Unity is Strength: Improving Health is a Multisectoral Endeavor

By Jay Gribble, Nicole Judice, and Suneeta Sharma

Photo: Tom Perry/World Bank

The social issues we address through development programs — such as ending poverty, improving quality of life, and strengthening democratic institutions — are complex, multicausal, and multifaceted. When we step back and look at the diverse needs of individuals — as the beneficiaries of development programs — we better see all the inputs necessary to help them achieve their potential, driving us to view development programming through a different lens.

A Swahili proverb — “Unity is strength, division is weakness” — sets a tone for the collaboration and multisectoral approaches needed to achieve quality, sustainable health programs and outcomes. We take this opportunity to launch a new blog series — A Multisectoral Endeavor Called Health: Working Across Sectors for Quality and Sustainability — to examine the benefits of multisectoral actions in responding to the complex environment in which we live and explore the interrelationships between health and other sectors.

Why Focus on Multisectoral Actions. Multisectoral actions break down silos, recognizing that working together ultimately leads to more sustainable, comprehensive results. Through multisectoral programs, partners can leverage expertise, perspectives, reach, and resources, bringing combined benefits and diverse strengths as they work toward the shared goal. The most pressing challenges in health cannot be solved without addressing underlying social and economic determinants, many of which lie beyond the health sector. Multisectoral approaches not only help to address health challenges that extend beyond sectoral boundaries, but they also promote good governance for health by building accountability across sectors that impact health. As a result, multisectoral policies and programs forge broader participation in the policy process, which leads to greater agreement across and between sectoral policies. Multisectoral actions upset “business as usual” arrangements, replacing them with intentional, innovative actions framed to allow multiple sectors to contribute and benefit. Because they are deliberately designed, they can focus on achieving key health and development objectives:

· Achieving Universal Health Coverage. Reaching country health and development goals requires interventions beyond the health sector. Collaboration between the health, finance, and planning ministries is essential to substantially increase funding allocations and improve budget execution. Economic growth, budget reprioritization, and efficient use of available resources are the main drivers for creating fiscal space for health spending. To achieve universal health coverage, health, finance, and planning sectors must be on the same page and share common policy objectives. Additional sectors also need to come into play. For example, gender and education play a role in whether women and girls have social permission to make decisions about using health services — whether for their own needs or those of their children. Achieving universal health coverage is a complex challenge requiring multisectoral actions to ensure joint commitment, resources, and empowerment.

· Reducing Malnutrition. Links between agriculture, nutrition, and health are apparent when we think about the supply and demand for food. Agriculture focuses on livelihoods and raising crops — many of which serve as food for the population. When pairing agriculture with nutrition programs, these efforts can ensure that mothers have access to local foods, which, when coupled with the capacity to prepare them well, contributes to improved childhood nutrition. Well-nourished children are healthier and better able to fight illness, perform better in school, and are better able to participate in the labor force. Reducing malnutrition requires multisectoral actions; a program that starts with an agricultural foundation can have positive impacts through better nutrition, leading to healthier people, higher-skilled jobs, and ultimately, economic growth.

· Responding to Emerging Diseases. Our current situation — living through pandemic threats like COVID-19 or Ebola — highlights the importance of sectors working together to address health needs. Through multisectoral actions, response efforts can be coordinated and timely. As we are experiencing with COVID-19, addressing the health dimensions of the pandemic is a critical component, but it does not by itself comprise a comprehensive response. Pandemics affect schools, the labor force, law enforcement, and financial sector — to mention only a few. Our experience reinforces the importance of a coordinated response that engages the many sectors that can be affected by such a crisis. To inform the needed multisectoral actions, we need to generate evidence about impact of non-action, as well as the positive effects that our actions may have on health and wellbeing. This evidence can spur action among decision-makers across all sectors, bringing them together to agree on coordinated effective responses.

· Expanding Resources and Reach. We tend to think that it is the role of the public sector to lead efforts that improve health systems and health status. However, the private sector plays a critical role in these endeavors. We can effectively integrate the private sector into the health system by creating an enabling policy and regulatory environment for private sector engagement, building new public and private sector partnerships, de-risking innovative interventions to leverage private capital, and strengthening government’s stewardship capacity to govern mixed health systems. Although public and private sectors function differently, multisectoral actions can bring these groups together to carry out collaborative efforts that expand the resources available and the reach of the health sector.

· Reaching Specific Populations. Multisectoral actions are important when addressing the needs of a specific segment of the population — particularly youth. Building human capital through access to quality education and health services are critical elements of multisectoral actions that respond to youth needs. At the same time, as the world becomes more complex, young people need a broader set of skills to achieve their potential. “Softer” skills related to communication, negotiation, and leadership complement the education they obtain in school. Young people can learn skills through in-school or out-of-school programs that align with labor force demands and prevent exploitation. Particularly for young people, health education is critical to avoiding unplanned pregnancies, stopping the transmission of HIV, and adopting healthy lifestyles. When we look at the complex needs of young people, multisectoral actions can remove many of the silos that don’t successfully give young people enough of what they need to navigate the complexity of life in the 21st century.

The examples above illustrate that multisectoral work embraces a diversity of ideas, actors, and approaches. Achieving improvements in health outcomes does not rely only on the availability of affordable, quality health services; in many ways, those services are the tip of the iceberg. Improved health is both a result of and contributor to economic growth, which is why multisectoral actions create win-win opportunities for development. To achieve these successes, the broader health and development community should more proactively turn its attention to multisectoral action — designing cross-sectoral interventions and building strong collaborations, networks, and alliances that focus on common goals and bring success to all their members.

Jay Gribble, Nicole Judice, and Suneeta Sharma are on the leadership team of the USAID-funded Health Policy Plus and members of Palladium’s health practice. Suneeta Sharma is vice president, health; Jay Gribble is a senior fellow; and Nicole Judice is a senior technical director, health.