Multisectoral Engagement Research Articles

Evaluating Collective Impact for Healthy Aging at the Intersection of Public Health and Age-Friendly Communities

There is mounting interest in promoting - and evaluating efforts that improve healthy aging in age-friendly communities. Additionally, there is increasing recognition that multi-sectoral engagement beyond the aging network is needed to maximize impact and sustainability. Within the context of collective impact, this paper reviews a framework that explicates public health activities in collaboration across a range of stakeholders in age-friendly communities. Metrics demonstrating evidence of five categorical roles, processes and outcomes will be presented including: 1) Connecting and Convening; 2) Coordinating; 3) Collecting and Disseminating Data; 4) Communicating; and 5) Complementing and Supplementing. Examples that illustrate evidence vis-à-vis the components and phases of collective impact will be presented.

The Changing Aspects of Motherhood in Face of the COVID-19 Pandemic in Low- and Middle-Income Countries.

PurposeTo advocate perspectives to strengthen existing healthcare systems to prioritize maternal health services amidst and beyond the COVID-19 pandemic in low- and middle income countries.DescriptionCOVID-19 directly affects pregnant women causing more severe disease and adverse pregnancy outcomes. The indirect effects due to the monumental COVID-19 response are much worse, increasing maternal and neonatal mortality.AssessmentAmidst COVID-19, governments must balance effective COVID-19 response measures while continuing delivery of essential health services. Using the World Health Organization’s operational guidelines as a base, countries must conduct contextualized analyses to tailor their operations. Evidence based information on different services and comparative cost-benefits will help decisions on trade-offs. Situational analyses identifying extent and reasons for service disruptions and estimates of impacts using modelling techniques will guide prioritization of services. Ensuring adequate supplies, maintaining core interventions, expanding non-physician workforce and deploying telehealth are some adaptive measures to optimize care. Beyond the COVID-19 pandemic, governments must reinvest in maternal and child health by building more resilient maternal health services supported by political commitment and multisectoral engagement, and with assistance from international partners.ConclusionsMulti-sectoral investments providing high-quality care that ensures continuity and available to all segments of the population are needed. A robust primary healthcare system linked to specialist care and accessible to all segments of the population including marginalized subgroups is of paramount importance. Systematic approaches to digital health care solutions to bridge gaps in service is imperative. Future pandemic preparedness programs must include action plans for resilient maternal health services.

Preconception care: developing and implementing regional and national programs

Introduction: During the past few decades, health workers have come to agree that there is a very important place for preconception care (PCC) in improving maternal and infant pregnancy outcomes. The United States Centers for Disease Control and Prevention (CDC) and the World Health Organization issued recommendations encouraging countries to develop and implement preconception care programs. The reports include an in-depth discussion of the rationale and scientific evidence behind PCC as well as definitions, goals, components and recommended interventions to be included in PCC. These reports also offer very broad guidelines but do not offer details on how to develop and implement preconception care programs. Objective: The CDC and WHO reports identify the need for multisectoral engagement in developing and implementing preconception care programs and propose some activities and strategies to be considered in developing PCC programs. However, the recommendations fall short of specifying real steps that countries and regions should take in implementing PCC programs. In this publication we propose action steps for developing and implementing regional or national preconception care programs. Methods: We reviewed the published and unpublished literature (using PubMed and the Internet) to identify reports that describe processes for developing and implementing PCC programs. We used information from the literature along with experiences we gained through our work and interaction with States and developing countries to prepare a detailed description of the steps involved in developing and implementing a PCC program. Results: We found very little in terms of “tools” for program managers and providers to use when developing and implementing PCC programs. We prepared a guide, including a summary of steps and a proposed timeline, for program directors to use for developing and implementing PCC programs. Conclusion: Developing and implementing a sustainable PCC program should address issues related to educating the public, providers and policy makers about the benefits of PCC. It also includes establishing an infrastructure within the departments of health and ensuring resources to build, guide, monitor and evaluate the PCC program. Finally, implementation of a successful program depends heavily on the proper training of public health and clinical care providers in the delivery of the services included in the program.

Developing co-funded multi-sectoral partnerships for chronic disease prevention: a qualitative inquiry into federal governmental public health staff experience

BackgroundMulti-sectoral partnerships (MSPs) are frequently cited as a means by which governments can improve population health while leveraging the resources and expertise of the private and non-profit sectors. As part of their efforts in this area, the Public Health Agency of Canada (the Agency) introduced a novel funding programme requiring applicants to procure matched resources from private sources to support large-scale interventions for chronic disease prevention. The current literature on MSPs is limited in its applicability to this model of multi-sectoral engagement. The purpose of this study was to explore the experiences of Agency staff working with potential partners to develop programme applications, such that we might identify lessons from adopting this type of partnership approach.MethodsSemi-structured interviews were conducted with the 12 staff working in the MSP programme. Interviews were recorded, transcribed and analysed using thematic analysis. Preliminary themes were used to inform follow up focus-groups sessions. A second round of analysis was conducted guided by a coding paradigm focused on understanding process.ResultsWe identified “experiencing uncertainty” to be a central concept in participants’ accounts of the MSP process, related specifically to the MSP programme’s novel conditions, shifts that occurred in sectoral roles and demands for new capacities. In response, Agency staff employed strategies to clarify partner interests, build trust in inter-sectoral relationships, and support internal and partner capacity. Outcomes associated with this process include impacts on trust between the Agency and potential partners, a deeper understanding of other sectors, and programme adaptations and refinements to address challenges related to the programme model.ConclusionsThe co-funding model employed by the Agency is a potentially popular one for government bodies wanting to leverage funding from private sector sources. Our study identifies the potential challenges that can occur under this model. Some challenges are related to addressing material conditions related to partner capacity, whereas other challenges speak to deeper and more difficult to address concerns regarding trust and alignment of motivations and interests between partners. Future research exploring the challenges associated with specific models of MSP engagement is necessary to inform approaches to addressing complex problems through collaborative efforts.

COVID-19 relief food distribution: impact and lessons for Uganda.

The COVID-19 pandemic continues to cause uncertainty to Uganda's food security among underprivileged households. The Corona virus Response Team inaugurated a relief food distribution campaign, ensuing from the countrywide COVID-19 lockdown to counter the rising food insecurities in many urban and rural poor households. However, the relief response campaign has received a lot of critics from both rural and urban communities who were planned as the beneficiaries. Three months into the COVID-19 pandemic the population reports; delays in the distribution, poor quality supplies, arrests and continued restrictions, slow paced distribution among household, and a negative impact on the health care system. As a learning from the current experience, we recommend; a multisectoral engagement, better planning, a decentralized food distribution, and formulation of clear food distribution guidelines to guide the future responses. Use of mobile cash transfers to reach out to the food insecure households can support local economies and lower the cost on middlemen and interrelated corruption.

Leaving no one behind: lessons from implementation of policies for universal HIV treatment to universal health coverage

BackgroundThe third Sustainable Development Goal (SDG − 3) aims to ensure healthy lives and promote well-being for all at all ages. SDG-3 has a specific target on universal health coverage (UHC), which emphasizes the importance of all people and communities having access to quality health services without risking financial hardship. The objective of this study is to review progress towards UHC using antiretroviral treatment (ART) as a case study.MethodsWe used a mixed-methods design including qualitative and quantitative approaches. We reviewed and synthesised the evidence on the evolution of the WHO HIV treatment guidelines between 2002 and 2019. We calculated ART coverage over time by gender, age group, and location. We also estimated ART coverage differences and ratios.FindingsART guidelines have evolved from “treating the sickest” to “treating all”. ART coverage increased globally from under 7% in 2005 to 62% in 2018. There have been successes in increasing ART coverage in all populations and locations. However, progress varies by population and location in many regions. There is inequity in ART coverage: women (68%) versus men (55%), and adults (62%) versus children (54%). This inequity has widened over time, and with expanded ART eligibility criteria. On the other hand, data from at least one high-burden country (Ethiopia) shows that inequity among regions has narrowed over time due to the improvements in the primary health care systems and implementation of the public health approach in the country.ConclusionART coverage has increased at global, regional and national levels to all population groups. However, the gains have not been equitable among locations and populations. Policies towards universality may widen the inequity in resource-limited settings unless countries take precautions and “put the last first”. We argue that primary health care and public health approaches, with multi-sectoral actions and community engagement, are vital to minimize inequity, achieve UHC and leave no one behind.

COVID-19 relief food distribution: impact and lessons for Uganda

The COVID-19 pandemic continues to cause uncertainty to Uganda's food security among underprivileged households. The Corona virus Response Team inaugurated a relief food distribution campaign, ensuing from the countrywide COVID-19 lockdown to counter the rising food insecurities in many urban and rural poor households. However, the relief response campaign has received a lot of critics from both rural and urban communities who were planned as the beneficiaries. Three months into the COVID-19 pandemic the population reports; delays in the distribution, poor quality supplies, arrests and continued restrictions, slow paced distribution among household, and a negative impact on the health care system. As a learning from the current experience, we recommend; a multisectoral engagement, better planning, a decentralized food distribution, and formulation of clear food distribution guidelines to guide the future responses. Use of mobile cash transfers to reach out to the food insecure households can support local economies and lower the cost on middlemen and interrelated corruption.

Reconstruction of agricultural calendar lessons from Western Kenya: crops, cultural events, astronomy and recurrent climate events

The Nganyi Community of Western Kenya is custodians of climatic indigenous knowledge (IK) on which their agricultural calendar has relied for close to 500 years. Reconstructing their agricultural calendar heavily depends on narratives. Constructivists argue that reality is socially-constructed and dynamically interpreted. Reconstruction of agricultural calendar requires analytical review of constructs of the calendar. Meteorological department archives digital data banks of climatic variability, but IK is critical and unique in reconstruction of pre-colonial agricultural calendar. Meteorological archival data and IK narratives come in handy. Discussions here-in refer to findings from participatory climate resilience projects conducted through multidisciplinary and multi-sectoral engagement of modern and traditional scientists for supporting documented social learning for climate change adaptation. Nganyi are Bantus whose genealogy is claimed to root from Sudan/Egypt/Congo; linked to Banyoro. In Kenya they are part of Banyore sub-clan of Luyia. They crossed to Kenya in search of arable land through Uganda settled on hilly grounds of Lake Kavirondo (Lake Victoria). Early settlements and food patterns are associated with hunting, gathering and limited agriculture supported on crude tools, indigenous plants with edible leaves, roots and fruits. They demonstrated IK application in managing agricultural calendar sustainably. Because the Nganyi share ecological zone with Luo, they also share how they have evolved their agriculture through application of IK. Like all communities in the world, they are prone to negative global climatic impacts of climate change on agricultural calender, and require adaptation to diversified agriculture for building resilience. Transdisciplinary empirical cases of pilot projects from Kenya, Zimbabwe and Tanzania validated IK’s role in tracking information through relating agricultural practices on agro-ecological zones. The conclusion is that IK and oral literature are plausible and critical sources of information for reconstructing pre-colonial agriculture and understanding of relationships of tribes and their settlements in contemporary times. Further research should integrate IK with modern meteorology for sustainable agriculture.

Mitigating air pollution: planetary health awaits a cosmopolitan moment

Mitigating air pollution: planetary health awaits a cosmopolitan moment

Innovative approaches to implement MPOWER policies in low-resource settings: A significant reduction in tobacco use (21.2%–16.1%) since Global Adult Tobacco Survey-1 in Himachal Pradesh, India

MPOWER is the evidence-based toolkit for effective tobacco control under the WHO-framework convention on tobacco control (FCTC). Indian Tobacco Control Law (COTPA, 2003) and National Tobacco Control Program (NTCP, 2006) are not fully compliant to FCTC. Himachal Pradesh a northern hilly state in India with a population of about 7 million was not included under NTCP till 2014 whereas as per the Global Adult Tobacco Survey (GATS) 2009–2010 the prevalence of smoking among males (33.4%) was much higher than the national average (24.3%) with high exposure of passive smoking (82.5%) at homes. Implementing MPOWER without technical and financial support was a huge challenge. The multisectoral engagement especially the partnership between the local NGO (HPVHA) and the State Health Department under the guidance of the International Union against TB and Lung Diseases New Delhi helped in bridging the policy gaps through advocacy and capacity building. Building partnerships, sharing the responsibilities, and empowering the key stakeholders to utilize the funds collected as fine for tobacco control helped in policy implementation effectively. MPOWER implementation has achieved substantial progress in all six demand and supply reduction strategies of tobacco in the state of Himachal Pradesh. GATS, 2016–2017 shows a significant decline (21.2%–16.1%) in tobacco use and passive smoking at homes (82.5%–32.9%) in the state. Innovative approaches of implementing MPOWER policies are the way forward for effective tobacco control in low resource settings.

Caribbean Wellness Day: promoting a region-wide day of action.

ABSTRACTIn response to the epidemic of non-communicable diseases (NCDs) in the Caribbean, the Heads of Government of the Caribbean Community (CARICOM) issued the 2007 Port-of-Spain Declaration, “Uniting to Stop the Epidemic of Chronic Non-communicable Diseases” and declared the second Saturday in September to be “Caribbean Wellness Day” (CWD). CWD is a call-to-action for engaging the population of the Member States in confronting NCDs and their risk factors.This report reviews the genesis, implementation, and institutionalization of CWD in CARICOM and beyond. The study used quantitative and qualitative methods, including 29 surveys, 7 in-depth interviews, and analysis of media content. Data was provided by NCD focal points at the Ministry of Health in 15 CARICOM countries, as well as by 7 non-governmental and 4 private organizations.Branding materials were well received and locally adapted; much of CWD media content originated from organization websites and were not community-based. Events typically focused on physical activity and health screenings and were attended by up to 3 000 participants. Though most were held in city centers, some CWD activities have involved rural and indigenous populations.CWD has become a catalyst for multisectoral engagement and health promotion activities. Inspired by CWD, PAHO initiated “Wellness Week in the Americas,” which includes CWD and promotes its tenets across the Region of the Americas. As CWD further develops, consideration should be given to reliable, adequate, and sustainable financing; to measuring and evaluating its impact on NCDs; and to widening its reach to include those outside of city centers.

Improving Access to Care Through Community Engagement: Zambian Case

Background and context: Zambia has total population of 16,405,229, life expectancy at birth is 53.3% and HIV prevalence rate is 13.3%. Though established in November 1977, the Zambia National Cancer Registry was only enhanced in 2015 leading to the publication of the 2008-2012 report. The overall age-standardized cancer incidence rate for both sexes in 2012 was 136.2 per 100,000 for all cancers, mortality rate was 104.9 per 100,000 71% these being new cancer cases due to patients presenting late with advanced disease. Aim: Increasing awareness and access to cancer care services within the existing health care and community-based systems in addressing the barriers to accessing care. Strategy/Tactics: Designed village-based screening program to provide services to the women in rural and hard to reach areas. Formulate a multisectoral approach engagement of the Ministry of Chiefs and Traditional Affairs (MOCTA) and Ministry of Local Government and Ministry of Education Formulated a VBS national roadmap based on: National Cancer Register Report (2012) and national geographical mapping of breast and cervical cancer clinics. Program/Policy process: Developed and signed a memorandum of understanding with Ministry of Chiefs and Traditional Affairs (MOCTA). Outcomes: Community engagement enabled easy flow of communication to all key stakeholders on the upcoming VBS activities within their area at all levels. Enabled easy acceptance of health education meetings by all key stakeholders to seek leadership buying and support, share VBS objectives and strategic planning of a successful community-based screening program in their area. Community awareness process: training/orientation: community health care workers (CHW) are trained on key messages on breast and cervical cancer and community-based referrals to health centers. Community sensitization: conducted by trained CHW and program staff through: PA announcing, one-to-one and focused group discussions. Developed referral systems: community based: trained community health care workers sensitize clients, clients who accepts to undergo screening are referred to the nearest screening clinic. Clinic based: trained health care workers screen clients those with positive findings are referred. Breast cancer screening: referred to the provincial hospital. Cervical cancer screening: eligible treated. Not eligible referred for further investigation (LEEP/biopsy) to the provincial hospital. What was learned: Engagement of key community stakeholders, multisectoral approach, strategic scale up of breast and cervical cancer services (HR, diagnostic equipment, pathology), standardized referrals systems at all levels (community, district and provincial), strategic continuous health promotion activities and advocacy, implementation of National Cancer Control Strategic Plan, monitoring and evaluation.

Analysis of tobacco control policies in Nigeria: historical development and application of multi-sectoral action

BackgroundTobacco use is a major risk factor for non-communicable diseases and policy formulation on tobacco is expected to engrain international guidelines. This paper describes the historical development of tobacco control policies in Nigeria, the use of multi-sectoral action in their formulation and extent to which they align with the World Health Organisation “best buy” interventions.MethodsWe adopted a descriptive case study methodology guided by the Walt and Gilson Policy Analysis Framework. Data collection comprised of document review (N = 18) identified through search of government websites and electronic databases with no date restriction and key informant interviews (N = 44) with stakeholders in public and private sectors. Data was integrated and analyzed using content analysis. Ethical approval was granted by the University of Ibadan and University College Hospital Ethics Review Committee.ResultsAlthough the agenda for development of a national tobacco control policy dates back to the 1950s, a comprehensive Framework Convention for Tobacco Control (FCTC) compliant policy was only developed in 2015, 10 years after Nigeria signed the FCTC. Lack of funding and conflict of interest (of protecting citizens from harmful effect of tobacco viz. a viz. the economic gains from the industry) are the major barriers that slowed the policy process. Current tobacco –related policies developed by the Federal Ministry of Health were formulated through strong multi-sectoral engagement and covering all the four WHO “best buy” interventions. Other policies had limited multi-sectoral engagement and “best buy” strategies. The tobacco industry was involved in the development of the Standards for Tobacco Control of 2014 contrary to the long-standing WHO guideline against engagement of the industry in policy formulation.ConclusionsNigeria has a comprehensive national policy for tobacco control which was formulated a decade after ratification of the FCTC due to constraints of funding and conflict of interest. Not all the tobacco control policies in Nigeria engrain the principles of multisectorality and best buy strategies in their formulation. There is an urgent need to address these neglected areas that may hamper tobacco control efforts in Nigeria.

Multisectoral prioritization of zoonotic diseases in Uganda, 2017: A One Health perspective.

BackgroundZoonotic diseases continue to be a public health burden globally. Uganda is especially vulnerable due to its location, biodiversity, and population. Given these concerns, the Ugandan government in collaboration with the Global Health Security Agenda conducted a One Health Zoonotic Disease Prioritization Workshop to identify zoonotic diseases of greatest national concern to the Ugandan government.Materials and methodsThe One Health Zoonotic Disease Prioritization tool, a semi-quantitative tool developed by the U.S. Centers for Disease Control and Prevention, was used for the prioritization of zoonoses. Workshop participants included voting members and observers representing multiple government and non-governmental sectors. During the workshop, criteria for prioritization were selected, and questions and weights relevant to each criterion were determined. We used a decision tree to provide a ranked list of zoonoses. Participants then established next steps for multisectoral engagement for the prioritized zoonoses. A sensitivity analysis demonstrated how criteria weights impacted disease prioritization.ResultsForty-eight zoonoses were considered during the workshop. Criteria selected to prioritize zoonotic diseases were (1) severity of disease in humans in Uganda, (2) availability of effective control strategies, (3) potential to cause an epidemic or pandemic in humans or animals, (4) social and economic impacts, and (5) bioterrorism potential. Seven zoonotic diseases were identified as priorities for Uganda: anthrax, zoonotic influenza viruses, viral hemorrhagic fevers, brucellosis, African trypanosomiasis, plague, and rabies. Sensitivity analysis did not indicate significant changes in zoonotic disease prioritization based on criteria weights.DiscussionOne Health approaches and multisectoral collaborations are crucial to the surveillance, prevention, and control strategies for zoonotic diseases. Uganda used such an approach to identify zoonoses of national concern. Identifying these priority diseases enables Uganda’s National One Health Platform and Zoonotic Disease Coordination Office to address these zoonoses in the future with a targeted allocation of resources.

Exploring the dynamics of food-related policymaking processes and evidence use in Fiji using systems thinking

BackgroundObesity and non-communicable diseases are significant public health issues globally and particularly in the Pacific. Poor diet is a major contributor to this issue and policy change is a powerful lever to improve food security and diet quality. This study aims to apply systems thinking to identify the causes and consequences of poor evidence use in food-related policymaking in selected government ministries in Fiji and to illicit strategies to strengthen the use of evidence in policymaking.MethodsThe Ministry of Health and Medical Services and the Ministry of Agriculture in Fiji were invited through their respective Permanent Secretaries to participate in the study. Three 180-minute group model building (GMB) workshops were conducted separately in each ministry over three consecutive days with selected policymakers who were instrumental in developing food-related policies designed to prevent non-communicable diseases. The GMB workshops mapped the process of food-related policymaking and the contribution of scientific and local evidence to the process, and identified actions to enhance the use of evidence in policymaking.ResultsAn average of 10 policymakers participated from each ministry. The causal loop diagrams produced by each ministry illustrated the causes and consequences of insufficient evidence use in developing food policies or precursors of the specific actions. These included (1) consultation, (2) engagement with stakeholders, (3) access and use of evidence, and (4) delays in policy processes. Participants agreed to potential leverage points on the themes above, addressing pertinent policymaker challenges in precursor control, including political influence, understanding of trade policies, competing government priorities and level of awareness on the problem. Specific actions for strengthening evidence use included training in policy development and research skills, and strengthening of coordination between ministries.ConclusionsThe GMB workshops improved participants’ understanding of how different parts of the policy system interact. The causal loop diagrams and subsequent action plans enabled the identification of systems-level interventions in both ministries to improve evidence-informed policy development. A guide for integrating multi-sectoral consultation and stakeholder engagement in developing cross-cutting policies is currently being developed.

A process for developing multisectoral strategies for zoonoses: the case of leptospirosis in Fiji

BackgroundZoonotic diseases such as leptospirosis occur as a result of the often complex interactions that exist at the human-animal-environment interface. The most obvious consequence of this complexity is the need for the health sector to partner with institutions in other sectors of society such as agriculture, labour and local government. This multisectoral engagement is complicated by the different agendas and cultures of the various institutions and their ability to “see” their role and ant benefits in a collaborative response.MethodsThe research used a realist review methodology combined with systems thinking frameworks to determine the optimal strategy and governance for the prevention and control of leptospirosis in Fiji. The process included facilitated workshops with multiple stakeholders to determine the needs, issues and potential interventions that was guided by a synthesis of locally available data and information on the impact of leptospirosis. This process was informed by interviews with bureaucrats from different government ministries.ResultsStakeholders concurred that leptospirosis generally only received wide-spread attention in outbreaks, when there is media coverage of deaths or a large number of hospitalisations. In general, all ministries expressed support for a multisectoral strategy but saw the Ministry of Health and Medical Services as the lead agency with overall responsibility. The final consultation workshop yielded a clearly articulated goal to reduce the case fatality rate attributable to leptospirosis by 50% by 2020 and 4 overarching strategies: 1) improved clinical management of leptospirosis, 2) improved surveillance for leptospirosis, 3) enhanced communication to minimise risk and improve health seeking behaviours, and 4) strengthening coordination and governance structures.ConclusionHuman mortality and morbidity remained the primary drive for government action, defining leptospirosis as a human health problem. The process of deliberative consultation, and the engagement of multidisciplinary partners has provided a platform for collaborative policy development, and a consensus for a National Action Plan from which further negotiated collaboration will be possible.

Spanning maternal, newborn and child health (MNCH) and health systems research boundaries: conducive and limiting health systems factors to improving MNCH outcomes in West Africa

BackgroundDespite improvements over time, West Africa lags behind global as well as sub-Saharan averages in its maternal, newborn and child health (MNCH) outcomes. This is despite the availability of an increasing body of knowledge on interventions that improve such outcomes. Beyond our knowledge of what interventions work, insights are needed on others factors that facilitate or inhibit MNCH outcome improvement. This study aimed to explore health system factors conducive or limiting to MNCH policy and programme implementation and outcomes in West Africa, and how and why they work in context.MethodsWe conducted a mixed methods multi-country case study focusing predominantly, but not exclusively, on the six West African countries (Burkina Faso, Benin, Mali, Senegal, Nigeria and Ghana) of the Innovating for Maternal and Child Health in Africa initiative. Data collection involved non-exhaustive review of grey and published literature, and 48 key informant interviews. We validated our findings and conclusions at two separate multi-stakeholder meetings organised by the West African Health Organization. To guide our data collection and analysis, we developed a unique theoretical framework of the link between health systems and MNCH, in which we conceptualised health systems as the foundations, pillars and roofing of a shelter for MNCH, and context as the ground on which the foundation is laid.ResultsA multitude of MNCH policies and interventions were being piloted, researched or implemented at scale in the sub-region, most of which faced multiple interacting conducive and limiting health system factors to effective implementation, as well as contextual challenges. Context acted through its effect on health system factors as well as on the social determinants of health.ConclusionsTo accelerate and sustain improvements in MNCH outcomes in West Africa, an integrated approach to research and practice of simultaneously addressing health systems and contextual factors alongside MNCH service delivery interventions is needed. This requires multi-level, multi-sectoral and multi-stakeholder engagement approaches that span current geographical, language, research and practice community boundaries in West Africa, and effectively link the efforts of actors interested in health systems strengthening with those of actors interested in MNCH outcome improvement.

Cancer prevention as part of precision medicine: 'plenty to be done'.

Cancer burden worldwide is projected to rise from 14 million new cases in 2012 to 24 million in 2035. Although the greatest increases will be in developing countries, where cancer services are already hard pressed, even the richest nations will struggle to meet demands of increasing patient numbers and spiralling treatment costs. No country can treat its way out of the cancer problem. Consequently, cancer control must combine improvements in treatment with greater emphasis on prevention and early detection. Cancer prevention is founded on describing the burden of cancer, identifying the causes and evaluating and implementing preventive interventions. Around 40-50% of cancers could be prevented if current knowledge about risk factors was translated into effective public health strategies. The benefits of prevention are attested to by major successes, for example, in tobacco control, vaccination against oncogenic viruses, reduced exposure to environmental and occupational carcinogens, and screening. Progress is still needed in areas such as weight control and physical activity. Fresh impetus for prevention and early detection will come through interdisciplinary approaches, encompassing knowledge and tools from advances in cancer biology. Examples include mutation profiles giving clues about aetiology and biomarkers for early detection, to stratify individuals for screening or for prognosis. However, cancer prevention requires a broad perspective stretching from the submicroscopic to the macropolitical, recognizing the importance of molecular profiling and multisectoral engagement across urban planning, transport, environment, agriculture, economics, etc., and applying interventions that may just as easily rely on a legislative measure as on a molecule.

Outcomes of Interorganizational Networks in Canada for Chronic Disease Prevention: Insights From a Concept Mapping Study, 2015.

IntroductionWe conducted a mixed methods study from June 2014 to March 2015 to assess the perspectives of stakeholders in networks that adopt a population approach for chronic disease prevention (CDP). The purpose of the study was to identify important and feasible outcome measures for monitoring network performance.MethodsParticipants from CDP networks in Canada completed an online concept mapping exercise, which was followed by interviews with network stakeholders to further understand the findings.ResultsNine concepts were considered important outcomes of CDP networks: enhanced learning, improved use of resources, enhanced or increased relationships, improved collaborative action, network cohesion, improved system outcomes, improved population health outcomes, improved practice and policy planning, and improved intersectoral engagement. Three themes emerged from participant interviews related to measurement of the identified concepts: the methodological difficulties in measuring network outcomes, the dynamic nature of network evolution and function and implications for outcome assessment, and the challenge of measuring multisectoral engagement in CDP networks.ConclusionResults from this study provide initial insights into concepts that can be used to describe the outcomes of networks for CDP and may offer foundations for strengthening network outcome-monitoring strategies and methodologies.

Creating a collective impact on childhood obesity: Lessons from the SCOPE initiative.

We describe the processes used in SCOPE, a community-based participatory research (CBPR) initiative, to achieve multisectoral engagement and collective action to prevent childhood obesity. SCOPE engages representatives from various sectors (local government, health, schools, recreation, local media, early childhood, community services) who influence the environments in which children live, learn and play. SCOPE has been implemented in three communities in British Columbia (BC). SCOPE (www.live5210.ca) is a multi-setting, multi-component initiative designed to enhance a community's capacity to create and deliver localized solutions to promote healthy weights among children. SCOPE, in partnership with a local organization, engages multiple stakeholders who plan and implement actions framed by a common evidence-based health message ('Live 5-2-1-0'). SCOPE's central team in Vancouver, BC facilitates alignment with provincial initiatives, knowledge translation and exchange (KTE) within and across communities, and the collection, analysis and reporting of shared data. Best practice processes that have emerged from SCOPE's experience align with the principles of CBPR and the five conditions of Collective Impact - a common agenda, mutually reinforcing action, continuous communication, a backbone organization and shared measurement. SCOPE has achieved sustainable practice change framed by a common agenda ('Live 5-2-1-0') leading to mutually reinforcing cross-sectoral action. A multi-pronged community-led childhood obesity prevention initiative can be achieved using CBPR principles and attending to the conditions for achieving collective impact.