Governing multisectoral action for health in low-income and middle-income countries: unpacking the problem and rising to the challenge
Governing multisectoral action for health in low-income and middle-income countries: unpacking the problem and rising to the challenge
复制标题
DOI：
10.1136/bmjgh-2018-000880
复制
发表时间：
2018-10-01
影响因子：
8.1
通讯作者：
Rasanathan, Kumanan
中科院分区：
文献类型：
--
作者：
Bennett, Sara;Glandon, Douglas;Rasanathan, Kumanan
多部门行动是应对许多紧迫的全球卫生挑战的关键，对实现可持续发展目标至关重要，但迄今为止，对如何最好地促进和支持多部门卫生行动的理解相对有限。在低收入和中等收入国家，多部门行动面临的挑战可能更为严峻，因为这些国家的机构往往薄弱，即使在卫生部门内部，也存在各自为政的现象，这可能会破坏协调。我们运用治理的透镜来理解多部门行动面临的挑战。本文件（1）提供了一个高层次的概述，可能的学科，框架和理论，可用于丰富在这一领域的分析;（2）总结了文献，试图描述治理的多部门行动，在中低收入国家使用一个简单的政治经济学框架，确定利益，机构和想法和（3）介绍了文件的补充。我们的审查突出了影响多部门行动成功的因素的多样性，但往往是政治性的。关键因素包括高级别政治承诺的重要性;鼓励竞争还是鼓励官僚机构之间的合作，以及各行为者对问题的共同理解程度。补编文件力求促进对多部门行动管理的研究和实践方法的辩论和理解，并通过案例研究说明突出问题。这里的文件无法涵盖这一主题的所有方面，但在最后两份文件中，我们力求为今后的行动制定一个议程。本文介绍了一份关于多部门卫生行动治理的补充文件。虽然许多案例研究存在于这一领域，我们确定需要更大的理论为基础的概念化的多部门的行动和更复杂的实证调查，这种合作。
Multisectoral action is key to addressing many pressing global health challenges and critical for achieving the Sustainable Development Goals, but to-date, understanding about how best to promote and support multisectoral action for health is relatively limited. The challenges to multisectoral action may be more acute in low-income and middle-income countries (LMICs) where institutions are frequently weak, and fragmentation, even within the health sector, can undermine coordination. We apply the lens of governance to understand challenges to multisectoral action. This paper (1) provides a high level overview of possible disciplines, frameworks and theories that could be applied to enrich analyses in this field; (2) summarises the literature that has sought to describe governance of multisectoral action for health in LMICs using a simple political economy framework that identifies interests, institutions and ideas and (3) introduces the papers in the supplement. Our review highlights the diverse, but often political nature of factors influencing the success of multisectoral action. Key factors include the importance of high level political commitment; the incentives for competition versus collaboration between bureaucratic agencies and the extent to which there is common understanding across actors about the problem. The supplement papers seek to promote debate and understanding about research and practice approaches to the governance of multisectoral action and illustrate salient issues through case studies. The papers here are unable to cover all aspects of this topic, but in the final two papers, we seek to develop an agenda for future action. This paper introduces a supplement on the governance of multisectoral action for health. While many case studies exist in this domain, we identify a need for greater theory-based conceptualisation of multisectoral action and more sophisticated empirical investigation of such collaborations.