Governing Multisectoral Actions: How to Lay a Foundation for Success
By: Alyson Lipsky
Multisectoral actions for health, those that non-health actors undertake sometimes in collaboration with health actors, are required to sustainably address many health priorities. But once a multisectoral action is identified, what can decisionmakers do to help it succeed? What kinds of platforms, incentives, and capacities does a country need to implement such actions? Any multisectoral action requires high levels of coordination among diverse stakeholders that all have different mandates, interests, and ideas. These requirements pose challenges for accountability as roles and responsibilities can get muddled, tensions between stakeholders can bubble up and impede progress, and competing priorities among those stakeholders can make it difficult to maintain attention on multisectoral actions over time. Governance approaches can help address and mediate these challenges.
Establish Actions at Every Level
No matter the topic or country of focus of a multisectoral action, there needs to be a platform that fosters dialogue and communication between stakeholders. When possible, platforms should leverage existing structures and work with all stakeholders in a participatory manner. A platform should also clearly define the goals of the multisectoral action, how each stakeholder could benefit if the action were to succeed, and the metrics for success. For example, in seeking to address its burden of non-communicable diseases (NCDs), the Nepalese government took a multisectoral approach, and in 2013 established a multisectoral steering committee under the Ministry of Health and Population. The committee’s first task was to develop an NCD action plan to clearly outline the goals, how each sector is affected by NCDs, and other key questions, such as what are each sector’s roles, responsibilities, and mechanisms for implementing the action plan.
While Nepal’s platform is an excellent example of a national-level mechanism — one that benefits from strong political will, a clear mandate, adequate resources, and accountability to high-level leadership — subnational platforms that foster collaboration at lower levels of government are also critical. An initiative around Malawi’s Youth-Friendly Health Services (YFHS) Strategy includes a district core team that mirrors the national-level team. The district team includes representation from four different ministries, each essential for the strategy’s implementation.
While dual national and subnational efforts are critical, civil society can serve as an important ally for multisectoral actions, representing affected communities and encouraging government actors to think creatively to find solutions. In fact, when implementing multisectoral actions, outside actors are sometimes the first to break down silos. For example, the civil society network Alliance Scaling Up Nutrition Mali provides support and oversight of the national policy and multisectoral action plan for nutrition.
Incentivize Success
Even with well-established and resourced platforms, multisectoral actions can still falter if participating stakeholders don’t have the right incentives to stay engaged, as core activities compete for time and attention. One key factor is financing. Multisectoral actions must be adequately resourced without relying too much on existing ministry budgets. Another is ensuring that multisectoral actions are included in annual workplans at ministry, county, and district levels. For example, the Malawi YFHS Strategy was included in workplans at multiple government levels. Finally, including multisectoral action priorities in leadership and staff performance evaluations can ensure that all levels of staff are held accountable for advancing multisectoral actions in the same way they work on more traditional programming.
Strengthen Capacity
Specific capacities need to exist within government ranks to ensure multisectoral actions can succeed. To achieve ambitious objectives, government staff need to be able to think creatively, explore new opportunities, and effectively plan out initiatives based on how different sectors can contribute. Creative exploration will only get you so far, however. Government actors promoting and implementing multisectoral actions must also: have a strong understanding of the political economy to enable successful power sharing; ensure multisectoral action leaders are responding to different stakeholders’ incentives; effectively convene, coordinate, and negotiate with different stakeholders; and know when it’s time to go back to the drawing board. In addition, government entities must be able to generate convincing evidence to successfully advocate for sustained political will at all levels of government and with non-state actors. The capacity to generate evidence will depend in part on the government’s ability to define metrics, many of which will likely fall outside of the health sector. For example, under the Scaling Up Nutrition initiative, Zambia established metrics to measure whether the country was making progress to “resolve the human resource and financial gaps in the five key line ministries.”
Foundation for Success
While there have been many attempts to develop and implement multisectoral actions, evidence on how to improve governance of multisectoral actions is scant. HP+’s experience related to governance in the health sector is that it can be tricky and that effective structures that work are scarce. When additional sectors are added, it can become even more complicated and challenging. However, developing joint metrics that require sectors to collaborate and implement together may be an effective way to ensure that the goals of a multisectoral action are achieved and that policy leads to its desired outcome. Further, gaining the attention of high-level decisionmakers, and cultivating that leadership throughout multiple levels of government, can raise the visibility of the action and create greater incentives for sectors to be on the same page. There is no one right way to govern multisectoral actions but incorporating the approaches and developing the capacities outlined above will help lay a foundation for success.
Alyson Lipsky is a health governance specialist at RTI and the Health Policy Plus technical leader for stewardship. Her recent technical support and research has concentrated on community engagement, social accountability, governance and health system strengthening, political will, capacity development, political economy, and social network analysis.
