Multisectoral Actions: Creative Thinking, Effective Planning, Power Sharing
By: Jay Gribble and Nicole Ross Judice
Why do so many policies fail to improve the problem they are designed to address? And why is it so difficult to measure progress in resolving complex, stubborn challenges? These and similar questions vex policymakers and policy wonks around the world. And one of the reasons that such questions remain unresolved is that the issues that many policies seek to improve fall beyond the expertise and domain of a single sector — and working across sectors can be so difficult because of turf issues.
The root to resolving complex issues through multisectoral actions is recognizing which sectors need to be engaged and finding the commitment, capacity, resources, and coordination to work together to make progress on the problem. In the kickoff to this series on a “Multisectoral Endeavor Called Health,” we drew attention to why collaborative policy endeavors are at the heart of addressing complex issues. We offered examples of some of the world’s largest health problems that are being addressed through policy initiatives the cut across more than one sector. But multisectoral actions are not reserved only for the biggest, most complex issues such as ending malnutrition or achieving universal health coverage. In fact, a multisectoral action can be used to address a variety of policy issues — large and small. Here, we consider three examples of country-focused multisectoral actions — long-term development plans, human development plans, and targeted policy initiatives — and why they may or may not work.
“Regardless of the sector, resolving complex issues requires effective governance that fosters creative thinking, effective planning, sharing power, and a willingness to admit when it’s time to rethink and regroup.”
Achieving long-term development goals requires effective planning. Achieving long-term development goals that include economic, human development, social, and political advances is a complex proposition. In 1998, Malawi launched its Vision 2020, which articulated its goal of being an environmentally sustainable, technologically driven middle-income country underpinned by social services, safety, and security. To translate the vision into action, Malawi developed a series of growth and development strategies designed to inform sector strategies and program design.
Malawi made progress on several fronts but is not yet a middle-income country. Among the reasons it has not yet achieved its vision for 2020 are continued fiscal deficits, high levels of poverty and inequality, rapid population growth and environmental degradation, energy shortages, and insufficient infrastructure. Vision statements can play an important role in setting a country’s pathway to change, but they need to be implemented through mid-term strategies that identify priorities and lay out a more specific policy agenda.
Malawi may not have achieved its vision, but can learn from other countries such as South Korea. With an economic planning board and four five-year development plans between 1962 and 1981, South Korea’s economy was able to transition from fishing- and farming-based to one based on industry and high tech. Guided by a long-term vision, South Korea’s focus was on achieving short- and medium-term human capital and economic milestones.
High-level coordination facilitates power sharing. Multisectoral actions can also be an effective way to address human capital development, which focuses on a smaller grouping of sectors and stakeholders — but is still a monumental effort. Guatemala put in place a national social development and population policy in 2002 that prioritized health, education, labor and migration, disaster preparedness, and social communication. And to facilitate implementation, the policy was to be coordinated at a high level — the President’s Secretariat for Planning and Programming — to ensure that power is shared and roles are defined and carried out. At the heart of Guatemala’s social development challenge is inequality, which contributes to malnutrition, inadequate education, and ongoing poverty. The objectives laid out for health in the 2002 policy included reductions in maternal and infant mortality as well as reductions in sexually transmitted infections and HIV.
Vision statements can play an important role in setting a country’s pathway to change, but they should rely on mid-term strategies that identify priorities and lay out a more specific policy agenda; an expansive policy such as this requires investments in capacity, sustained commitment, and financial resources. Guatemala’s experience demonstrated the downside of a broad policy such as this — it became a wish list that successive administrations politicized by cherry-picking strategies to pursue in the short term. However, stakeholders were able to leverage the existence of the policy into passage of a sin tax-funded family planning budget line item, which itself requires sustained advocacy by civil society to ensure funding commitments are met on an ongoing basis. No doubt, the way to achieving the multisectoral policy’s objectives was to push for strong sectoral policies and programs — that require both resources and capable staff. Even with sustained high-level commitment, sufficient funding, and coordination among the different actors, such policies can serve as a rallying cry that end up functioning as a platform to hold governments accountable for follow-through.
Creative thinking can inspire targeted multisectoral actions. Multisectoral actions can be useful for implementing specific priorities and new initiatives. Kenya’s Vision 2030 includes medical tourism — including access to cancer treatment — as an emerging priority to encourage both Kenyans and non-Kenyans to seek treatment within the country. The initiative was framed as a collaboration among the ministries of health, immigration, and tourism, with engagement of other public- and private-sector entities. This initiative resulted in three key policy changes: (1) the National Hospital Insurance Fund began to cover oncology services so that people could get treatment locally and the funds would not flow outside of Kenya; (2) the passage of the National Cancer Act, which prioritized investments in key hospitals to provide treatment for cancer; and (3) an increase in government investments in universal health coverage to cover cancer detection. These efforts required collaboration among ministries of health and finance, the national parliament, and other stakeholders. The medical tourism initiative also helped strengthen public-private partnerships, encouraging the private sector to invest in cancer detection and treatment equipment to be located in the country’s referral hospitals.
Multisectoral actions can be an effective way to address high-level goals or to launch a new targeted initiative. Achieving the goals of an initiative such as Vision 2030, for example, requires a sustained commitment that transcends the agenda of a political party currently in power. On the other hand, a targeted initiative, such as medical tourism in Kenya, may play out differently because the goal of this type of initiative can be divided into manageable, discrete pieces that advance different facets of the underlying issue. Beyond commitment, achieving a vision’s objectives requires coordination and resources. Positioning the coordination mechanism within high levels of government — Guatemala’s policy was coordinated by the president’s office — can create political pressure to implement activities and achieve results. Finally, for these types of policies to achieve results, there needs to be resources and follow-through at the sector level that identify who is responsible for what.
Jay Gribble is a senior director in Palladium’s health practice leadership team and deputy director for family planning and reproductive health on the USAID-funded Health Policy Plus project. Nicole Ross Judice is the HP+ senior technical advisor for monitoring, evaluation, and learning and the country activity manager for Kenya and East Africa.
