Abstract
BackgroundIntersectoral actions (ISA) are a recognized relationship between the health sector and other sectors to improve health outcomes. Although a frequent topic in public health studies, evidence for systematic evaluation of implementation of ISA is scarce. An intersectoral health intervention for infants under one-year-old with, and at risk of, stunting (low height-for-age) was developed by a public-private partnership in Bogotá, Colombia, during 2018 and 2019. Here we report a case study conducted in parallel to the intervention designed to assess factors that influenced implementation of the ISA.MethodsThe case study was developed using a concurrent mixed-methods design, with the qualitative component giving context to the quantitative results. The qualitative component was obtained from four workshops, three focus groups, and 17 semi-structured interviews with actors involved in the intersectoral intervention. The quantitative component was obtained with two questionnaires that evaluated perceptions on improvement and partnership functioning of the ISA.ResultsThis study collected information from 122 participants. The intervention demanded intersectoral collaboration. Political will, motivated human resources, and recognition that health improvement results from collaboration, were factors that facilitated intersectoral actions. Intersectoral actions were limited by difficulties in engaging the health sector, communication challenges related to local health service decentralization, and administrative barriers.ConclusionsIntersectoral actions have recently been discussed in the literature due to challenges in implementation and doubts regarding economic outcomes. The implementation of intersectoral public health interventions can be jeopardized by a lack of coordination and management skills.
Highlights
Intersectoral actions (ISA) are a recognized relationship between the health sector and other sectors to improve health outcomes
Malnutrition is an example of the call for ISA, and a common topic in governmental agendas that highlights the need for public-private partnerships [8]
Stunting is a form of malnutrition characterized by a low height-forage that leads to irreversible damage including shorter adult height, lower attained schooling, and reduced adult income [9]
Summary
Intersectoral actions (ISA) are a recognized relationship between the health sector and other sectors to improve health outcomes. Intersectoral actions (ISA) are recognized relationships between part or parts of the health sector and part or parts of another sector to act on health-related issues in a way that is more efficient and sustainable than could be achieved by the health sector alone [1] This requires considerable coordination efforts and questions the durability of ISA, what Greer and Lillvis described as “bureaucratic obstacles to intersectoral governance” [2]. A recent systematic review by Aguilera and Daher collated macro-level policies and programs for stunting across government, health, and social assistance sectors of several countries including Peru, Malawi, Ethiopia, and Nigeria [14] Other sectors such as agriculture, social assistance, health, education, water and sanitation, and the private sector have been identified with technical competencies to maximize nutrition results [7]. Identification of the various sectors’ responsibilities and roles does not necessarily mean that effectiveness of ISA is guaranteed, nor that a favorable environment for collaboration between sectors ensues
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