Ensuring multisectoral action on the determinants of reproductive, maternal, newborn, child, and adolescent health in the post-2015 era

Rasanathan, Kumanan; Damji, Nazneen; Atsbeha, Tesmerelna; Drisse, Marie-Noël Bruné; Davis, Austen; Dora, Carlos; Karam, Azza; Kuruvilla, Shyama; Mahon, Jacqueline; Neira, María; Montesinos, Eugenio Villar; Zinkernagel, Deborah von; Webb, Douglas

doi:10.1136/bmj.h4213

Cited by 53 publications

(67 citation statements)

References 23 publications

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“…Additionally, there is a need to go beyond tracking sector performance individually and to integrate measurement of intersectoral collaboration for maternal health. Intersectoral collaboration refers to the mutually beneficial, integrated efforts of sectors who ideally share a common M&E framework [42]. According to our participants, intersectoral collaboration indicators would capture the true interface of the health system with other sectors.…”

Section: Discussionmentioning

confidence: 99%

Improving the validity, relevance and feasibility of the continuum of care framework for maternal health in South Africa: a thematic analysis of experts’ perspectives

Mothupi

Knight

Tabana

2020

Health Res Policy Sys

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Background: The continuum of care is a key strategy for ensuring comprehensive service delivery for maternal health, while acknowledging the role of the social determinants of health. However, there is little research on the operationalisation of the framework by decision-makers and implementers to address maternal health challenges. The framework should be measurable and feasible for implementation in low-and middle-income country contexts. In this study, we explore experts' perspective on monitoring indicators for continuum of care and key issues related to their use in the South African context. Methods: We conducted key informant interviews with a range of experts in decision-making and programme implementation roles in the health system and relevant sectors. Key informants provided their perspectives on systematically selected, nationally representative monitoring indicators in terms of validity, relevance and feasibility. We interviewed 13 key informants and conducted a thematic analysis of their responses using multi-stage coding techniques in Atlas.ti 8.4. Results: Experts believed that the continuum of care framework and monitoring indicators offer a multisectoral perspective for maternal health intervention missing in current programmes. To improve validity of monitoring indicators, experts suggested reflection on the use of proxy indicators and improvement of data to allow for equity analysis. In terms of relevance and feasibility, experts believe there was potential to foster co-accountability using continuum of care indicators. However, as experts stated, new indicators should be integrated that directly measure intersectoral collaboration for maternal health. In addition, experts recommended that the framework and indicators should evolve over time to reflect evolving policy priorities and public health challenges. Conclusion: Experts, as decision-makers and implementers, helped identify key issues in the application of the continuum of care framework and its indicators. The use of local indicators can bring the continuum of care framework from an under-utilised strategy to a useful tool for action and decision-making in maternal health. Our findings point to measurement issues and systematic changes needed to improve comprehensive monitoring of maternal health interventions in South Africa. Our methods can be applied to other low-and middle-income countries using the continuum of care framework and locally available indicators.

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Section: Discussionmentioning

confidence: 99%

Improving the validity, relevance and feasibility of the continuum of care framework for maternal health in South Africa: a thematic analysis of experts’ perspectives

Mothupi

Knight

Tabana

2020

Health Res Policy Sys

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“…In our meeting, we adapted an existing typology [29] to differentiate four broad types of multisectoral action, noting that they overlap:…”

Section: Key Considerations and Lessons For Successful Governance Of mentioning

confidence: 99%

Governing multisectoral action for health in low- and middle-income countries

et al. 2017

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“…For example, in confronting zoonotic diseases which threaten human security such as the H5N1 outbreaks in 2004, it is compelling that wildlife, animal, agriculture and public health agencies felt that their institutional mandates could only be achieved by “working together” to gain a mutual benefit. 4 In this case, multisectoral action was an enabling tool to facilitate their “mutual gain.” 5,6 …”

Section: Challenges Of Multisectoral Actions For Healthmentioning

confidence: 99%

Multisectoral Actions for Health: Challenges and Opportunities in Complex Policy Environments

Tangcharoensathien

Srisookwatana²,

Pinprateep³

et al. 2017

Int J Health Policy Manag

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Multisectoral actions for health, defined as actions undertaken by non-health sectors to protect the health of the population, are essential in the context of inter-linkages between three dimensions of sustainable development: economic, social, and environmental. These multisectoral actions can address the social and economic factors that influence the health of a population at the local, national, and global levels. This editorial identifies the challenges, opportunities and capacity development for effective multisectoral actions for health in a complex policy environment. The root causes of the challenges lie in poor governance such as entrenched political and administrative corruption, widespread clientelism, lack of citizen voice, weak social capital, lack of trust and lack of respect for human rights. This is further complicated by the lack of government effectiveness caused by poor capacity for strong public financial management and low levels of transparency and accountability which leads to corruption. The absence of or rapid changes in government policies, and low salary in relation to living standards result in migration out of qualified staff. Tobacco, alcohol and sugary drink industries are major risk factors for non-communicable diseases (NCDs) and had interfered with health policy through regulatory capture and potential law suits against the government. Opportunities still exist. Some World Health Assembly (WHA) and United Nations General Assembly (UNGA) resolutions are both considered as external driving forces for intersectoral actions for health. In addition, Thailand National Health Assembly under the National Health Act is another tool providing opportunity to form trust among stakeholders from different sectors. Capacity development at individual, institutional and system level to generate evidence and ensure it is used by multisectoral agencies is as critical as strengthening the health literacy of people and the overall good governance of a country.

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Ensuring multisectoral action on the determinants of reproductive, maternal, newborn, child, and adolescent health in the post-2015 era

Cited by 53 publications

References 23 publications

Improving the validity, relevance and feasibility of the continuum of care framework for maternal health in South Africa: a thematic analysis of experts’ perspectives

Improving the validity, relevance and feasibility of the continuum of care framework for maternal health in South Africa: a thematic analysis of experts’ perspectives

Governing multisectoral action for health in low- and middle-income countries

Multisectoral Actions for Health: Challenges and Opportunities in Complex Policy Environments

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