Crossing Sectors - Experiences in Intersectoral Action, Public Policy and Health
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4. Intersectoral Action: Navigating Barriers and Enablers
Drivers of intersectoral action
The need to act is a core driver for IA efforts. Additional
drivers for intersectoral action have included:
- lobbying and political pressure from the public, opposition
parties, non-government organisations, the media, or coalitions of
interested groups to address a significant policy challenge;
- favourable economic conditions supporting intersectoral action
to address complex policy challenges. Since IA often costs more in
the short-term than simpler, “quick-fix” responses,
strong economies may offer the resources for sustained investment
in intersectoral work. In periods of fiscal constraint, innovative
approaches to cross-sectoral actions may be undertaken as a means
of addressing overlapping and intersecting organisational
mandates;
- the existence of a “feedback” loop between citizens
and government, to drive, define and respond to the issues. Timely
information-sharing between citizens and government is
required;
- strong central agencies that oversee and guide approaches to
ensure that organisational mandates, authorities and reporting are
respected. While central agencies do not necessarily lead these
approaches, they often play a strong support role in ensuring
adequate resources for initiatives; guiding policies through formal
decision-making avenues; and, designing and monitoring compliance
with accountability frameworks; and
- negative data from reports of commissions and/or task forces,
studies, statistics, poll results. Bad news sometimes attracts more
public and political attention than success stories. Comparing
nations’ health status and conditions for health can spark
interest in intersectoral efforts to address shared problems and
promote equitable conditions for health and social
development.
The documented experiences clearly demonstrate that context and
culture are critical to the success of intersectoral initiatives.
Conditions or approaches that obtain results in one sector, or one
environment, may not necessarily prevail in another. The literature
suggests that while there is no universally “correct”
way to proceed with IA efforts, adhering to certain principles
promotes IA success.
Presentation materials related to health promotion in schools
(Rowling & Jeffreys 2005) illustrate this point. Challenges in
achieving collaboration between the health and education sectors
included: “vertical funding; professional diversity of
paradigms and views; competing priorities and decision-making
processes; and complex processes of engagement.” While health
research relied on the assumption that health promotion strategies
have the potential to work equally well in all schools, educational
research captured the critical point that schools have vastly
different cultures [e.g. compare rural with inner-city
schools]—cultures which depend on a variety of shifting
factors. Effective collaboration between the sectors could only be
achieved if the partners are able to see “mutually beneficial
outcomes, feasible implementation strategies and compatible
monitoring and evaluation methods.”
In conflict-driven and politically fragile states, intersectoral
actions have proved vital in restoring security and promoting
health equity. The breakdown of government has, in some
circumstances, yielded an opportunity to establish IA as an
accepted way of working— an outcome that is not always
possible in more established environments (WHO: Health Systems
Knowledge Network 2006).
The literature demonstrates that good intentions do not always
translate into successful intersectoral initiatives.
Australia’s National Youth Suicide Prevention Strategy fell
short of stated objectives due to a host of unintended factors:
lack of consultation with states and territories; insufficient
networking; inexperienced project staff; and, inadequate government
planning processes. Australia’s experiences with the Strategy
teach a valuable lesson on the importance of advance planning to
avoid pitfalls and mitigate risks.
Conditions for effective
intersectoral action |
- The parties have identified a need to
work together in order to achieve their goals. This requires
clarity on individual organisational goals, as well as joint
goals.
- In the broader operating environment, there are opportunities that promote intersectoral
collaboration, e.g., the community understands and is
supportive.
- Organisations have the capacity—the required resources,
skills, and knowledge—to take action.
- The parties have developed a relationship on which to base
cooperative, planned action. The relationship is clearly defined
and is based on trust and respect.
- The planned action is well-conceived
and can be implemented and evaluated. The action is clear and there
is agreement to undertake it. Roles and responsibilities are
clear.
- There are plans to monitor and sustain outcomes.
(Adapted from: Harris et al. 1995) |
Conditions for success
Many sources provide advice on conditions for IA success at
local, national, and regional levels, and across jurisdictions
(F/P/T Advisory Committee on HIV/AIDS 1999; WHO 1997; Swedish
International Development Co-operation Agency, 1999, Rychetnik
& Wise 2004, Canadian Public Health Association 1997).
“Working together: intersectoral action for health”
(Harris et al. 1995) provides a comprehensive list of
these enabling factors, or conditions of success.
Other readings and checklists offer additional variations and
considerations (Rachlis 1999; FPT 1999; Bauld 2005 and Goumans
1997). Many lists of “enablers” include some of the
elements listed below:
- Create a philosophical framework and approach to
health that is conducive to IA. For example,
favouring health determinants over a disease-driven approach
automatically builds connections with other sectors and allows them
to see a role for themselves in addressing the problem.
- Emphasize shared values, interests, and objectives
among partners and potential partners. Many writers
have emphasized the importance of seeking trust and shared values:
individuals engaged in IA must be like-minded. Personal values, for
individuals, are more significant indicators than association with
organisational values. Societal values that align with the
objectives of IA can also be influential.
- Ensure political support; build on positive factors
in the policy environment. Often, politicians lead or
champion progressive IA initiatives, both within and beyond the
health sector. Strong connections with political leaders,
administrators and the media are key to securing their
support.
A clear mandate and a supportive policy environment are equally
desirable in fostering a sense of solidarity, facilitating
collective action, acknowledging the requirement for long-term
investment in IA, and boosting a favourable economic climate.
Alternatively, the intersectoral initiatives themselves may
identify the creation of a more supportive policy environment for
the future as a specific goal. A proactive stance is encouraged.
This means, for example, assisting senior decision-makers and
policy-makers in all sectors to understand the benefits of IA, and
encouraging them to foster intersectoral action in research, policy
and practice.
- Engage key partners at the very beginning: be
inclusive. Strong, dedicated partners are critical to
the success of intersectoral action. Involving the right people and
institutions, and reaching beyond government to involve civil
society and the voluntary sector, are vital steps.
- Ensure appropriate horizontal linking across
sectors, as well as vertical linking of levels within
sectors. When links are drawn across sectors and
between levels of government, the resulting “fabric” is
stronger. However, it is essential to recognize the potential for
failure due to inadequate communication or consultation, lack of
policy coherence, lack of clarity on respective roles, and/or lack
of sensitivity to power imbalances.
- Invest in the alliance-building process by working
toward consensus at the planning stage. Ensuring that
the action is well-planned, or that there is a good relationship
between the parties, does not guarantee success. Efforts can be
strengthened by engaging all players at the outset, confronting
differences, and inviting collaboration in the planning
process.
- Focus on concrete objectives and visible
results. The act of establishing health goals, on its
own, has done little to promote intersectoral action. Some Canadian
provinces have chosen to set overarching, whole-of-government
goals, but it is too early to determine whether this approach has
been effective. It is also difficult to monitor achievement toward
such goals.
While short-term gains may be highly motivating, they can also be
counter- productive, as in the case of the United Kingdom’s
Health Action Zones.
- Ensure leadership, accountability and rewards are
shared among partners. Increasingly, people and
organisations in the health sector play different roles in IA.
Partners must learn to be effective, whether they are acting as
catalysts, leaders, partners or supporters. All partners in
intersectoral work must be able to perceive that the process is
mutually beneficial and that responsibilities and rewards are
distributed appropriately.
- Build stable teams of people who work well
together, with appropriate support systems. Goumans
(1997) draws a distinction between “core group” and
“peripheral group” participants. Core group
participants are committed ideologically to the concept of IA,
while peripheral group participants are involved because the
activity relates to their particular interests. This observation
highlights the important role that individual participants play in
effective intersectoral action. Adequate capacity and resources,
shared goals, mutual respect, and trust make it easier for
individuals to make long-term commitments to working across
sectors.
- Develop practical models, tools and mechanisms to
support the implementation of intersectoral action. A
lack of appro-priate support mechanisms can serve as a barrier to
intersectoral action. Collaborative planning models, evaluation
frameworks that assess multiple indicators, shared accountability
models and innovative governance structures are examples of
tangible support.
- Ensure public participation; educate the public and
raise awareness about health determinants and intersectoral
action. The existence of a clear channel of
communication between citizens and government is needed – to
give and receive feedback; to properly evaluate the success of
intersectoral action; and to take corrective measures, as
necessary.
Whole-of-government approaches create additional imperatives for
successful intersectoral action. Once there has been a decision
that it is necessary to work together, care must be taken in
determining how to do so. Suggested actions to create conditions
for success include (National Audit Office 2001, Exworthy, Berney
& Powell 2002, Bauld 2005):
- reinforcing the policy direction with a statutory duty to
collaborate, where appropriate;
- ensuring that partner organisations align their vision and
policy objectives, and that central agencies (while providing
appropriate guidance) avoid undue interference in
partnerships;
- providing incentives for joint working (e.g., financial incentives, flexible decision-making, or appropriate
performance assessment). Reducing the variety of funding streams,
using pooled budgets, and reducing administrative and reporting
burdens are also effective incentives;
- setting realistic time frames to achieve results; and
- ensuring that there are clear lines of redress for citizens, as
well as a clear accountability framework.
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