Multisector collaboration for health is hard to evaluate but is it worth it?
Multisector collaborations for health are hard to evaluate. Corinne Armstrong was part of a team that looked at 12 multisector collaborations for health around the world. She explores what we can learn.
Covid-19 has affected everything from the food supply to classrooms to law enforcement. We’re much more acutely aware of the relationship between public health and society, the social determinants of health and the roles many sectors play in supporting a healthier population.
But working across different sectors brings challenges, not least because when another sector collaborates with the health sector, there are typically multiple if not competing priorities, different expectations, varied ways of working, and divergent motivations. When two or more sectors come together for multisector collaboration (MSC) there’s a whole new world of politics, power and purpose to navigate. Which makes it pretty challenging to evaluate MSC and learn about success.
I was part of a team at the World Health Organization that tried to capture lessons learned from MSC for health and understand the pathways to success. Those successes were almost always measured in terms of tentative health or health services delivery outcomes. Our challenge was to uncover important lessons of missed opportunities and slower progress, not least because these collaborations were often new or fragile. They had operated thus far within good faith agreements, with many people reluctant to shine a spotlight on where the collaboration hadn’t done as well as hoped.
That isn’t unusual. MSC are often happening between sectors, ministeries, departments and geographic areas that had previously been operating in silos. But the act of carrying out research and bringing multisector stakeholders together to reflect and learn from the collaboration, can be a powerful mechanism in and of itself for fostering stronger relationships, and better more effective collaboration.
The act of bringing multisector stakeholders together to reflect and learn from the collaboration was a powerful mechanism in and of itself for fostering stronger relationships.
Our research team drew out four considerations for researchers and evaluators to better explore and understand MSC.
1) Use theoretical frameworks to frame research questions as relevant to all sectors
Evaluating collaboration between multiple sectors requires a research framework that can accommodate the different ways that stakeholders may define and measure success. It helps to have a structure that is designed explicitly for MSC, where different sectors involved in the collaboration may have varying purposes, motivations, data, norms, and appetite for leadership.
For example a case study from South Africa studied the “She Conquers” multisectoral campaign which aimed to reduce the burden of HIV among women aged 15–24 years. For the MSC, this problem was defined not as a biomedical issue of disease transmission or of reducing viral loads, but in terms of girls’ and young women’s agency and empowerment. This broader framing was important so different sectors could see the relevance of the problem to their work, and encouraged their engagement and collaboration.
2) Specifically incorporate sectoral analysis into MSC research methods
Explicitly investigate the trade-offs and benefits for different sectors, the governance arrangements and the brokering relationships that build trust and deliver successful collaboration. Be deliberate about exploring how the MSC interacts to deliver more effectiveness, greater efficiency, or other impact.
3) Develop a core set of research questions, using mixed methods and contextual adaptations as needed
MSC is still quite rare, which means you’re unlikely to find comparable examples in existing research literature. Developing a bespoke set of research questions will help to identify and define the purpose, features and successes of the collaboration. A mix of qualitative and quantitative approaches will help to incorporate the different sector data, which are unlikely to be harmonised.
4) Identify shared indicators of success and failure across sectors to assess MSCs
Ideally MSC stakeholders should co-produce the success indicators, especially given that there will be different perceptions of what constitutes progress, beyond outcomes or impact related to a single sector or discipline. Qualitative and process outcomes around the success of the collaborative relationships will be just as important as health outcomes data, if the collaboration itself is expected to lead to better health outcomes in the future.
These four considerations are grounded in the practical experience of conducting evaluative case studies across 12 different countries. Despite the efforts and intention for a systematic and rigorous approach across the case studies, it was clear to the research team just how wildly different each example of MSC collaboration was.
It felt like a huge endeavour to try to synthesize commonalities across the portfolio and deliver lessons learned for better mutisector collaboration. But collaboration across different groups and sectors has been a vital part of the Covid-19 response and recovery periods. Social challenges require a multisector response. And a multisector response requires collaboration, often between institutions and government departments that rarely had any previous contact let alone coordination or collaboration. Our social systems are not usually set up to facilitate a whole-system approach to solving problems.
We’ve been working with the NHSEI Beneficial Changes Network over the past six months to understand the positive effects of collaboration across the health and care, voluntary, community and public sectors. Whether we move into a ‘post-Covid’ period soon or not, there will be many more lessons to learn about how to move from cooperation to collaboration and shared purpose, and how these positive collaborations can be sustained into the future.