A realist review of power dynamics in the implementation of intersectoral collaborative health programmes and policies in LMICs: Protocol

Abstract

Introduction: Intersectoral Collaboration (ISC) is increasingly recognised as a critical aspect of global health and an important prerequisite for developing integrated public health policies. However, in practice, ISC has proven challenging due to its complexity. While studies have documented factors that have facilitated ISC (like shared vision, leadership and clear delineation of sectoral roles) and those that have hindered ISC (including resource constraints, competing priorities and a lack of accountability), there is a limited understanding of the role of power on collaboration effectiveness while implementing ISC interventions. Thus, the present review is expected to bridge this knowledge gap by synthesising evidence from the literature on exploring how, why, for whom, under what circumstances and to what extent power dynamics between different sectors influence the collaboration while implementation of intersectoral health programmes and policies in Low and Middle-Income Countries (LMICs). Method and analysis: A realist review will be conducted to explain the role of power dynamics in the implementation of intersectoral policies through following a number of iterative steps: (1) Eliciting initial programme theories by engaging key experts for input and feedback, (2) Performing systematic and purposive searches for grey and peer-reviewed literature on Medline, Embase, CINAHL and Web of Science databases along with Google Scholar (3) Selecting appropriate documents while considering rigour and relevance, (4) Extracting data, (5) Synthesising data and (6) Refining the initial programme theory into a middle range realist theory. By generating Context-Mechanism-Outcome (CMO) configurations, this review seeks to understand how power dynamics between different sectors influence the implementation of intersectoral health programmes and policies and explore the mechanisms that trigger specific outcomes (implementation success or failure) in LMICs. Discussion: Given the complex nature of power dynamics in ISCs, realist philosophy is well suited to address the aim of this study. The findings from this review (refined programme theory) will be tested through case studies of the national nutrition mission in Assam, India, which uses an ISC approach to implement nutrition interventions. The outcomes of this synthesis are also expected to guide the implementation of other ISC approaches in similar settings.