Rasanathan Kumanan, Atkins Vincent, Mwansambo Charles, Soucat Agnès, Bennett Sara
Health Section, UNICEF, New York City, New York, USA.
Caribbean Community, Bridgetown, Barbados.
BMJ Glob Health. 2018 Oct 10;3(Suppl 4):e000890. doi: 10.1136/bmjgh-2018-000890. eCollection 2018.
Drawing on experiences reviewed in the accompanying supplement and other literature, we present an agenda for the way forward for policy-makers, managers, civil society and development partners to govern multisectoral action for health in low-income and middle-income countries and consider how such an agenda might be realised. We propose the following key strategies: understand the key actors and political ecosystem, including type of multisectoral action required and mapping incentives, interests and hierarchies; frame the issue in the most strategic manner; define clear roles with specific sets of interventions according to sector; use existing structures unless there is a compelling reason not to do so; pay explicit attention to the roles of non-state sectors; address conflicts of interest and manage tradeoffs; distribute leadership; develop financing and monitoring systems to encourage collaboration; strengthen implementation processes and capacity; and support mutual learning and implementation research. To support countries to strengthen governance for multisectoral action, the global community can assist by further developing technical tools and convening peer learning by policy-makers (particularly from beyond the health sector), supporting knowledge management and sharing of experiences in multisectoral action beyond health, developing an agenda for and execution of implementation research and, finally, driving multilateral and bilateral development partners to transcend their own silos and work in a more multisectoral manner.
借鉴随附增刊及其他文献中回顾的经验,我们为政策制定者、管理人员、民间社会和发展伙伴提出了一个前进议程,以指导低收入和中等收入国家卫生领域的多部门行动,并思考如何实现这样一个议程。我们提出以下关键战略:了解关键行为体和政治生态系统,包括所需的多部门行动类型以及梳理激励措施、利益和层级关系;以最具战略性的方式界定问题;根据部门明确规定具有特定干预措施集的角色;除非有令人信服的理由,否则利用现有结构;明确关注非国家部门的作用;解决利益冲突并权衡利弊;分散领导权;建立鼓励合作的融资和监测系统;加强实施过程和能力;支持相互学习和实施研究。为支持各国加强多部门行动的治理,国际社会可以通过进一步开发技术工具、召集政策制定者(特别是卫生部门以外的政策制定者)进行同行学习、支持知识管理和分享卫生领域以外多部门行动的经验、制定实施研究议程并推动实施研究、最后促使多边和双边发展伙伴超越各自的孤立状态并以更具多部门性的方式开展工作来提供协助。