Intersectoral Partnerships Research Articles

Evaluation of partnership working in cities in phase IV of the WHO Healthy Cities Network.

An intersectoral partnership for health improvement is a requirement of the WHO European Healthy Cities Network of municipalities. A review was undertaken in 59 cities based on responses to a structured questionnaire covering phase IV of the network (2003-2008). Cities usually combined formal and informal working partnerships in a pattern seen in previous phases. However, these encompassed more sectors than previously and achieved greater degrees of collaborative planning and implementation. Additional WHO technical support and networking in phase IV significantly enhanced collaboration with the urban planning sector. Critical success factors were high-level political commitment and a well-organized Healthy City office. Partnerships remain a successful component of Healthy City working. The core principles, purpose and intellectual rationale for intersectoral partnerships remain valid and fit for purpose. This applied to long-established phase III cities as well as newcomers to phase IV. The network, and in particular the WHO brand, is well regarded and encourages political and organizational engagement and is a source of support and technical expertise. A key challenge is to apply a more rigorous analytical framework and theory-informed approach to reviewing partnership and collaboration parameters.

Group Decision Making in an Intersectoral Mental Health Community Partnership

Background: In a major Canadian jurisdiction that includes several regions, an intersectoral working group with community partners was formed to enable change in systems and policies for individuals with serious and persistent mental illness. The top priority of the working group was housing. Purpose: The study explored how the working group members experienced decision-making power in their efforts to enable change in housing policies. Method: The research used a qualitative single-case design to study the decision-making processes as experienced by the group members. Data were collected through individual semi-structured interviews, two focus groups and review of key public documents. The data were analysed using the constant comparative method, with critical reflection on group decision making and the contextual influences of system-level policies. Group members contributed to the analysis. Findings: Amid positive experiences of working together, group members experienced challenges related to power differentials between service providers, government personnel and consumers, and the impact of the systemic environment on the group processes. Implications: Implications are raised for occupational therapy education and practice, and for studying group decision making as an occupation.

The Mechanism of Effective Intersectoral Partnership as a Necessary Component of Creation of Innovative Economy of Russia

The paper proposes a theoretical concept mechanism for effective intersector partnership that includes such components as the purpose of creation, characterization of subjects, methods and principles of their interaction, the constituent elements of the mechanism of interaction, assessment of effectiveness.

Addressing Cancer Disparities via Community Network Mobilization and Intersectoral Partnerships: A Social Network Analysis

Community mobilization and collaboration among diverse partners are vital components of the effort to reduce and eliminate cancer disparities in the United States. We studied the development and impact of intersectoral connections among the members of the Massachusetts Community Network for Cancer Education, Research, and Training (MassCONECT). As one of the Community Network Program sites funded by the National Cancer Institute, this infrastructure-building initiative utilized principles of Community-based Participatory Research (CBPR) to unite community coalitions, researchers, policymakers, and other important stakeholders to address cancer disparities in three Massachusetts communities: Boston, Lawrence, and Worcester. We conducted a cross-sectional, sociometric network analysis four years after the network was formed. A total of 38 of 55 members participated in the study (69% response rate). Over four years of collaboration, the number of intersectoral connections reported by members (intersectoral out-degree) increased, as did the extent to which such connections were reported reciprocally (intersectoral reciprocity). We assessed relationships between these markers of intersectoral collaboration and three intermediate outcomes in the effort to reduce and eliminate cancer disparities: delivery of community activities, policy engagement, and grants/publications. We found a positive and statistically significant relationship between intersectoral out-degree and community activities and policy engagement (the relationship was borderline significant for grants/publications). We found a positive and statistically significant relationship between intersectoral reciprocity and community activities and grants/publications (the relationship was borderline significant for policy engagement). The study suggests that intersectoral connections may be important drivers of diverse intermediate outcomes in the effort to reduce and eliminate cancer disparities. The findings support investment in infrastructure-building and intersectoral mobilization in addressing disparities and highlight the benefits of using CBPR approaches for such work.

Why is Intersectoral Cooperation Difficult to Maintain? Insights from French Cluster Policy

Intersectoral cooperation is increasingly perceived as important to regional renewal. Yet, studies of local cooperation generally show that few ties exist among actors from different sectors. However, we know little about the mechanisms behind this lack, which exists despite efforts by policy makers and, sometimes, despite the desires of upper-level managers within firms. I attempt to examine mechanisms that might explain this lack of intersectoral partnerships. To this end, I will use a study of the cluster at Plateau de Saclay (in the Paris suburbs), which was founded in response to the French government's Pôle de compétitivité policy. The paper shows that, in order to understand these mechanisms, it is necessary to examine both local arrangements and employees' work within firms. The former explains dynamics of inclusion and exclusion, while the latter sheds light on the way firm strategy is constructed. Local arrangements have made it difficult to build intersectoral partnerships. In some cases policy does succeed in making firms from different sectors cooperate, but these partnerships are difficult to maintain—a problem that results from negotiations inside large firms with conflicting economic goals and a lack of experience in measuring knowledge benefits.

Exploring the partnership networks of churches and church-affiliated organisations in health promotion

Health promotion professionals often work with community organisations and voluntary associations, including churches and church-affiliated organisations, to reduce health inequities within communities. How voluntary and church-affiliated organisations form intersectoral relationships and partnerships, and the challenges they face in doing so, has been well researched. However, there is a need to investigate further the extent to which local churches collaborate or form partnerships with other actors, such as government, peak bodies and welfare organisations. This paper reports a Victorian-based mapping exercise of partnerships and funding involving document analysis of the annual reports from 126 organisations and 35 interviews conducted with church-affiliated organisations and local churches. The discussion begins with the exploration of the nature of, and the reason why churches partner with other sectors. The paper also examines funding sources and partnership pathways that churches access to undertake the activities and programs they conduct. Interview themes highlight the value to churches of the sharing of expertise and resources, the provision of support to communities, a shared ethos of social justice and the empowerment of vulnerable populations. The findings about the extent to which local churches are involved in partnerships across society, and the extent of public and private funds they draw on to provide resources and assistance to local communities, indicate that churches are now a key player not just in welfare provision but also in health promotion activities. The findings contribute to the understanding of church activities in relation to health promotion and will assist organisations who may be potential partners to consider their collaborative efforts in the health promotion field.

PUBLIC–NONPROFIT PARTNERSHIP PERFORMANCE IN A DISASTER CONTEXT: THE CASE OF HAITI

During disasters, partnerships between public and nonprofit organizations are vital to provide fast relief to affected communities. In this article, we develop a process model to support a performance evaluation of such intersectoral partnerships. The model includes input factors, organizational structures, outputs and the long-term outcomes of public–nonprofit partnerships. These factors derive from theory and a systematic literature review of emergency, public, nonprofit, and network research. To adapt the model to a disaster context, we conducted a case study that examines public and nonprofit organizations that partnered during the 2010 Haiti earthquake. The case study results show that communication, trust, and experience are the most important partnership inputs; the most prevalent governance structure of public–nonprofit partnerships is a lead organization network. Time and quality measures should be considered to assess partnership outputs, and community, network, and organizational actor perspectives must be taken into account when evaluating partnership outcomes.

L’Outil diagnostique de l’action en partenariat : fondements, élaboration et validation

Intervening on social determinants of health requires that public health stakeholders enter into intersectoral partnerships. The lack of valid tools to evaluate the quality of partnerships is a significant constraint to formulating convincing arguments for this kind of action. In light of this shortcoming, the tool described in this article evaluates processes of collective action based on key aspects of its effectiveness. The tool is based on a theoretical model that followed from case studies identifying the conditions associated with quality of partnerships. The tool was developed by operationalizing these conditions into a series of statements, and pretested using the cognitive interviewing method. Construct validity and ecological validity were verified. The tool includes 18 items, with 3 answer choices provided for each item. It is sensitive to variations in judgement. It allows for good convergence among respondents from participating organizations within a partnership; it can also distinguish between partnerships that have difficulty meeting certain conditions and those that do not. The tool is suitable for self-evaluation of partnerships engaged in common projects that involve more than information exchange. The tool's validity resides in its validation procedure and in the basic soundness of its theoretical model, which is supported by a number of literature reviews on how partnerships function and their results.

L’Outil diagnostique de l’action en partenariat: fondements, élaboration et validation

OBJECTIVES Intervening on social determinants of health requires that public health stakeholders enter into intersectoral partnerships. The lack of valid tools to evaluate the quality of partnerships is a significant constraint to formulating convincing arguments for this kind of action. In light of this shortcoming, the tool described in this article evaluates processes of collective action based on key aspects of its effectiveness. METHOD The tool is based on a theoretical model that followed from case studies identifying the conditions associated with quality of partnerships. The tool was developed by operationalizing these conditions into a series of statements, and pretested using the cognitive interviewing method. Construct validity and ecological validity were verified. RESULTS The tool includes 18 items, with 3 answer choices provided for each item. It is sensitive to variations in judgement. It allows for good convergence among respondents from participating organizations within a partnership; it can also distinguish between partnerships that have difficulty meeting certain conditions and those that do not. The tool is suitable for self-evaluation of partnerships engaged in common projects that involve more than information exchange. DISCUSSION The tool's validity resides in its validation procedure and in the basic soundness of its theoretical model, which is supported by a number of literature reviews on how partnerships function and their results.

Implementation of integrated vector management for disease vector control in the Eastern Mediterranean: where are we and where are we going?

Integrated vector management (IVM) is an acknowledged strategy of choice for the prevention and control of vector-borne diseases. The paper describes and documents the progress countries of the World Health Organization (WHO) Eastern Mediterranean Region have made in endorsing and translating the strategy into action at the national level. These include increased political commitment; strengthened intersectoral coordination and partnership; strengthened capacity in entomology and vector control; and scaling up of vector control interventions through universal access. These efforts, however, are compromised by inappropriate institutional arrangements in some countries; weak national capacities to address management of pesticides; , development and spread of vector resistance to insecticides, including to pyrethroids; and the expansion of emerging and re-emerging vector-borne diseases. With WHO leadership and support from partners, countries continue to address these challenges head-on.

Spilt milk: an inter-sectoral partnership that failed to advance milk security for low-income lone mothers in Nova Scotia, Canada

Canadian agricultural policy supports higher milk prices. Consequently, poor families lack sufficient funds to purchase adequate quantities of milk. Low-income lone mothers in the Canadian province of Nova Scotia suggested their preferred strategies for improved access to milk. We then built inter-sectoral support for a policy intervention to address their recommendations. Our research-to-action process led to a policy dialogue focusing on an electronic smart card that would permit the delivery of lower-priced milk to poor households. While all agreed that milk insecurity was an important issue, the project ultimately failed because of the entrenched positions of influential stakeholder groups.

Distinguishing Between Health Education and Health Information Dissemination

Wong and Higgins' article illustrates innovative ways nontraditional public health providers such as park rangers are connecting with consumers on health issues.1 Similarly, the Centers for Disease Control and Prevention's Action Communities for Health, Innovation, and EnVironmental ChangE (ACHIEVE) program works with the National Recreation and Park Association and other groups to promote physical activity and reduce chronic disease risks.2 Such collaborations are long overdue, given that the Institute of Medicine, World Health Organization, and other prestigious bodies have underscored the importance of transdisciplinary approaches to achieving public health goals.3–5 An important distinction must be made, however, between these park rangers' efforts and the formal approaches of health education as a core public health discipline. Health educators conduct rigorous assessment, planning, implementation, research, evaluation, advocacy, and program management to encourage healthy lifestyles, policies, and environments. In achieving our goals, we: (1) collect and analyze quantitative and qualitative data; (2) use scientific, multidisciplinary theories to plan interventions; (3) translate scientific research into practical, applied programming; (4) plan and conduct mass media and health communications campaigns to change knowledge, attitudes, behaviors, and norms of select populations; (5) implement programs; (6) provide training to individuals, lay health advisors, but also to other professionals, and policymakers; and (7) evaluate health promotion programs for continuous program improvement. Health education is the first population-based profession to develop competencies that serve as the basis for professional preparation and workforce development.6 These distinct, scientifically verified competencies7 are also recognized by the US Department of Labor through a unique standard occupational classification for health educators.8 We applaud the park rangers' creativity. As health educators, we also note the absence of a true science-based approach in their efforts, better described as providing health information, not education. Failure to distinguish between information dissemination and health education and to recognize the overarching ecological models guiding our practice contributes to limited views of health education as “ancillary rather than integral, superfluous rather than essential” in public health planning and interventions.9,10(p1824-1825) Health educators must strengthen intersectoral partnerships with park rangers, urban planners, economists, environmentalists, law enforcement officers, and other nontraditional public health partners. The American Public Health Association's Public Health Education and Health Promotion Section, the largest in the association, is a natural leader for catalyzing such alliances. If we are to deliver on the promise of prevention in health reform, moving beyond awareness to action is essential—both within and outside the park.

Exploring the relationship between synergy and partnership functioning factors in health promotion partnerships

Intersectoral partnerships have been identified as a useful mechanism for addressing the health challenges that face society. In theory, partnerships achieve synergistic outcomes that amount to more than can be achieved by individual partners working on their own. This study aimed to identify key factors that influence health promotion partnership synergy. Data were collected from 337 partners in 40 health promotion partnerships using a postal survey. The questionnaire incorporated a number of multidimensional scales designed to assess the contribution of factors that influence partnership synergy. New validated scales were developed for synergy, trust, mistrust and power. Pearson's correlations and multiple regression analysis were used to identify the significance of each factor to partnership synergy. Trust, leadership and efficiency were shown to be the most important predictors of partnership synergy. Synergy is predicated on trust and leadership. Trust-building mechanisms need to be built into the partnership forming stage and this trust needs to be sustained throughout the collaborative process. We need to develop systems where the best leaders are put forward for intersectoral partnerships. This should be consistent across all sectors and organizations.

The Tourist Potential of Rural Areas in Poland

The Tourist Potential of Rural Areas in Poland This paper critically examines the role tourism can play in the stabilisation and diversification of rural areas using the example of Poland. Based on the literature and statistical data, the past development and current state of rural tourism in Poland is analysed. Then an analytical framework based on Porter (1990) is developed to assess the future tourist potential of Polish rural areas and identify barriers and chances of tourist development. The analysis revealed that the future tourist potential of rural areas in Poland is limited and often overestimated. Considerable deficits on the supply side and poor financial resources are combined with a limited and recently shrinking demand. The economic significance of tourism in most rural areas outside of the traditional tourist destinations has so far been marginal. Rural tourism in Poland can grow on a small scale and in niche markets requiring: 1) sound market research at national level, 2) regional tourism strategies based on an analysis of the seven depicted success factors, 3) organisations and intersectoral partnerships at regional level, and 4) a high level of interest and initiative of the local population to develop creative ideas for supply ‘bundles’ and to overcome the numerous barriers. Rural tourism is not a panacea for the structural problems of rural areas in Poland. The majority of regions - particularly outside of the traditional tourist destinations and far from big cities - will have to base their diversification on more pillars than tourism.

Development of a Mental Health Policy and System in Tanzania: An Integrated Approach to Achieve Equity

Development of a Mental Health Policy and System in Tanzania: An Integrated Approach to Achieve Equity

Partnerships for Sustainable Change in Cotton: An Institutional Analysis of African Cases

This article examines intersectoral partnerships formed to promote sustainable cotton production and the extent to which such partnerships are facilitated or constrained by their institutional environment. Based on an analysis of five partnerships in sub-Saharan Africa, this article shows that institutional factors create both opportunities and obstacles for partnership implementation which are inextricably linked to their adoption of particular farming strategies and sustainability standards. In general, these institutional factors tend to facilitate the implementation of partnerships using contract farming and mainstream sustainability standards, and hinder those adopting cooperative farming methods and organic standards.

The new kids on the block – Building environmental governance in the Western Balkans

The influence of the EU over environmental policy frameworks, plus the availability of project funding for ENGOs in acceding and candidate states across post-socialist Europe has significantly shaped action repertoires, issue agendas and patterns of mobilisation. It has also been claimed that EU intervention has determined the institutionalisation of ‘green’ civil society networks by the introduction of, for example, environmental impact assessment (EIA) processes and policy-making norms that emphasise intersectoral partnership and multilevel governance. However, research on the impact of EU assistance for environmental mobilisations in Bosnia–Herzegovina and Serbia reveals the extent to which EU intervention and influence builds professionalism, but only partially institutionalises recipient ENGOs; if they are accorded political access at all, it is ephemeral and within less contentious policy areas where they are encouraged to deliver expertise and assistance rather than to act as advocates for community interests or to express political opposition to contentious developments. This article concludes that the professionalisation and increased managerial capacity of a handful of ENGOs cannot be equated with good governance and with the institutionalisation of non-governmental actors. Indeed, increased professionalism is invariably confined to a very narrow spectrum of policy enactment and is insufficient to generate environmental governance in the absence of state or governmental capacity.

Social paediatrics: creating organisational processes and practices to foster health care access for children ‘at risk’

In recent years understanding and addressing child health inequities has become a priority for research and practice. In this paper we share research insights on an approach that shows promise for engaging across the spectrum of health services to foster access to services and supports for child development to reduce child health inequities. As pathways of influence on children’s health and development extend beyond the biomedical domain new approaches to practice are needed to foster health care access and to mobilise needed supports. The Social Paediatrics Initiative has been introduced in one of Canada’s poorest inner city neighbourhoods where a disproportionate number of children experience adverse childhood events and enter school developmentally delayed. The research was undertaken in partnership with practitioners, community based organisations and the formal health services sector. The study gathered data from parents, community members and clinicians to understand the range of conditions that interfere with access to health care and to illustrate the ways the Social Paediatrics Initiative sought to foster access and provide care that was responsive to the health and developmental needs of children at risk because of their social and material circumstances. In particular we illustrate ways in which intersectoral and interdisciplinary partnerships enabled clinicians to provide needed supports to address the social determinants of health.

Assessing the incremental effects of combining economic and health interventions: the IMAGE study in South Africa

To explore whether adding a gender and HIV training programme to microfinance initiatives can lead to health and social benefits beyond those achieved by microfinance alone. Cross-sectional data were derived from three randomly selected matched clusters in rural South Africa: (i) four villages with 2-year exposure to the Intervention with Microfinance for AIDS and Gender Equity (IMAGE), a combined microfinance-health training intervention; (ii) four villages with 2-year exposure to microfinance services alone; and (iii) four control villages not targeted by any intervention. Adjusted risk ratios (aRRs) employing village-level summaries compared associations between groups in relation to indicators of economic well-being, empowerment, intimate partner violence (IPV) and HIV risk behaviour. The magnitude and consistency of aRRs allowed for an estimate of incremental effects. A total of 1409 participants were enrolled, all female, with a median age of 45. After 2 years, both the microfinance-only group and the IMAGE group showed economic improvements relative to the control group. However, only the IMAGE group demonstrated consistent associations across all domains with regard to women's empowerment, intimate partner violence and HIV risk behaviour. The addition of a training component to group-based microfinance programmes may be critical for achieving broader health benefits. Donor agencies should encourage intersectoral partnerships that can foster synergy and broaden the health and social effects of economic interventions such as microfinance.

Practice and Academic Nurse Educators: Finding Common Ground

Two university-based schools of nursing and two healthcare regions, supported by a nurses' union, have formed an intersectoral collaboration to develop a practice educator curriculum. The curriculum is designed to increase educator capacity and practice-academic relationships. This article describes the preliminary groundwork among intersectoral partners. Practice and academic educators do not always recognize each others' expertise or share resources effectively. An online survey and focus groups were conducted to identify educators' similar successes and challenges, their perspectives of key criteria necessary to establish practice-academic collaborations and learning environments, and intent to leave. The findings revealed many similarities across sectors, although practice and academic educators had different foci or perspectives that will need to be bridged by the collaboration. Strategies are suggested to maximize educators' commonalities, provide better supports to minimize intent to leave, and ensure sustainability.