Multisectoral action for health in low-income and middle-income settings: how can insights from social science theories inform intragovernmental coordination efforts?

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.

‘Writing budgets for meetings and teas?’: a multitheoretical analysis of intragovernmental coordination for multisectoral action for health in Uganda

“…By illuminating the donors' power in shaping the development agenda over the last three decades, this study underscores a context particular to donor-dependent LMICs, and a period when certain donors pushed for institutional strengthening of MDAs as a way to bolster ('good') governance. 65 83 Applying a multitheoretical approach: reflections and implications This paper contributes to the literature on theory building and, more specifically, applying a multitheoretical approach to research 84 85 and examines the empirical relevance of the multitheoretical framework proposed by Ssennyonjo et al 12 This work contributes to studies that have used theories to analyse data and interpret findings. 33 36 37 86 We demonstrated how a multitheoretical approach is particularly pertinent to intragovernmental coordination.…”

“…Consistent with PE perspectives and RDT, the findings confirm that these costs could be positively mediated by trust, considerations of what interdependence entails, a communication strategy and earmarked budgets for coordination. 12 The political nature of coordination The study revealed several manifestations of power dynamics, including competition and conflicts over resources (especially budgets), donor inducing compliance through conditioning coordination on aid, contestations over mandates, framing issues in self-interested ways and adopting behaviours (such as non-compliance to rules) to undermine the power of coordinating agencies. Consistent with the PE literature, 60 68 informal norms of demanding teas and transport allowances and instances of corruption, such as misappropriation of funds, were documented.…”

“… 10 11 However, there remains a lack of information on how internal coordination within the central governments, especially in LMICs, can be enhanced to advance health aspirations and social objectives. 12 The central government level deserves studying as it is meant to perform core functions such as policy-making and supporting the subnational level governments. 13 The functioning of the central government bears down on the overall performance of government.…”

Tackling the politics of intersectoral action for the health of people and planet

“…Health (and illness) results from actions taken by individuals, communities, corporations, and governments within and, crucially, outside the health sector. The same logic applies to planetary health16 with health, business, and environment literature reporting similar barriers to, and facilitators of, intersectoral action 171819202122. We conducted a pragmatic review, grouping the wide variety of barriers and opportunities described into seven themes (box 3).…”

Analysis of Cameroon’s Sectoral Policies on Physical Activity for Noncommunicable Disease Prevention

“…Filho et al [ 40 ] reported that only few studies in the literature have explored PA interventions in LMICs, mainly noting the importance of school-based, multicomponent interventions. More studies have rather explored multisectoral approaches involved in the promotion of PA related outcomes such as NCDs and general health in LMICs [ 39 , 41 , 42 , 43 ]. The multisectoral nature of PA is exemplified in the 2018–2023 Kenyan National Physical Activity Plan, led by the Kenyan Ministry of Health.…”