A Multisectoral Endeavor Called Health — a Few Lessons Learned
By: Jay Gribble
Over the past few months, my colleagues and I have been thinking a lot about multisectoral actions and policies. The title of this series — a Multisectoral Endeavor Called Health — has made me reflect on the ideas behind the blogs in this series. Our goal was to elevate a dialogue on the lasting impact of multisectoral policy actions. The topics addressed reinforce the need to do the hard work on integration and working across sectors, geographies, and levels for lasting impact.
Multisectoral endeavors aren’t just a set of random efforts. Rather, they are designed to focus efforts on achieving a goal. They illustrate the need to reach outside of our comfort zones and work in a variety of collaborative and coordinated ways to achieve improved health systems and outcomes. This series has considered diverse ways in which those multisectoral efforts improve the health of individuals, communities, and nations around the world. Each blog offers a different perspective on how multisectoral actions can work, as well as insights and lessons for their successful implementation.
Policy and Governance
National development strategies and vision statements aspire to high-level goals. But achieving those goals requires understanding the root causes to barriers and coordinating across sectors. The goal of becoming a middle-income country, for example, requires a thoughtful roadmap that identifies the role of each sector, their priorities, benchmarks, and program efforts. Achieving this goal requires breaking down complex issues into manageable pieces. The actions cannot remain at the national level; actions need to be rolled out to subnational and local levels, with everyone playing a part — and knowing what their part is. Stakeholder engagement fosters commitment to the goal. At the same time, success may depend on who has set the goal and where accountability for achieving the goal resides. In other words, the signature on the policy document can make a big difference when it comes to achieving high-level goals.
Pandemics
We are currently living through a global pandemic, and each of us understands the importance of the multisectoral efforts needed both to prepare for and respond to a pandemic. We recognize the importance of coordination structures, adequate finances, and supply chains to manufacture and distribute supplies — at least for now. Policies have been put into place around the world to coordinate responses. But how long will those policies stay in place? Resources for the response are likely to be reprogrammed to address recovery issues. To keep the preparedness efforts in place, stakeholders need to continue to make the case that those investments are important to mobilize a rapid, effective response. A key aspect of sustaining the interest in preparedness is knowing who to engage in advocacy efforts, understanding how to talk to those stakeholders, and having the right evidence at hand to make the case effectively.
Universal Health Coverage
While the technical issues of policy implementation require both capacity and commitment, the experience with universal health coverage in Nigeria reinforces that we need to have our elevator speeches ready. We never know when or where we will meet our next policy champion. Knowing how to make the case and catalyze someone into action is vital for effective policy implementation. We must also do our homework on the key actors we wish to engage, asking, “What is their stance and why?” Understanding the political economy of issues and policy actors, as well as investing time to cultivate relationships and allies, cannot be underestimated when working on multisectoral issues. If we don’t care about their issues, why should they care about ours?
Private Sector
The public and private sectors are intricately linked in any country’s health system. The demands of healthcare service delivery in any country are generally greater than the public sector can provide; the private sector has a logical role to play in responding to the public’s health needs. Working together, the public and private sectors can go further than each could go separately. Collaborations like public-private partnerships can serve as creative opportunities to address stubborn challenges that would be more difficult to address through either sector separately. Beyond private health practices, clinics, and hospitals, the private sector can play an additional role of mobilizing capital for longer-term investments in increased service delivery or innovative technologies. For this long-term private sector investment to continue, stewardship and dialogue between the sectors are vital to keeping interests aligned in support of improved health outcomes.
Malnutrition
Reducing malnutrition requires both short- and long-term solutions, as well as investments in the health and non-health sectors. Focusing only on caloric intake and micronutrients may be short-term solutions, but other approaches are needed to address food insecurity and insufficient agricultural practices that are underlying causes on malnutrition. In Malawi, AgDiv project partners thought creatively to address underlying causes of malnutrition, linking agriculture to economic growth opportunities for women. It also addressed more immediate causes by introducing new farming practices that allow higher yields, more produce to sell, and more food for the household. To solve complex problems, we need to think creatively about both the immediate and underlying causes of the problems.
Youth
Creating silos is a natural way to protect our turf and funding. However, instead of thinking about health programs that address youth, education programs that address youth, and job creation programs that address youth, wouldn’t we do better to think about youth as the focus and create integrated, comprehensive programs that consider the individual rather than the sector? Breaking down silos is difficult because it means ceding power and authority. However, evidence indicates that an integrated approach leads to better and lasting results. Integrated approaches need to extend beyond the public sector, especially those related to creating alliances for job creation and economic growth. Once again, tapping all available resources in both public and private sectors can foster win-win opportunities that advance youth development.
Achieving Lasting Results
Several of the lessons from multisectoral actions align with other aspects of policy work: the importance of understanding context, the need to have good communications, and the role of stakeholder engagement. However, the complexity of multisectoral actions also leads to additional lessons. While complex problems need to be broken down into manageable pieces, as illustrated by sectoral plans, existing silos also need to be broken down, especially when focused on a specific population, such as youth. Similarly, long-term and short-term solutions should play different roles in the attainment of goals, just as immediate and more complex underlying causes of a problem need to be recognized and addressed as separate parts of a complex solution. Through developing and implementing multisectoral actions, countries can successfully tackle complex problems and achieve lasting results.
Jay Gribble is a senior director in Palladium’s health practice leadership team and deputy director for family planning and reproductive health on the USAID-funded Health Policy Plus project.
