The Role of Intersectoral Action in Response to COVID-19: A Qualitative Study of the Roles of Academia and the Private Sector in Colombia

Background: The integration of health services with other sectors is hypothesised to support adaptation of health systems in response to coronavirus disease 2019 (COVID-19). This study identified barriers and enablers associated with intersectoral coordination at an early stage of the pandemic. The study focused on the roles played by the academic and private sector in different areas of public health planning and delivery concerning COVID-19 in Colombia. Methods: A qualitative approach was used to understand stakeholders’ experiences and perceptions of intersectoral working in response to COVID-19 in three Colombian cities (Bogotá, Cali and Cartagena). Between March and November 2020, data was collected via semi-structured interviews conducted online with 42 key actors, including representatives of governmental bodies, universities, and professional associations. The dataset was analysed thematically using a combination of inductive and deductive methods. Results: Organizations adjacent to the health system, including universities and the private sector, supported responses to COVID-19 by providing evidence to inform decision-making, additional service capacity, and supporting coordination (eg, convening intersectoral "roundtables"). The academic and private sector involvement in intersectoral coordination was stimulated by solidarity (being the "right thing to do") and motivation for supporting local companies (reopening the economy). Intersectoral working was influenced by pre-existing (substantive) and emerging (situational) enablers and barriers. Conclusion: This study showed that intersectoral coordination has played an important role in responding to COVID-19 in Colombia. Coordination was influenced by substantive and situational enablers and barriers. Based on our findings, policy-makers should focus on addressing substantive barriers to coordination, including the pre-existing tensions and mistrust among national and local healthcare actors, strict regulations and limited financial and human resources, while providing support for situational enablers, including alignment of public and private actors’ interests, intersectoral government support and establishing frequent communication channels and formal spaces of interaction among sector, in processes of decision-making.

Health in Food Systems Policies in India: A Document Review

Background: Food systems affect nutritional and other health outcomes. Recent literature from India has described policy aspects addressing nutritional implications of specific foods (eg, fruits, vegetables, and trans-fats), and identified opportunities to tackle the double burden of malnutrition. This paper attempts to deepen the understanding on how health concerns and the role of the health sector are addressed across food systems policies in India. Methods: This qualitative study used two approaches; namely (i) the framework method and (ii) manifest content analysis, to investigate national-level policy documents from relevant sectors (ie, food security, agriculture, biodiversity, food processing, trade, and waste management, besides health and nutrition). The documents were selected purposively. The textual data were coded and compared, from which themes were identified, described, and interpreted. Additionally, mentions of various health concerns and of the health ministry in the included documents were recorded and collated. Results: A total of 35 policy documents were included in the analysis. A variety of health concerns spanning nutritional, communicable and non-communicable diseases (NCDs) were mentioned. Undernutrition received specific attention even beyond nutrition policies. Only few policies mentioned NCDs, infectious diseases, and injuries. Governing and advisory bodies were instituted by 17 of the analysed policies (eg, food safety, agriculture, and food processing), and often included representation from the health ministry (9 of the 17 identified inter-ministerial bodies). Conclusion: We found some evidence of concern for health, and inclusion of health ministry in food policy documents in India. The ongoing and planned intersectoral coordination to tackle undernutrition could inform actions to address other relevant but currently underappreciated concerns such as NCDs. Our study demonstrated a method for analysis of health consideration and intersectoral coordination in food policy documents, which could be applied to studies in other settings and policy domains.

The Expanded Immunization Program (EPI): On which exogenous factors does it depend its success?

Background EPI is one of the successful public health programs for the control and prevention of infectious diseases worldwide. In Latin America and the Caribbean, EPI achieved high rates of vaccination and reached both the eradication of poliomyelitis (1994) and the elimination of the indigenous transmission on the measles virus (2016). Between 2006 and 2011, 174. 000 deaths were also avoided. Objective To identify exogenous conditions that were in place before the establishment of the EPI, which contributed to a better implementation of the program and increased vaccine coverage levels since 1980. Methods an exploratory mixed ecological study with information from twenty-five Latin American and the Caribbean countries were studied in 1980. The exogenous variables were: Number of nurses per 10.000 inhabitants (as a proxy level for the level of development of the health services), Infant mortality (progress of health conditions), Annual GDP (Economy growth in production), and Human Development Index (HDI). The primary outcome was vaccine coverage (measles and OPV3) from 1980 to 2013, and secondary outcomes were inter and intersectoral coordination of PNI. The effects were estimated through regression models. Results In the univariate models, there was a positive relationship between HDI and vaccination coverage, and an inverse effect of infant mortality; an obvious situation since it is expected that as vaccination coverage increased, infant mortality declines. The number of nurses had a positive relationship between inter and intersectoral coordination. In the multivariate model, three of the four exogenous variables explained 35.7% of the increase in coverage: number of nurses, HDI, and GDP. Conclusions Exogenous factors played an essential role in the improvement of the immunizations program in Latin America and the Caribbean countries, as well as could be for other public health interventions. Key messages Economy growth and Human Development are essential for the implementation of public health programs. The level of development of health services contributes to the success of a public health program.

Lesson from COVID-19: restructuring the current health system and policies in Nepal

Although COVID-19 pandemic has created a state of alarm worldwide, the downfall in health and economy is rather paramount in low income countries. Nepal, due to its inadequate health resources and poor health system, is more vulnerable to the plight. But on a positive note, the weaknesses that have been exposed can be taken as lessons to learn. With the policies committed to achieving health as the fundamental right of people as per the constitution, capacity building, intersectoral coordination, preventive, promotive and curative facilities, and appropriate strategies and preparedness plan, Nepal can combat the pandemic and develop a resilient and well-functioning health system in future. Now is a moment of historic opportunity. Public health program must be strengthened as soon as possible by ensuring that at least minimum requirement are in place at the province and municipality levels and media partnership should be created to prevent societal fear. Furthermore, this is an opportunity to implement the power devolution in federal republic of Nepal

Intersectoral coordination and diabetes prevention: building capacity through professional agency

Background Intersectoral coordination of disease prevention is highly complex. The case of women who develop diabetes during pregnancy (GDM) is a case in point: intersectoral coordination mainly concerns diabetes prevention and thus stretches over the life course of women and their families. Our study aims to analyse how health professions through their day-to-day practice contribute to the creation, maintenance and transformation of intersectoral coordination of diabetes prevention over the life course; and how contexts at systems/organisational influences such processes. Methods The study draws on organisational studies of professions and focuses on the mechanisms underlying the making of intersectoral coordination. As part of a pilot study, we conducted a review of the international literature on intersectoral coordination of public health, a review of national policy documents, and a secondary analysis of interviews conducted as part of the development of the Face-it intervention. Results The organisation of GDM diabetes prevention in Denmark emerges as fragmented. Care pathways are divided between different phases, types of services, sectors and health professions. There are additional variations among municipalities. Formal (intersectoral) coordination is also limited to vulnerable women and their families. GDM diabetes prevention involves a broad range of professions; professional agency in GDM diabetes prevention is dispersed. Clinical specialists in hospitals show the strongest interest, rooted in healthcare knowledge on prevention. General practitioners have a similar knowledge base, but consider prevention less central. The same applies to health visitors and midwives, whose knowledge base also includes social care. Conclusions Individual professions have a strong capacity for intersectoral agency. Strengthening this capacity requires alignment across professions and adaptation to specific contexts.