocial healthcare intervention which aims at improving the identification of psychosocial needs and navigation in the outpatient gynaecologic and paediatric setting. In this cluster randomized-controlled trail we examined the effect of KID-PROTEKT on the referrals (to support services) in comparison to the regular gynaecologic and paediatric outpatient healthcare . A variant based on the qualification of the healthcare providers (qualified treatment, QT) and a variant with social worker (supported treatment, ST) were compared to the regular healthcare (treatment as usual, TAU). Twenty-four gynaecologic and paediatric practices were randomized to one of three study arms. Therefore 8,458 pregnant women and families recruited in one of these practices were enrolled in the study. Participating patients reported on average 1.73 (SD = 1.34) psychosocial risks. In total 522 patients were linked to a support service. Compared to TAU, the probability of a referral was significantly higher in QT (OR = 10.70) and ST (OR = 11.28). Also, a higher number of psychosocial risks were linked to a referral (OR = 2.72). These findings support the importance of a psychosocial assessment in the gynaecologic and paediatric setting.
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Affiliation(s)
- Désirée Kolodziej
- University Medical Center Hamburg-EppendorfHamburgGermanyUniversity Medical Center Hamburg-Eppendorf, Hamburg, Germany;
| | - Philipp Wolkwitz
- University Medical Center Hamburg-EppendorfHamburgGermanyUniversity Medical Center Hamburg-Eppendorf, Hamburg, Germany;
| | - Gerhard Schön
- University Medical Center Hamburg-EppendorfHamburgGermanyUniversity Medical Center Hamburg-Eppendorf, Hamburg, Germany;
| | - Sönke Siefert
- Catholic Children’s Hospital WilhelmstiftHamburgGermanyCatholic Children’s Hospital Wilhelmstift, Hamburg, Germany
| | - Silke Pawils
- University Medical Center Hamburg-EppendorfHamburgGermanyUniversity Medical Center Hamburg-Eppendorf, Hamburg, Germany;
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Exploring barriers and facilitators to integrated policy formulation and implementation of family planning and urban development programmes in Nigeria. Health Res Policy Syst 2022; 20:115. [PMID: 36307811 PMCID: PMC9617294 DOI: 10.1186/s12961-022-00924-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 10/06/2022] [Indexed: 11/23/2022] Open
Abstract
Background As more people now live in urban areas than in rural communities in Nigeria, urban development (UD) requires urgent policy and programmatic attention. Although the population factor has been identified as important to achieving national development goals, and evidence suggests that meeting the family planning (FP) and reproductive health (RH) needs of the vulnerable urban population can serve as an important recipe for achieving population growth rates consistent with building sustainable, habitable and prosperous urban settings, FP remains a neglected subject in UD initiatives in Nigeria. This study explored barriers and facilitators in achieving integrated policy formulation and implementation of FP and UD programmes in Nigeria.
Methods We conducted key informant interviews (n = 37) with relevant FP/RH and UD stakeholders in Ibadan and Kaduna—two megacities that have undergone several UD and FP intervention programmes in the south and north of Nigeria. The sample size was determined by data saturation. Data were organized using ATLAS.ti and NVivo 12 software, and analysis was conducted using a thematic approach. Results We found that relevant government agencies largely work in silos. Other identified barriers to integrated policy formulation/implementation of FP and UD programmes in Nigeria include lack of knowledge about the FP–UD nexus between professionals, ineffective implementation and monitoring of existing guidelines, lack of policy documentation that clearly links FP and UD, and frequent transfer of government stakeholders. Notwithstanding the identified barriers, the study established ways of achieving synergy between FP and UD sectors, including stakeholder engagement, intersectoral collaborations, sensitization and publicity, roundtable discussion, interdisciplinary research, conferences and other interactive and knowledge-sharing fora. Conclusions We conclude that addressing barriers to the intersectoral linkage between FP and UD is fundamental to achieving sustainable urbanization in Nigeria.
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Scarr JP, Jagnoor J. Identifying opportunities for multisectoral action for drowning prevention: a scoping review. Inj Prev 2022; 28:585-594. [DOI: 10.1136/ip-2022-044712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 08/26/2022] [Indexed: 11/05/2022]
Abstract
BackgroundDrowning is a complex health issue, where global agendas call for greater emphasis on multisectoral action, and engagement with sectors not yet involved in prevention efforts. Here, we explored the conceptual boundaries of drowning prevention in peer-review and grey literature, by reviewing the contexts, interventions, terminologies, concepts, planning models, and sector involvement, to identify opportunities for multisectoral action.MethodsWe applied scoping review method and have reported against Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews checklist. We searched four electronic databases for peer-reviewed articles published on 1 January 2005 and 31 December 2020 and five databases for grey literature published on 1 January 2014 and 31 December 2020. We applied the search term “drowning,” and charted data addressing our research questions.ResultsWe included 737 peer-reviewed articles and 68 grey documents. Peer-publications reported situational assessments (n=478, 64.86%) and intervention research (n=259, 35.14%). Drowning was reported in the context of injury (n=157, 21.30%), commonly in childhood injury (n=72, 9.77%), mortality studies (n=60, 8.14%) and in grey documents addressing adolescent, child, environmental, occupational and urban health, refugee and migrant safety and disaster. Intervention research was mapped to World Health Organization recommended actions. The leading sectors in interventions were health, leisure, education and emergency services.ConclusionAlthough drowning is often described as a major health issue, the sectors and stakeholders involved are multifarious. The interventions are more often initiated by non-health sectors, meaning multisectoral action is critical. Framing drowning prevention to reinforce cobenefits for other health and development agendas could strengthen multisectoral action. Greater investment in partnerships with non-health sectors, encouraging joint planning and implementation, and creating systems for increased accountability should be a priority in future years.
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Ye P, Jin Y, Er Y, Yin X, Yao Y, Li B, Zhang J, Ivers R, Keay L, Duan L, Tian M. Perceptions of Facilitators and Barriers to Implementation of Falls Prevention Programs in Primary Health Care Settings in China. JAMA Netw Open 2022; 5:e2228960. [PMID: 36018587 PMCID: PMC9419020 DOI: 10.1001/jamanetworkopen.2022.28960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
IMPORTANCE Falls have become a major public health issue in China with population aging. Although falls prevention for older community-dwelling people has been included in the National Essential Public Health Service Package since 2009, there is limited understanding of the implementation of this program. OBJECTIVE To identify the associated factors and provide recommendations to inform the better implementation of falls prevention in the Chinese primary health care system. DESIGN, SETTING, AND PARTICIPANTS This qualitative study was conducted in 3 purposively selected cities in China from March 1 to June 7, 2021. Health administrators from the local health commission or bureau, staff members from local Centers for Disease Control and Prevention and primary health care facilities and community-dwelling older people were recruited, using a combination of purposive sampling and snowball sampling. MAIN OUTCOMES AND MEASURES In-depth interviews were conducted with health administrators and focus groups with other participants. Data analysis followed the guidance of the Consolidated Framework for Implementation Research. Study outcomes included facilitators and barriers of implementing falls prevention for older people in the Chinese primary health care settings. A framework with recommendations was developed to inform the future intervention implementation. RESULTS Among a total of 130 participants interviewed, 77 (59.2%) were female and the mean (SD) age was 47.4 (16.7) years. Clear recognition of the challenges and benefits of falls prevention, adaptive regionally tailored guidance plans, and continuous governmental policy and financial support were the major facilitators, whereas the major barriers consisted of insufficient confidence in delivering interventions and poor understanding of the falls burden, low recognition of the importance of falls prevention, limited multisectoral collaboration, and weak financial incentives. A 7-strategy embedded framework-including data-driven surveillance, audit and feedback, implementation strategy, workforce strengthening, community empowerment, internal services integration, and external enabling environment-was developed to foster successful implementation. CONCLUSIONS AND RELEVANCE This qualitative study identified major facilitators and barriers to the implementation of falls prevention for older people at the primary care level, which have the potential to contribute to better implementation of falls prevention for older people in the Chinese primary health care system.
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Affiliation(s)
- Pengpeng Ye
- The George Institute for Global Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
- National Centre for Non-Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Ye Jin
- The George Institute for Global Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
- National Centre for Non-Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Yuliang Er
- National Centre for Non-Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Xuejun Yin
- The George Institute for Global Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - Yao Yao
- China Centre for Health Development Studies, Peking University, Beijing, China
| | - Bingqin Li
- Social Policy Research Centre, UNSW Sydney, Sydney, Australia
| | - Jing Zhang
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - Rebecca Ivers
- The George Institute for Global Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - Lisa Keay
- The George Institute for Global Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
- School of Optometry and Vision Science, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - Leilei Duan
- National Centre for Non-Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Maoyi Tian
- The George Institute for Global Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
- School of Public Health, Harbin Medical University, Harbin, China
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Trowbridge J, Tan JY, Hussain S, Osman AEB, Di Ruggiero E. Examining Intersectoral Action as an Approach to Implementing Multistakeholder Collaborations to Achieve the Sustainable Development Goals. Int J Public Health 2022; 67:1604351. [PMID: 35652124 PMCID: PMC9149775 DOI: 10.3389/ijph.2022.1604351] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 03/31/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives: The Sustainable Development Goals (SDGs) re-orient action towards improving the social and ecological determinants of health and equity. SDG 17 calls for enhanced policy and institutional coherence and strong multi-stakeholder partnerships. Intersectoral action (IA) has a promising history in public health, including health promotion and global health. Some experts see IA as crucial to the SDGs. Yet less is known about how IA is conceptualized and what promising models exist with relevance to the SDGs. We sought to investigate how IA is understood conceptually and empirically. Methods: We conducted a narrative review of global public health and political science literatures and grey literature on the SDGs to identify theoretical models, case studies and reviews of IA research. Results: Multiple competing conceptualizations of IA exist. Research has focused on case studies in high-income countries. More conceptual clarity, analyses of applications in LMICs, and explorations of political and institutional factors affecting IA are needed, as is attention to power dynamics between sectors. Conclusion: IA is required to collaborate on the SDGs and address equity. New models for successful implementation merit exploration.
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Affiliation(s)
- Joslyn Trowbridge
- Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Julia Y. Tan
- Faculty of Arts and Science, University of Toronto, Toronto, ON, Canada
| | - Sameera Hussain
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Ahmed Esawi Babiker Osman
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Erica Di Ruggiero
- Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- *Correspondence: Erica Di Ruggiero,
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Pearce T, Maple M, Wayland S, McKay K, Woodward A, Brooks A, Shakeshaft A. A mixed-methods systematic review of suicide prevention interventions involving multisectoral collaborations. Health Res Policy Syst 2022; 20:40. [PMID: 35422050 PMCID: PMC9009036 DOI: 10.1186/s12961-022-00835-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 03/06/2022] [Indexed: 11/15/2022] Open
Abstract
Background Governments and third-sector organizations (TSOs) require support to reduce suicide mortality through funding of suicide prevention services and innovative research. One way is for researchers to engage individuals and services in multisectoral collaborations, to collaboratively design, develop and test suicide prevention services and programmes. However, despite widespread support, to date, it remains unclear as to the extent to which stakeholders are being included in the research process, or if they are, how these partnerships occur in practice. To address this gap, the authors conducted a systematic review with the aim of identifying evidence of multisectoral collaborations within the field of suicide prevention, the types of stakeholders involved and their level of involvement. Methods The authors conducted a strategic PRISMA-compliant search of five electronic databases to retrieve literature published between January 2008 and July 2021. Hand-searching of reference lists of key systematic reviews was also completed. Of the 7937 papers retrieved, 16 papers finally met the inclusion criteria. Because of data heterogeneity, no meta-analysis was performed; however, the methodological quality of the included studies was assessed. Results Only one paper included engagement of stakeholders across the research cycle (co-ideation, co-design, co-implementation and co-evaluation). Most stakeholders were represented by citizens or communities, with only a small number of TSOs involved in multisectoral collaborations. Stakeholder level of involvement focused on the co-design or co-evaluation stage. Conclusion This review revealed a lack of evidence of multisectoral collaborations being established between researchers and stakeholders in the field of suicide prevention research, even while such practice is being espoused in government policies and funding guidelines. Of the evidence that is available, there is a lack of quality studies documenting the collaborative research process. Also, results showed that the inclusion of co-researchers from communities or organizations is defined as co-creation, but further analysis revealed that collaboration was not consistent across the duration of projects. Researchers and practitioners should consider issues of power and equity in multisectoral collaborations and encourage increased engagement with TSOs, to rigorously research and evaluate suicide prevention services.
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Pulido-Fuentes M, Palmar-Santos AM, Flores-Martos JA, Cipriano-Crespo C, Rubio LA, González LA, Navarta-Sánchez MV. Internal dynamics within primary care teams in two Spanish regions during the COVID-19 pandemic: a qualitative study. BMC PRIMARY CARE 2022; 23:64. [PMID: 35361146 PMCID: PMC8970064 DOI: 10.1186/s12875-022-01674-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 03/21/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Pandemics and epidemics have represented public health emergencies with severe consequences at a global level. Primary care teams have played a crucial role in disease surveillance and monitoring during the COVID-19 pandemic through early detection, contact tracing, and isolation of positive cases. The objective of this study was to explore the impact of the COVID-19 pandemic on primary care teams regarding their internal dynamics and their professional performance. METHODS Qualitative study carried out between July and December 2020 in two large central and southern Spanish regions (Castilla la Mancha and Madrid). Semi-structured interviews and focus groups were conducted with primary care workers. Data was analysed using thematic content analysis. Participants were accessed using purposive sampling. RESULTS A total of 53 primary care workers participated in the study, of which 38 were individually interviewed, and 15 participated in three focus groups.The analysis of their experiences revealed two main themes regarding the impact of the COVID-19 pandemic on primary care teams: 1) The need to reorganise traditional roles: Primary care settings closed their doors to the public and their workers restructured their roles to ensure the delivery of essential services; 2) The need to implement a new primary care delivery model: Each primary care team had to self-organise, making sure their reference population was cared for and developing resource optimisation strategies. CONCLUSIONS Primary care teams have quickly adapted their roles and internal dynamics to respond to the demands generated by COVID-19. In the new delivery model, some positive aspects could be highlighted - such as increased communication between professionals and the use of telemedicine for some cases. However, it is important to address the negative impact that the COVID-19 crisis has had on of the main functions of primary care. These measures are necessary to promote well-being in primary care teams, and to provide quality care that addresses the complex and individual needs of each person and reduces inequalities in healthcare delivery.
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Affiliation(s)
- Montserrat Pulido-Fuentes
- Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de La Reina, Spain Avenida Real Fábrica de Sedas S/N, 45600 ToledoTalavera de la Reina, Toledo, Spain
| | - Ana María Palmar-Santos
- Departamento de Enfermería, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo nº 4, 28029 Madrid, Spain
| | | | - Carmen Cipriano-Crespo
- Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de La Reina, Spain Avenida Real Fábrica de Sedas S/N, 45600 ToledoTalavera de la Reina, Toledo, Spain
| | - Laura Alicia Rubio
- Departamento de Enfermería, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo nº 4, 28029 Madrid, Spain
| | - Luisa Abad González
- Faculty of Education Sciences and Humanities, University of Castilla -La Mancha, 16071 Cuenca, Spain
| | - MVictoria Navarta-Sánchez
- Departamento de Enfermería, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo nº 4, 28029 Madrid, Spain
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Ghai S, Hemachudha T. Continued Failure of Rabies Elimination—Consideration of Challenges in Applying the One Health Approach. Front Vet Sci 2022; 9:847659. [PMID: 35425835 PMCID: PMC9001886 DOI: 10.3389/fvets.2022.847659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/24/2022] [Indexed: 11/13/2022] Open
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van der Vliet N, den Broeder L, Romeo-Velilla M, Staatsen B, Kruize H, Friedrich B, Schuit AJ. Facilitators and barriers of intersectoral co-operation to promote healthier and more environmentally friendly behaviour: a qualitative evaluation through focus groups for the INHERIT project. BMC Public Health 2022; 22:617. [PMID: 35351055 PMCID: PMC8966286 DOI: 10.1186/s12889-022-12974-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/08/2022] [Indexed: 11/10/2022] Open
Abstract
Background Tackling challenges related to health, environmental sustainability and equity requires many sectors to work together. This “intersectoral co-operation” can pose a challenge on its own. Research commonly focuses on one field or is conducted within one region or country. The aim of this study was to investigate facilitators and barriers regarding intersectoral co-operative behaviour as experienced in twelve distinct case studies in ten European countries. The COM-B behavioural system was applied to investigate which capabilities, opportunities and motivational elements appear necessary for co-operative behaviour. Method Twelve focus groups were conducted between October 2018 and March 2019, with a total of 76 participants (policymakers, case study coordinators, governmental institutes and/or non-governmental organisations representing citizens or citizens). Focus groups were organised locally and held in the native language using a common protocol and handbook. One central organisation coordinated the focus groups and analysed the results. Translated data were analysed using deductive thematic analysis, applying previous intersectoral co-operation frameworks and the COM-B behavioural system. Results Amongst the main facilitators experienced were having highly motivated partners who find common goals and see mutual benefits, with good personal relationships and trust (Motivation). In addition, having supportive environments that provide opportunities to co-operate in terms of support and resources facilitated co-operation (Opportunity), along with motivated co-operation partners who have long-term visions, create good external visibility and who have clear agreements and clarity on roles from early on (Capability). Barriers included not having necessary and/or structural resources or enough time, and negative attitudes from specific stakeholders. Conclusions This study on facilitators and barriers to intersectoral co-operation in ten European countries confirms findings of earlier studies. This study also demonstrates that the COM-B model can serve as a relatively simple tool to understand co-operative behaviour in terms of the capability, opportunity and motivation required amongst co-operation partners from different sectors. Results can support co-operators’ and policymakers’ understanding of necessary elements of intersectoral co-operation. It can help them in developing more successful intersectoral co-operation when dealing with challenges of health, environmental sustainability and equity.
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Affiliation(s)
- Nina van der Vliet
- National Institute for Public Health and the Environment, Bilthoven, Netherlands. .,Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.
| | - Lea den Broeder
- National Institute for Public Health and the Environment, Bilthoven, Netherlands.,Achieve, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Maria Romeo-Velilla
- EuroHealthNet, Brussels, Belgium.,University College Leuven-Limburg, Leuven, Belgium
| | - Brigit Staatsen
- National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Hanneke Kruize
- National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | | | - A Jantine Schuit
- Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
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Buse K, Tomson G, Kuruvilla S, Mahmood J, Alden A, van der Meulen M, Ottersen OP, Haines A. Tackling the politics of intersectoral action for the health of people and planet. BMJ 2022; 376:e068124. [PMID: 37462013 PMCID: PMC8790677 DOI: 10.1136/bmj-2021-068124] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Kent Buse
- George Institute for Global Health, Imperial College London, London, UK
| | - Göran Tomson
- Karolinska Institutet, Stockholm, Sweden
- Swedish Institute for Global Health Transformation, Royal Swedish Academy of Sciences, Stockholm, Sweden
| | | | - Jemilah Mahmood
- Sunway Centre for Planetary Health, Sunway University, Malaysia
| | - Anastasia Alden
- George Institute for Global Health, Imperial College London, London, UK
| | | | | | - Andy Haines
- London School of Hygiene and Tropical Medicine, London, UK
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Mondal S, Bhojani U, Lobbo S, Law S, Maioni A, Van Belle S. Using social network analysis to understand multisectoral governance in district-level tobacco control programme implementation in India. BMJ Glob Health 2022; 7:e006471. [PMID: 34992075 PMCID: PMC8739058 DOI: 10.1136/bmjgh-2021-006471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 11/20/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Interest in multisectoral policies has increased, particularly in the context of low-income and middle-income countries and efforts towards Sustainable Development Goals, with greater attention to understand effective strategies for implementation and governance. The study aimed to explore and map the composition and structure of a multisectoral initiative in tobacco control, identifying key factors engaged in policy implementation and their patterns of relationships in local-level networks in two districts in the state of Karnataka, India. METHODS Social network analysis (SNA) was used to examine the structure of two district tobacco control networks with differences in compliance with the India's national tobacco control law. The survey was administered to 108 respondents (n=51 and 57) in two districts, producing three distinct network maps about interaction, information-seeking and decision-making patterns within each district. The network measures of centrality, density, reciprocity, centralisation and E-I index were used to understand and compare across the two districts. RESULTS Members from the department of health, especially those in the District Tobacco Control Cell, were the most frequently consulted actors for information as they led district-level networks. The most common departments engaged beyond health were education, police and municipal. District 1's network displayed high centralisation, with a district nodal officer who exercised a central role with the highest in-degree centrality. The district also exhibited greater density and reciprocity. District 2 showed a more dispersed pattern, where subdistrict health managers had higher betweenness centrality and acted as brokers in the network. CONCLUSION Collaboration and cooperation among sectors and departments are essential components of multisectoral policy. SNA provides a mechanism to uncover the nature of relationships and key actors in collaborative dynamics. It can be used as a visual learning tool for policy planners and implementers to understand the structure of actual implementation and concentrate their efforts to improve and enhance collaboration.
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Affiliation(s)
- Shinjini Mondal
- Family Medicine, McGill University Faculty of Medicine, Montreal, Québec, Canada
- Institute of Public Health Bengaluru, Bangalore, Karnataka, India
| | - Upendra Bhojani
- Institute of Public Health Bengaluru, Bangalore, Karnataka, India
| | | | - Susan Law
- Institute for Better Health, Trillium Health Partners, Ontario, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Antonia Maioni
- Institute for Health and Social Policy, McGill University, Montreal, Québec, Canada
| | - Sara Van Belle
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Antwerpen, Belgium
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Alhassan JAK, Gauvin L, Judge A, Fuller D, Engler-Stringer R, Muhajarine N. Improving health through multisectoral collaboration: enablers and barriers. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2021; 112:1059-1068. [PMID: 34105113 PMCID: PMC8651820 DOI: 10.17269/s41997-021-00534-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 04/26/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Multisectoral partnerships (MPs) are increasingly viewed as an excellent strategy for promoting population health, although the Canadian evidence on MPs remains scant. The objective of this research was to identify enablers and barriers to multisectoral collaboration across three MPs (focused on food systems, urban development, and active transportation) in a Canadian urban centre. METHODS This study is part of a pan-Canadian research program-MUSE (Multisectoral Urban Systems for health and Equity in Canadian cities). A qualitative case study methodology was used to explore enablers and barriers to collaboration among three MPs in a mid-sized Canadian city. Key strategy documents of the MPs and 13 in-depth, semi-structured interviews were conducted with stakeholders from each MP. Interview data were transcribed and subjected to thematic analysis using NVivo 12 software, with rigour ensured through member checking. RESULTS Enablers to collaboration included agenda and goal alignment among partners, quality of relationships in MPs, and external enabling factors. Barriers to multisectoral collaboration included agenda and priority differences, factors related to partnership structure, constitution and processes, and external barriers. Based on these factors, we developed a multisectoral collaboration matrix that dichotomizes enablers and barriers into intrinsic/internal and extrinsic/external to increase understanding of health-promoting MPs in Canada. CONCLUSION Various enablers and barriers promote or inhibit multisectoral partnerships. By casting these factors into a matrix, members of ongoing or emerging MPs could take advantage of the factors that promote their work and are in their control (intrinsic enablers) or outside their control (extrinsic enablers) while working to overcome challenges presented by collaboration barriers.
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Affiliation(s)
- Jacob Albin Korem Alhassan
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, 107 Wiggins Rd, Saskatoon, SK, S7N 5E5, Canada
- Saskatchewan Population Health and Evaluation Research Unit, Saskatoon, Canada
| | - Lise Gauvin
- École de santé publique, Université de Montréal, Montréal, QC, Canada
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Allap Judge
- School of Public Health, University of Saskatchewan, Saskatoon, Canada
| | - Daniel Fuller
- Saskatchewan Population Health and Evaluation Research Unit, Saskatoon, Canada
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Rachel Engler-Stringer
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, 107 Wiggins Rd, Saskatoon, SK, S7N 5E5, Canada
- Saskatchewan Population Health and Evaluation Research Unit, Saskatoon, Canada
| | - Nazeem Muhajarine
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, 107 Wiggins Rd, Saskatoon, SK, S7N 5E5, Canada.
- Saskatchewan Population Health and Evaluation Research Unit, Saskatoon, Canada.
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Abbas SS, Shorten T, Rushton J. Meanings and Mechanisms of One Health Partnerships: Insights from a Critical Review of Literature on Cross-Government Collaborations. Health Policy Plan 2021; 37:385-399. [PMID: 34791224 PMCID: PMC8896336 DOI: 10.1093/heapol/czab134] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 09/10/2021] [Accepted: 11/15/2021] [Indexed: 11/18/2022] Open
Abstract
Complex health policy challenges such as antimicrobial resistance and other emerging infections are driven by activities in multiple sectors. Therefore, addressing these also requires joint efforts from multiple sectors as exemplified in the One Health approach. We undertake a critical review to examine the different ways in which multisector partnerships have been conceptualized across multiple disciplines and thematic areas. We started with a set of six articles from the disciplines of health, nutrition and public administration that reviewed conceptual frameworks within their respective fields. We conducted backward citation tracing using the bibliography of the six articles to identify other articles in the same and related fields that conceptualized multisector partnerships. We identified 58 articles published from 1967 to 2018 from the fields of global health, infectious diseases, management, nutrition and sustainability sciences indicating that multisector partnerships have been a topic of study across different fields for several decades. A thematic analysis of the 58 articles revealed that multisector partnerships assume a variety of forms and have been described in different ways. Partnerships can be categorized by scope, scale, formality and strength. Multisector partnerships emerge in conditions of dynamic uncertainty and sector failure when the information and resources required are beyond the capacities of any individual sector. Such partnerships are inherently political in nature and subsume multiple competing agendas of collaborating actors. Sustaining collaborations over a long period of time will require collaborative approaches like One Health to accommodate competing political perspectives and include flexibility to allow multisector partnerships to respond to changing external dynamics.
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Affiliation(s)
- Syed Shahid Abbas
- Institute of Development Studies, Brighton, UK.,Public Health Foundation of India, New Delhi, India
| | | | - Jonathan Rushton
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
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Dorstewitz P, Lal D. Re-Imagining Business Agency through Multi-Agent Cross-Sector Coalitions: Integrating CSR Frameworks. PHILOSOPHY OF MANAGEMENT 2021; 21:87-103. [PMID: 34812263 PMCID: PMC8598216 DOI: 10.1007/s40926-021-00180-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 07/01/2021] [Indexed: 11/29/2022]
Abstract
This theoretical paper takes an agency-theoretic approach to questions of corporate social responsibility (CSR). A comparison of various extant frameworks focusses on how CSR agency emerges in complex multi-agent and multi-sector stakeholder networks. The discussion considers the respective capabilities and relevance of these frameworks – culminating in an integrative CSR practice model. A short literature review of the evolution of CSR since the 1950’s provides the backdrop for understanding multi-agent cross-sectoral stakeholder coalitions as a strategic determinant of today’s organizational behavior. The paper turns to Werhane’s coupling of moral imagination and systems thinking and forging stakeholder coalitions in problem contexts that were traditionally deemed intractable by for-profit organizations. However, it identifies the problem that the systems approach treats macro-agents (organizations, stakeholders) as given (“black-boxed”) and shies away from more radically re-imagining the possibilities of reassembling agency from the bottom up. Actor Network Theory (ANT) provides such a method, which strictly commits to treating organizational behavior as a product of technological, human and environmental micro-processes. ANT, however, is lacking a genuine moral deliberative stance in designing complex CSR coalitions. In an attempt to capitalize on the respective strengths of these frameworks (Systems thinking and ANT) the paper tends to a recent iterative series of “situational transactive” models that are rooted in the US pragmatist tradition and seek to capture intelligent planning processes in complex problematic contexts. The contribution proposes a new CSR practice model, which assigns specific roles to the theoretical contributions of ANT, system thinking and pragmatism in complex deliberation processes. This model can be industry-tested in a future study.
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Affiliation(s)
- Philipp Dorstewitz
- American University of Ras Al Khaimah (AURAK), Ras Al Khaimah, United Arab Emirates
| | - David Lal
- American University of Ras Al Khaimah (AURAK), Ras Al Khaimah, United Arab Emirates
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de León EA, Shriwise A, Tomson GÖ, Morton S, Lemos DS, Menne B, Dooris M. Beyond building back better: imagining a future for human and planetary health. Lancet Planet Health 2021; 5:e827-e839. [PMID: 34774123 PMCID: PMC8600369 DOI: 10.1016/s2542-5196(21)00262-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 06/28/2021] [Accepted: 09/09/2021] [Indexed: 05/12/2023]
Abstract
COVID-19 is disrupting and transforming the world. We argue that transformations catalysed by this pandemic should be used to improve human and planetary health and wellbeing. This paradigm shift requires decision makers and policy makers to go beyond building back better, by nesting the economic domain of sustainable development within social and environmental domains. Drawing on the engage, assess, align, accelerate, and account (E4As) approach to implementing the 2030 Agenda for Sustainable Development, we explore the implications of this kind of radical transformative change, focusing particularly on the role of the health sector. We conclude that a recovery and transition from the COVID-19 pandemic that delivers the future humanity wants and needs requires more than a technical understanding of the transformation at hand. It also requires commitment and courage from leaders and policy makers to challenge dominant constructs and to work towards a truly thriving, equitable, and sustainable future to create a world where economic development is not an end goal itself, but a means to secure the health and wellbeing of people and the planet.
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Affiliation(s)
- Emilia Aragón de León
- Health Policy Development and Implementation, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Amanda Shriwise
- Political Economy of the Welfare State, Forschungszentrum Ungleichheit und Sozialpolitik, Research Centre on Inequality and Social Policy, Universität Bremen, Bremen, Germany; Department of Sociology, University of Kansas, Lawrence, KS, USA.
| | - GÖran Tomson
- President's Office, Karolinska Institutet, Stockholm, Sweden; Swedish Institute for Global Health Transformation, Royal Swedish Academy of Sciences, Stockholm, Sweden
| | - Stephen Morton
- Health and Sustainable Settings Unit, University of Central Lancashire, Preston, UK
| | - Diogo Simão Lemos
- Health Emergencies Programme, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Bettina Menne
- Office for Investment for Health and Development, World Health Organization Regional Office for Europe, Venice, Italy
| | - Mark Dooris
- Institute of Citizenship, Society, and Change, University of Central Lancashire, Preston, UK
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Koshal SS, Ray A, Mehra R, Kaur A, Quadri SF, Agarwal P, Kapur S, Debroy A, Haldar P. Partnering for rotavirus vaccine introduction in India: A retrospective analysis. Vaccine 2021; 39:6470-6476. [PMID: 34538521 DOI: 10.1016/j.vaccine.2021.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/31/2021] [Accepted: 09/03/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The pre-existing partner network created in India for the delivery of polio vaccines was initially used to eradicate polio and later on embedded in the health systems network to promote routine immunization and other health interventions efficiently. The experience from this network offered lessons for strengthening the health care systems and provided a well-established network that could be utilized for other vaccine initiatives. It has also been established that successful partnerships between a broad range of stakeholders provide support, strengthen the health system, and accelerate vaccine innovation, introduction, access, logistics, and communication support. However, beyond polio eradication, there have not been too many documented success stories of vaccine introduction, which could be replicated in other new vaccine introductions and allied health initiatives. The authors have reviewed the successful and time-bound introduction of rotavirus vaccine (RVV) in India in the present article. METHODS The review was conducted based on a partnership framework which analysed multiple factors-partnership prerequisites, partnership model, partnership process, and partnership performance, thereby providing a comprehensive insight into the successful utilization of partnership networks for rotavirus vaccine introduction under the Universal Immunization Program in India. RESULTS & CONCLUSION The review also highlights the role of a lead agency in creating a fertile ground for lush, efficient, and effective partnerships amongst different stakeholders. The already existing RVV partnership framework reviewed by the authors can be successfully utilized for future new vaccine introductions.
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Affiliation(s)
| | - A Ray
- Bill and Melinda Gates Foundation, New Delhi, India
| | - R Mehra
- John Snow India, New Delhi, India
| | - A Kaur
- John Snow India, New Delhi, India
| | | | | | - S Kapur
- John Snow India, New Delhi, India
| | - A Debroy
- John Snow India, New Delhi, India
| | - P Haldar
- Ministry of Health and Family Welfare, New Delhi, India
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A Scoping Review of National Policies for Healthy Ageing in Mainland China from 2016 to 2020. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2021; 12:100168. [PMID: 34527965 PMCID: PMC8356098 DOI: 10.1016/j.lanwpc.2021.100168] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/15/2021] [Accepted: 04/30/2021] [Indexed: 11/23/2022]
Abstract
There remains limited literature to facilitate understanding of healthy ageing-related policies in China over the last five-year policy planning cycle. This study aims to characterise all relevant policies and identifies the policy gaps from a health system perspective. A scoping review framework was used. A thorough search for healthy ageing-related policies was performed on the websites of all government ministries affiliated with the Chinese State Council. Essential information was extracted and mapped to an integrated framework of the World Health Organization's Health System Building Blocks and the Chinese 13th Five-Year Plan for Healthy Ageing. A total of 12471 policy documents were identified, while 99 policy documents were included. There were 14 ministries involved in the generation of policies, but multisectoral collaboration between the ministries remained limited. National Health Commission and Ministry of Civil Affairs were the leading ministries. Promoting the integration of medical services and older people care was most frequently addressed within these policies. Applying the health system perspective, governance and financing were often addressed, but there were limited policies on other components of the health system. The findings of this study support four policy recommendations: (1) to enhance multisectoral collaboration in policy development; (2) to strengthen health system building blocks, including healthcare workforce, service delivery, health information, and medical products and technologies; (3) to establish a consolidated policy system centered on the national healthy ageing plan; (4) to formulate a national implementation work plan to promote an integrated health care model for older people.
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Finnegan A, Biru B, Taylor A, Rajan S, Udayakumar K, Baumgartner JN. Improving global maternal and newborn survival via innovation: Stakeholder perspectives on the Saving Lives at Birth Grand Challenge. PLoS One 2021; 16:e0254589. [PMID: 34260640 PMCID: PMC8279342 DOI: 10.1371/journal.pone.0254589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 06/30/2021] [Indexed: 11/19/2022] Open
Abstract
The Saving Lives at Birth (SL@B) funding partners joined in 2011 to source, support, and scale maternal and newborn health (MNH) innovations to improve maternal and newborn survival by focusing on the 24 hours around the time of birth. A multi-methods, retrospective portfolio evaluation was conducted to determine SL@B's impact. Forty semi-structured, key informant interviews (KIIs) were conducted with experts in global MNH based in low- and middle-income and in high-income countries to assess the SL@B program. KIIs were conducted with global MNH technical experts, innovators, government officials in low- and middle-income countries, donors, private investors, and implementing partners to include the full spectrum of voices involved in identifying and scaling innovations. Data were analyzed using thematic analysis. Stakeholders believe the SL@B program has been successful in changing the way maternal and newborn health programs are delivered with a focus on doing things differently through innovation. The open approach to sourcing innovation was seen as positive to the extent that it brought more interdisciplinary stakeholders to think about the problem of maternal and newborn survival. However, a demand-driven approach that aims to source innovations that address MNH priority needs and takes into account the needs of end users (e.g. individuals and governments) was suggested as a strategy for ensuring that more innovations go to scale.
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Affiliation(s)
- Amy Finnegan
- Evidence Lab, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Blen Biru
- Evidence Lab, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Andrea Taylor
- Duke Global Health Innovation Center, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Sowmya Rajan
- Duke Global Health Innovation Center, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Krishna Udayakumar
- Duke Global Health Innovation Center, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Joy Noel Baumgartner
- Evidence Lab, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
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Ssennyonjo A, Van Belle S, Titeca K, Criel B, Ssengooba F. Multisectoral action for health in low-income and middle-income settings: how can insights from social science theories inform intragovernmental coordination efforts? BMJ Glob Health 2021; 6:bmjgh-2020-004064. [PMID: 34039586 PMCID: PMC8160194 DOI: 10.1136/bmjgh-2020-004064] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 04/17/2021] [Accepted: 04/19/2021] [Indexed: 12/21/2022] Open
Abstract
There is consensus in global health on the need for multisectoral action (MSA) to address many contemporary development challenges, but there is limited action. Examples of issues that require coordinated MSA include the determinants of health conditions such as nutrition (malnutrition and obesity) and chronic non-communicable diseases. Nutrition, tobacco control and such public health issues are regulated separately by health, trade and treasury ministries. Those issues need to be coordinated around the same ends to avoid conflicting policies. Despite the need for MSA, why do we see little progress? We investigate the obstacles to and opportunities for MSA by providing a government perspective. This paper draws on four theoretical perspectives, namely (1) the political economy perspective, (2) principal–agent theory, (3) resource dependence theory and (4) transaction cost economics theory. The theoretical framework provides complementary propositions to understand, anticipate and prepare for the emergence and structuring of coordination arrangements between government organisations at the same or different hierarchical levels. The research on MSA for health in low/middle-income countries needs to be interested in a multitheory approach that considers several theoretical perspectives and the contextual factors underlying coordination practices.
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Affiliation(s)
- Aloysius Ssennyonjo
- School of Public Health, Department of Health Policy Planning and Management, Makerere University College of Health Sciences, Kampala, Uganda .,Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Institute of Development Policy, University of Antwerp, Antwerp, Belgium
| | - Sara Van Belle
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Kristof Titeca
- Institute of Development Policy, University of Antwerp, Antwerp, Belgium
| | - Bart Criel
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Freddie Ssengooba
- School of Public Health, Department of Health Policy Planning and Management, Makerere University College of Health Sciences, Kampala, Uganda
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Glandon D, Leoutsakos JM, Gupta S, Marsteller J, Paina L, Bennett S. Development and psychometric testing of the FLW-MSC scale for measuring frontline worker multisectoral collaboration in rural India. BMJ Open 2021; 11:e037800. [PMID: 33664062 PMCID: PMC7934724 DOI: 10.1136/bmjopen-2020-037800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Multisectoral collaboration (MSC) is widely recognised as a critical aspect of policies, programmes and interventions addressing complex public health issues, yet it is undertheorised and difficult to measure. Limited understanding of the intermediate steps linking MSC formation to intended health outcomes leaves a substantial knowledge gap about the types of strategies that may be most effective in making such collaborations successful. This paper, which reports the quantitative strand of a broader mixed-methods study, takes a step toward filling in this 'missing middle' of MSC evaluation by developing and testing the FLW-MSC scale, an instrument to assess collaboration among the frontline workers of one of India's largest and most widely known MSCs: the Integrated Child Development Services (ICDS) scheme. DESIGN This study involved development, field-testing and psychometric testing of an 18-item, Likert-type frontline worker collaboration scale, including internal consistency, construct validity and criterion validity. SETTING Village-level primary healthcare in rural Uttar Pradesh, India. PARTICIPANTS 281 anganwadi workers, 266 accredited social health activists and 124 auxiliary nurse midwives selected based on random sampling of anganwadi catchment areas from 346 gram panchayats (GPs), including 173 intervention GPs and 173 pair-matched control GPs from a parent evaluation study. RESULTS Results support the scale's internal consistency (ordinal α=0.92-0.95), construct validity (reasonable exploratory factor analysis model fit for five of the six dyadic relationships Tucker-Lewis Index=0.84-0.88; Root Mean Squared Error of Approximation=0.09-0.11), and criterion validity (regression of collaboration score on an information-sharing indicator β=3.528; p=0.006). CONCLUSIONS The scale may be useful for ICDS managers to detect and address poor collaboration as the Indian government redoubles its efforts to strengthen and monitor MSC, or 'convergence', with important implications for the critical priority of child development. Further, the FLW-MSC scale may be adapted for measuring frontline worker collaboration across sectors in many other scenarios and low/middle-income country contexts.
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Affiliation(s)
- Douglas Glandon
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jeannie-Marie Leoutsakos
- Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shivam Gupta
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jill Marsteller
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ligia Paina
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sara Bennett
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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George A, Jacobs T, Ved R, Jacobs T, Rasanathan K, Zaidi SA. Adolescent health in the Sustainable Development Goal era: are we aligned for multisectoral action? BMJ Glob Health 2021; 6:e004448. [PMID: 33727279 PMCID: PMC7970238 DOI: 10.1136/bmjgh-2020-004448] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/10/2021] [Accepted: 02/15/2021] [Indexed: 11/24/2022] Open
Abstract
Adolescents are an increasing proportion of low and middle-income country populations. Their coming of age is foundational for health behaviour, as well as social and productive citizenship. We mapped intervention areas for adolescent sexual and reproductive health, including HIV, mental health and violence prevention to sectors responsible for them using a framework that highlights settings, roles and alignment. Out of 11 intervention areas, health is the lead actor for one, and a possible lead actor for two other interventions depending on the implementation context. All other interventions take place outside of the health sector, with the health sector playing a range of bilateral, trilateral supporting roles or in several cases a minimal role. Alignment across the sectors varies from indivisible, enabling or reinforcing to the other extreme of constraining and counterproductive. Governance approaches are critical for brokering these varied relationships and interactions in multisectoral action for adolescent health, to understand the context of such change and to spark, sustain and steer it.
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Affiliation(s)
- Asha George
- School of Public Health, University of the Western Cape Faculty of Community and Health Sciences, Cape Town, Western Province, South Africa
| | - Tanya Jacobs
- School of Public Health, University of the Western Cape Faculty of Community and Health Sciences, Cape Town, Western Province, South Africa
| | - Rajani Ved
- National Health Systems Resource Centre, New Delhi, Delhi, India
| | - Troy Jacobs
- Global Health Support Initiative III, Rockville, MD, USA
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | | | - Shehla Abbas Zaidi
- Community Health Sciences, Aga Khan University Faculty of Health Sciences, Karachi, Pakistan
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Kuchenmüller T, Reeder JC, Reveiz L, Tomson G, El-Jardali F, Lavis JN, Rashidian A, Reinap M, Grove JT, Swaminathan S. COVID-19: investing in country capacity to bridge science, policy and action. BMJ Glob Health 2021; 6:bmjgh-2021-005012. [PMID: 33597281 PMCID: PMC7893206 DOI: 10.1136/bmjgh-2021-005012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 01/19/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Tanja Kuchenmüller
- Department of Research for Health, World Health Organization, Geneve, Switzerland
| | - John C Reeder
- Department of Research for Health, World Health Organization, Geneve, Switzerland
| | - Ludovic Reveiz
- Department of Evidence and Intelligence for Action in Health and Incident Management System for COVID-19, WHO Regional Office for the Americas/Pan American Health Organization, Washington, District of Columbia, USA
| | - Goran Tomson
- President's Office, Karolinska Institutet, Stockholm, Stockholm, Sweden,Swedish Institute for Global Health Transformation, Royal Swedish Academy of Sciences, Stockholm, Sweden
| | - Fadi El-Jardali
- Knowledge to Policy (K2P) Center/WHO Collaborating Centre for Evidence-Informed Policymaking and Practice, American University of Beirut, Beirut, Lebanon,Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon
| | - John N Lavis
- McMaster Health Forum/WHO Collaborating Centre for Evidence-Informed Policy, McMaster University, Hamilton, Ontario, Canada,Department of Health Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Arash Rashidian
- Department of Science, Information and Dissemination, World Health Organisation Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Marge Reinap
- Division of Country Health Policies and System, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - John T Grove
- Department of Quality Assurance, Norms and Standards, World Health Organization, Geneve, Switzerland
| | - Soumya Swaminathan
- Office of Chief Scientist, World Health Organization, Geneve, Switzerland
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Specific considerations for research on the effectiveness of multisectoral collaboration: methods and lessons from 12 country case studies. Global Health 2021; 17:18. [PMID: 33522937 PMCID: PMC7848879 DOI: 10.1186/s12992-021-00664-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 01/08/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The success of the Sustainable Development Goals (SDGs) is predicated on multisectoral collaboration (MSC), and the COVID-19 pandemic makes it more urgent to learn how this can be done better. Complex challenges facing countries, such as COVID-19, cut across health, education, environment, financial and other sectors. Addressing these challenges requires the range of responsible sectors and intersecting services - across health, education, social and financial protection, economic development, law enforcement, among others - transform the way they work together towards shared goals. While the necessity of MSC is recognized, research is needed to understand how sectors collaborate, inform how to do so more efficiently, effectively and equitably, and ascertain similarities and differences across contexts. To answer these questions and inform practice, research to strengthen the evidence-base on MSC is critical. METHODS This paper draws on a 12-country study series on MSC for health and sustainable development, in the context of the health and rights of women, children and adolescents. It is written by core members of the research coordination and country teams. Issues were analyzed during the study period through 'real-time' discussions and structured reporting, as well as through literature reviews and retrospective feedback and analysis at the end of the study. RESULTS We identify four considerations that are unique to MSC research which will be of interest to other researchers, in the context of COVID-19 and beyond: 1) use theoretical frameworks to frame research questions as relevant to all sectors and to facilitate theoretical generalizability and evolution; 2) specifically incorporate sectoral analysis into MSC research methods; 3) develop a core set of research questions, using mixed methods and contextual adaptations as needed, with agreement on criteria for research rigor; and 4) identify shared indicators of success and failure across sectors to assess MSCs. CONCLUSION In responding to COVID-19 it is evident that effective MSC is an urgent priority. It enables partners from diverse sectors to effectively convene to do more together than alone. Our findings have practical relevance for achieving this objective and contribute to the growing literature on partnerships and collaboration. We must seize the opportunity here to identify remaining knowledge gaps on how diverse sectors can work together efficiently and effectively in different settings to accelerate progress towards achieving shared goals.
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Dhimal M, Dhimal ML, Dahal S, Shrestha MP, Gyanwali P, Shao R, Mikkelsen B, Wickramasinghe K, Marten R, Jha AK, Townsend N. Barriers and facilitators to the implementation of a national multisectoral action plan for the prevention and control of noncommunicable diseases in Nepal: perspectives of stakeholders. Glob Health Action 2021; 14:1963069. [PMID: 34448675 PMCID: PMC8405092 DOI: 10.1080/16549716.2021.1963069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/28/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Nepal adopted the Multisectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (MSAP) in 2014. Implementation of the plan has been challenging, with limited participation from non-health sectors. OBJECTIVES The overall aim of the study was to gain the perspectives of key stakeholders involved in the Nepal MSAP on the barriers and facilitators to its implementation, through the participation of relevant sectors in the plan. METHODS We held face-to-face semi-structured interviews with 12 stakeholders working in sectors involved in the MSAP. These sectors included the Office of the Prime Minister and Council of Ministries; Ministry of Health and Population (MOHP); Ministry of Education, Science and Technology; Ministry of Forest and Environment; academia; and professional organizations. Thematic analysis of transcripts was used to identify themes on awareness of NCDs, awareness of the MSAP, and barriers and facilitators to participation in the MSAP. RESULTS Participants recognised NCDs as a growing and major burden in Nepal. However, a number of participants were not familiar with the MSAP, identifying a lack of leadership and poor dissemination. Political and systemic transformation, since the adoption of the MSAP, was seen as a key barrier to implementation. International commitments to develop multisectoral action made by the Government of Nepal were identified as drivers. The recent establishment of a separate section for NCDs and Mental Health within the Department of Health Services of MOHP and the promotion of a Health in All Policies (HiAP) approach in recent national documents, were both considered to support implementation. CONCLUSIONS The establishment of permanent multisectoral or multistakeholder mechanisms has been challenging despite strong political calls for their development. Moving beyond 2020, multisectoral action plans should engage with stakeholders from federal, provincial and local governments in order to develop costed action plans with specific roles and responsibilities for each sector.
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Affiliation(s)
- Meghnath Dhimal
- Nepal Health Research Council (NHRC) Government of Nepal Ministry of Health and Population Complex, Kathmandu, Nepal
| | - Mandira Lamichhane Dhimal
- Nepal Health Research Council (NHRC) Government of Nepal Ministry of Health and Population Complex, Kathmandu, Nepal
- Policy Research Institute, Kathmandu, Nepal
| | - Sushma Dahal
- Nepal Health Research Council (NHRC) Government of Nepal Ministry of Health and Population Complex, Kathmandu, Nepal
| | | | - Pradip Gyanwali
- Nepal Health Research Council (NHRC) Government of Nepal Ministry of Health and Population Complex, Kathmandu, Nepal
| | - Ruitai Shao
- Department of Noncommunicable Diseases, World Health Organization, Headquarters, Geneva, Switzerland
| | - Bente Mikkelsen
- Division of Non-communicable Diseases and Promoting Health through the Life-course, WHO Regional Office for Europe, Copenhagen, Denmark
| | | | - Robert Marten
- Alliance for Health Policy and Systems Research, WHO, Geneva, Switzerland
| | - Anjani Kumar Jha
- Nepal Health Research Council (NHRC) Government of Nepal Ministry of Health and Population Complex, Kathmandu, Nepal
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Brault MA, Mwinga K, Kipp AM, Kennedy SB, Maimbolwa M, Moyo P, Ngure K, Haley CA, Vermund SH. Measuring child survival for the Millennium Development Goals in Africa: what have we learned and what more is needed to evaluate the Sustainable Development Goals? Glob Health Action 2020; 13:1732668. [PMID: 32114967 PMCID: PMC7067162 DOI: 10.1080/16549716.2020.1732668] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Reducing child mortality is a key global health challenge. We examined reasons for greater or lesser success in meeting under-five mortality rate reductions, i.e. Millennium Development Goal #4, between 1990 and 2015 in Sub-Saharan Africa where child mortality remains high. We first examined factors associated with child mortality from all World Health Organization African Region nations during the Millennium Development Goal period. This analysis was followed by case studies of the facilitators and barriers to Millennium Development Goal #4 in four countries – Kenya, Liberia, Zambia, and Zimbabwe. Quantitative indicators, policy documents, and qualitative interviews and focus groups were collected from each country to examine factors within and across countries related to child mortality. We found familiar themes that highlighted the need for both specific services (e.g. primary care access, emergency obstetric and neonatal care) and general management (e.g. strong health governance and leadership, increasing community health workers, quality of care). We also identified methodological opportunities and challenges to assessing progress in child health, which can provide insights to similar efforts during the Sustainable Development Goal period. Specifically, it is important for countries to adapt general international goals and measurements to their national context, considering baseline mortality rates and health information systems, to develop country-specific goals. It will also be critical to develop more rigorous measurement tools and indicators to accurately characterize maternal, neonatal, and child health systems, particularly in the area of governance and leadership. Valuable lessons can be learned from Millennium Development Goal successes and failures, as well as how they are evaluated. As countries seek to lower child mortality further during the Sustainable Development Goal period, it will be necessary to prioritize and support countries in quantitative and qualitative data collection to assess and contextualize progress, identifying areas needing improvement.
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Affiliation(s)
- Marie A Brault
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Kasonde Mwinga
- Rwanda Country Office, World Health Organization, Kigali, Rwanda (Formerly, WHO African Regional Office, Brazzaville, Congo)
| | - Aaron M Kipp
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, TN, USA.,Department of Medicine, Division of Epidemiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stephen B Kennedy
- University of Liberia-Pacific Institute for Research & Evaluation (UL-PIRE) Africa Center, University of Liberia, Monrovia, Liberia
| | - Margaret Maimbolwa
- Department of Nursing Sciences, University of Zambia School of Medicine, Lusaka, Zambia
| | - Precious Moyo
- Collaborative Research Program, University of Zimbabwe-University of California, San Francisco, Harare, Zimbabwe
| | - Kenneth Ngure
- Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Connie A Haley
- Division of Infectious Diseases and Global Medicine, University of Florida, Gainesville, FL, USA
| | - Sten H Vermund
- Office of the Dean, Yale School of Public Health, New Haven, CT, USA
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'One Health' Actors in Multifaceted Health Systems: An Operational Case for India. Healthcare (Basel) 2020; 8:healthcare8040387. [PMID: 33036422 PMCID: PMC7712196 DOI: 10.3390/healthcare8040387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 11/18/2022] Open
Abstract
The surging trend of (re)emerging diseases urges for the early detection, prevention, and control of zoonotic infections through the One Health (OH) approach. The operationalization of the OH approach depends on the contextual setting, the presence of the actors across the domains of OH, and the extent of their involvement. In the absence of national operational guidelines for OH in India, this study aims to identify potential actors with an attempt to understand the current health system network strength (during an outbreak and non-outbreak situations) at the local health system of Ahmedabad, India. This case study adopted a sequential mixed methods design conducted in two phases. First, potential actors who have been involved directly or indirectly in zoonoses prevention and control were identified through in-depth interviews. A network study was conducted as part of the second phase through a structured network questionnaire. Interest and influence matrix, average degree, network density, and degree of centralization were calculated through Atlas.Ti (ATLAS.ti Scientific Software Development GmbH, Berlin, Germany), UCINET (Analytic Technologies, Lexington, KY, USA) software. The identified actors were categorized based on power, administrative level (either at the city or district level), and their level of action: administrative (policy planners, managers), providers (physicians, veterinarians), and community (health workers, community leaders). The matrix indicated that administrative actors from the district level were ‘context setters’ and the actors from the city level were either ‘players’ or ‘subjects’. The network density showed a strength of 0.328 during the last outbreak of H5N1, which decreased to 0.163 during the non-outbreak situation. Overall, there was low collaboration observed in this study, which ranged from communication (during non-outbreaks) to coordination (during outbreaks). The private and non-governmental actors were not integrated into collaborative activities. This study concludes that not only collaboration is needed for OH among the sectors pertaining to the human and the animal health system but also better structured (‘inter-level’) collaboration across the governance levels for effective implementation.
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van Dale D, Lemmens L, Hendriksen M, Savolainen N, Nagy P, Marosi E, Eigenmann M, Stegemann I, Rogers HL. Recommendations for Effective Intersectoral Collaboration in Health Promotion Interventions: Results from Joint Action CHRODIS-PLUS Work Package 5 Activities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186474. [PMID: 32899521 PMCID: PMC7557573 DOI: 10.3390/ijerph17186474] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/28/2020] [Accepted: 09/01/2020] [Indexed: 01/02/2023]
Abstract
The burden of chronic disease in Europe continues to grow. A major challenge facing national governments is how to tackle the risk factors of sedentary lifestyle, alcohol abuse, smoking, and unhealthy diet. These factors are complex and necessitate intersectoral collaboration to strengthen health promotion, counter-act the social determinants of health, and reduce the prevalence of chronic disease. European countries have diverse intersectoral collaboration to encourage health promotion activities. In the Joint Action CHRODIS-PLUS success factors for intersectoral collaboration within and outside healthcare which strengthen health promotion activities were identified with a mixed method design via a survey of 22 project partners in 14 countries and 2 workshops. In six semi-structured interviews, the mechanisms underlying these success factors were examined. These mechanisms can be very context-specific but do give more insight into how they can be replicated. In this paper, 20 health promotion interventions from national programs in CHRODIS PLUS are explored. This includes community interventions, policy actions, integrated approaches, capacity building, and training activities. The interventions involved collaboration across three to more than six sectors. The conclusion is a set of seven recommendations that are considered to be essential for fostering intersectoral collaboration to improve health-promoting activities.
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Affiliation(s)
- Djoeke van Dale
- National Institute of Public Health and Environment, 3720 BA Bilthoven, The Netherlands; (L.L.); (M.H.)
- Correspondence:
| | - Lidwien Lemmens
- National Institute of Public Health and Environment, 3720 BA Bilthoven, The Netherlands; (L.L.); (M.H.)
| | - Marieke Hendriksen
- National Institute of Public Health and Environment, 3720 BA Bilthoven, The Netherlands; (L.L.); (M.H.)
| | - Nella Savolainen
- National Institute for Health and Welfare, Fl-100271 Helsinki, Finland;
| | - Péter Nagy
- National Institute of Oncology, 1122 Budapest, Hungary; (P.N.); (E.M.)
| | - Edit Marosi
- National Institute of Oncology, 1122 Budapest, Hungary; (P.N.); (E.M.)
| | - Michela Eigenmann
- Foundation IRCCS Neurological Institute “Carlo Besta”, 20133 Milan, Italy;
| | | | - Heather L. Rogers
- Biocruces Bizkaia Health Research Institute, 48903 Barakaldo, Spain;
- Ikerbasque Basque Foundation for Science, 48013 Bilbao, Spain
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Efevbera Y, Haj-Ahmed J, Lai J, Hainsworth G, Levy M, Sirivansanti N, Winnie A, Zurak M, Petroni S. Multisectoral Programming for Adolescent Health and Well-being in Sub-Saharan Africa-Insights From a Symposium Hosted by UNICEF and the Bill & Melinda Gates Foundation. J Adolesc Health 2020; 67:24-25. [PMID: 32448599 PMCID: PMC7322518 DOI: 10.1016/j.jadohealth.2020.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/01/2020] [Indexed: 01/22/2023]
Affiliation(s)
| | | | | | | | | | | | - Apio Winnie
- Uganda Youths and Adolescents Health Forum, Kampala, Uganda
| | - Mohammed Zurak
- The MindMe Initiative & Zurak Cancer Foundation, Accra, Ghana
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McGuire F, Vijayasingham L, Vassall A, Small R, Webb D, Guthrie T, Remme M. Financing intersectoral action for health: a systematic review of co-financing models. Global Health 2019; 15:86. [PMID: 31849335 PMCID: PMC6918645 DOI: 10.1186/s12992-019-0513-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 10/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Addressing the social and other non-biological determinants of health largely depends on policies and programmes implemented outside the health sector. While there is growing evidence on the effectiveness of interventions that tackle these upstream determinants, the health sector does not typically prioritise them. From a health perspective, they may not be cost-effective because their non-health outcomes tend to be ignored. Non-health sectors may, in turn, undervalue interventions with important co-benefits for population health, given their focus on their own sectoral objectives. The societal value of win-win interventions with impacts on multiple development goals may, therefore, be under-valued and under-resourced, as a result of siloed resource allocation mechanisms. Pooling budgets across sectors could ensure the total multi-sectoral value of these interventions is captured, and sectors' shared goals are achieved more efficiently. Under such a co-financing approach, the cost of interventions with multi-sectoral outcomes would be shared by benefiting sectors, stimulating mutually beneficial cross-sectoral investments. Leveraging funding in other sectors could off-set flat-lining global development assistance for health and optimise public spending. Although there have been experiments with such cross-sectoral co-financing in several settings, there has been limited analysis to examine these models, their performance and their institutional feasibility. AIM This study aimed to identify and characterise cross-sectoral co-financing models, their operational modalities, effectiveness, and institutional enablers and barriers. METHODS We conducted a systematic review of peer-reviewed and grey literature, following PRISMA guidelines. Studies were included if data was provided on interventions funded across two or more sectors, or multiple budgets. Extracted data were categorised and qualitatively coded. RESULTS Of 2751 publications screened, 81 cases of co-financing were identified. Most were from high-income countries (93%), but six innovative models were found in Uganda, Brazil, El Salvador, Mozambique, Zambia, and Kenya that also included non-public and international payers. The highest number of cases involved the health (93%), social care (64%) and education (22%) sectors. Co-financing models were most often implemented with the intention of integrating services across sectors for defined target populations, although models were also found aimed at health promotion activities outside the health sector and cross-sectoral financial rewards. Interventions were either implemented and governed by a single sector or delivered in an integrated manner with cross-sectoral accountability. Resource constraints and political relevance emerged as key enablers of co-financing, while lack of clarity around the roles of different sectoral players and the objectives of the pooling were found to be barriers to success. Although rigorous impact or economic evaluations were scarce, positive process measures were frequently reported with some evidence suggesting co-financing contributed to improved outcomes. CONCLUSION Co-financing remains in an exploratory phase, with diverse models having been implemented across sectors and settings. By incentivising intersectoral action on structural inequities and barriers to health interventions, such a novel financing mechanism could contribute to more effective engagement of non-health sectors; to efficiency gains in the financing of universal health coverage; and to simultaneously achieving health and other well-being related sustainable development goals.
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Affiliation(s)
- Finn McGuire
- University of York (Centre for Health Economics), York, UK
| | - Lavanya Vijayasingham
- United Nations University-International Institute for Global Health, Kuala Lumpur, Malaysia.
| | - Anna Vassall
- London School of Hygiene and Tropical Medicine, (Centre for Health Economics in London (CHIL)), London, UK
| | - Roy Small
- United Nations Development Programme (HIV, Health and Development Group), New York, USA
| | - Douglas Webb
- United Nations Development Programme (HIV, Health and Development Group), New York, USA
| | - Teresa Guthrie
- United Nations Development Programme (HIV, Health and Development Group), New York, USA
- Independent consultant, Cape Town, South Africa
| | - Michelle Remme
- United Nations University-International Institute for Global Health, Kuala Lumpur, Malaysia
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Graham WJ, Kuruvilla S, Hinton R, Veitch E, Simpson PJ. Multisectoral collaboration for health and sustainable development. BMJ 2018; 363:k4868. [PMID: 30530466 PMCID: PMC6282722 DOI: 10.1136/bmj.k4868] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Wendy J Graham
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Rachael Hinton
- Partnership for Maternal, Newborn, and Child Health, Geneva, Switzerland
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