Developing a metric for frontline worker collaboration in India's Integrated Child Development Services: A step toward measuring the "missing middle" of multi-sectoral collaboration

Multi-sectoral collaboration (MSC) is widely recognized as a critical aspect of policies, programs, and interventions to address complex public health issues, yet it tends to be undertheorized and difficult to measure. Limited understanding of the intermediate steps linking MSC formation to intended health outcomes leaves a substantial knowledge gap about the types of strategies that may be most effective in making such collaborations successful. This dissertation takes a step toward filling in this “missing middle” of MSC by developing and testing a scale-based instrument to assess collaboration between the frontline workers of one of India’s largest and most widely known MSCs: the Integrated Child Development Services (ICDS) scheme. Informed by Emerson’s & Nabatchi’s Integrative Framework for Collaborative Governance, the study follows a mixed methods design for instrument development and construct validation, including a quantitative strand (Paper 1) to develop the 18-item, Likert-type scale and test its psychometric properties; a qualitative strand (Paper 2) to identify key collaboration factors among the frontline workers through in-depth interviews (IDIs) and inductive thematic analysis of transcripts; and a mixed analysis (Paper 3) triangulating the quantitative and qualitative findings to further assess the construct and content validity of the scale. Embedded within a parent study conducted in two districts of Uttar Pradesh, India, data collection involved field testing of the scale in Hindi with frontline workers in 346 villages and in-depth interviews with those workers in six purposively sampled villages. Results provide clear evidence supporting the internal consistency and validity of the frontline worker collaboration scale in the study context and serve as a proof of concept for possible adaptation of the scale elsewhere. Recommendations for scale refinement are provided, including the development and testing of two additional scale items (flexibility and locus of control). The frontline worker collaboration scale may be useful for ICDS managers as the Indian Government redoubles its efforts to strengthen and monitor MSC, or “convergence”, in the scheme, while identified collaboration factors may have implications for ICDS program management, training, and hiring. Finally, the study’s design introduces a useful adaptation of an existing mixed methods instrument development framework

Health systems for all in the SDG era: Key reflections based on the Liverpool statement for the fifth global symposium on health systems research

The year 2018 marked anniversaries of several significant milestones in public health: the birth of the UK National Health Service, the Alma Ata declaration and the Commission on Social Determinants of Health. The Fifth Global Symposium on Health Systems Research in Liverpool reflected on these foundational events and their significance for the maturing field of health policy and systems research (HPSR) and for our growing professional association, Health Systems Global (HSG; Text Box 1). The Symposium’s theme, Health Systems for All in the Sustainable Development Goal Era, encapsulated the spirit of those historical commitments and brought them forward into current con- texts, framing universal health coverage and beyond (5th Global Symposium on Health Systems Research, 2018). Our democracies are under threat, our societies more polarized and our ecosystems undermined. Conflict and epidemics are not given adequate political attention, and across countries gender and intersectional inequalities remain glaring. It is amidst these contexts that our histories remind us of the progressive values that underpin ideal health systems. A key aim of HSG is to strengthen health systems by combining socially relevant science with effective, accountable and inclusive institutions to guide diverse social actors on the path to health and equity. In doing so, it is critical for health policy and systems researchers and practitioners to, above all, remain undaunted in striving for the realization of our aspirational goals despite these contemporary challenges

Governing multisectoral action for health in low- and middle-income countries

Kumanan Rasanathan and colleagues argue that the potential of multisectoral collaboration for improving health remains untapped in many low- and middle-income countries

Measuring resilience is not enough; we must apply the research. Researchers and practitioners need a common language to make this happen.

This article is contributed by a practitioner in the area of country-level health systems strengthening who also has a background in resilience research. The intent of the article is to offer constructive reflection on the disconnect between the insights of resilience research and the application of those insights through development assistance. The primary reason for the existence of this communication block is that resilience research findings are not often translated in a format that is useful to those implementing resilience promotion projects. As a result, implementers do not usually review relevant research to guide their interventions. Resilience researchers and practitioners need a common language, one that arises from effective community engagement

Cost-effectiveness analysis and joint public production of outputs for development: a preliminary framework.

The 2030 Sustainable Development Goals are highly interdependent. Lasting progress towards these goals requires collaboration among actors operating in diverse sectors and thematic domains. Yet, multi-sectoral collaboration is complicated by a variety of factors that tend to incentivise siloed action organised around individual interventions and budgets. This paper presents an analytical framework based on the concept of “economies of scope” for assessing and enhancing the efficiency of development projects for which there is a joint production process. We focus on the use of fair cost sharing methods such as the Shapley Value to dis-incentivise actors operating in inefficient siloes

Resilience in Post-Katrina New Orleans, Louisiana: A Preliminary Study

Background: Much scholarly and practitioner attention to the impact of Hurricane Katrina on the city of New Orleans, Louisiana has focused on the failures of government disaster prevention and management at all levels, often overlooking the human strength and resourcefulness observed in individuals and groups among the worst-affected communities. Objectives: This preliminary study sought to investigate human resilience in the city of New Orleans, State of Louisiana, eighteen months after Hurricane Katrina struck the Mississippi delta region. Methods: The Sense of Coherence scale, short form (SOC-13) was administered to a sample of 41 residents of Lower Ninth Ward and adjacent Wards who had been displaced by Hurricane Katrina but were either living in or visiting their home area during March 2007. Study participants were recruited through the local branch of the Association of Community Organizations for Reform Now (ACORN), a nation-wide grassroots organization whose mission is to promote the housing rights of low and moderate-income individuals and families across the USA and in several other countries. Results: Those who had returned to their homes had significantly higher SOC scores compared to those who were still displaced (p<0.001). Among the latter, those who were members of ACORN scored significantly higher than non-members (pp<0.005), and their SOC-13 scores were not significantly different from the scores of study participants who had returned home (including both members and non-members of ACORN). Conclusions: The findings of this preliminary study concur with previous reports in the literature on the deleterious impact of displacement on individual and collective resilience to disasters. Relevant insight gleaned from the qualitative data gathered during the course of administering the SOC-13 scale compensate for the limitations of the small sample size as they draw attention to the importance of the study participants&apos; sources of social support. Possible avenues for further research are outlined

Using social network analysis to plan, promote and monitor intersectoral collaboration for health in rural India.

BackgroundAs population health and well-being are influenced by multiple factors that cut across sectoral boundaries, an intersectoral approach that acknowledges and leverages the multiple determinants, actors and sectors at play is increasingly seen as critical for achieving meaningful and lasting improvements. In this study, we utilize social network analysis (SNA) to characterize the intersectoral collaboration between the organizations working on maternal & child health (MCH) and water & sanitation (WASH) before and immediately after the implementation of HCL Foundation (HCLF)-funded HCL Samuday Project (2015-2017) in a rural block of Uttar Pradesh state, India. While SNA has been used to examine public health issues, few have used it monitor stakeholder relationships, intervene, improve and facilitate project implementation involving intersectoral partnerships, particularly in the context of a low-and middle-income countries.MethodAn organization-level SNA was conducted with 31 key informants from 24 organizations working on MCH and/or WASH in Kachhauna, Uttar Pradesh, India. Data were collected using face-to-face, semi-structured interviews between June and September 2017. Density, centrality and homophily were calculated to describe the network and a qualitative analysis was also conducted to identify the strengths and weaknesses of collaboration between organizations working on MCH and WASH.ResultsOverall, our findings showed that the network of organizations working on MCH and WASH in Kachhauna grew in number since the implementation of Samuday. HCLF rapidly achieved centrality, thus positioning the organization to serve as a gatekeeper of information and enabling it to play a coordinator role within the network. Direct collaboration between other organizations working on MCH and WASH was low at both time points. Interviews with key informants indicated widespread interest in increasing interorganizational interactions and engagement throughout the network.ConclusionThis study demonstrates the feasibility and practical application of SNA for projects like Samuday that involve intersectoral collaboration. It also provides lessons about the use of SNA with organizations as the unit of analysis and in the context of rural India, including challenges, practical considerations, and limitations

Understanding the implications of the Sustainable Development Goals for health policy and systems research : results of a research priority setting exercise

CITATION: Bennett, S., et al. 2020. Understanding the implications of the Sustainable Development Goals for health policy and systems research : results of a research priority setting exercise. Globalization and Health, 16:5, doi:10.1186/s12992-019-0534-2.The original publication is available at https://globalizationandhealth.biomedcentral.comBackground: Given the paradigmatic shift represented by the Sustainable Development Goals (SDGs) as compared to the Millennium Development Goals - in particular their broad and interconnected nature - a new set of health policy and systems research (HPSR) priorities are needed to inform strategies to address these interconnected goals. Objectives: To identify high priority HPSR questions linked to the achievement of the Sustainable Development Goals. Methods: We focused on three themes that we considered to be central to achieving the health related SDGs: (i) Protecting and promoting access to health services through systems of social protection (ii) Strengthening multisectoral collaborations for health and (iii) Developing more participatory and accountable institutions. We conducted 54 semi-structured interviews and two focus group discussions to investigate policy-maker perspectives on evidence needs. We also conducted an overview of literature reviews in each theme. Information from these sub-studies was extracted into a matrix of possible research questions and developed into three domain-specific lists of 30–36 potential priority questions. Topic experts from the global research community then refined and ranked the proposed questions through an online platform. A final webinar on each theme sought feedback on findings. Results: Policy-makers continue to demand HPSR for many well-established issues such as health financing, human resources for health, and service delivery. In terms of service delivery, policy-makers wanted to know how best to strengthen primary health care and community-based systems. In the themes of social protection and multisectoral collaboration, prioritized questions had a strong emphasis on issues of practical implementation. For participatory and accountable institutions, the two priority questions focused on political factors affecting the adoption of accountability measures, as well as health worker reactions to such measures. Conclusions: To achieve the SDGs, there is a continuing need for research in some already well established areas of HPSR as well as key areas highlighted by decision-makers. Identifying appropriate conceptual frameworks as well as typologies of examples may be a prerequisite for answering some of the substantive policymaker questions. In addition, implementation research engaging non-traditional stakeholders outside of the health sector will be critical.https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-019-0534-2Publisher's versio

Methodological gaps and opportunities for studying multisectoral collaboration for health in low- and middle-income countries

The current body of research into multisectoral collaborations (MSCs) for health raises more questions than it answers, both in terms of how to implement MSCs and how to study them. This article reflects on current methodological gaps and opportunities for advancing MSC research, based on a targeted review of existing literature and qualitative input from researchers and practitioners at the 2018 Health Systems Research (HSR) Symposium in Liverpool. Through framework analysis of 205 MSC research papers referenced in a separately published MSC \u27overview of reviews\u27 paper, this article identifies six broad MSC question domains (\u27meta questions\u27) and applies content analysis to estimate the relative frequency with which these meta questions and the research method(s) used to answer them are present in the literature. Results highlight a preponderance of research exploring MSC implementation using case study methods, which, in aggregate, does not seem to adequately meet policymakers\u27 and practitioners\u27 needs for generalizable or transferable insights. The content analysis is complemented by qualitative insights from HSR Symposium participants and the authors\u27 own experience to identify six key methodological gaps in research on MSC for health. For each of these gaps, we propose areas in which we believe there are opportunities for methodological development and innovation to help advance this field of study, including: better understanding the role of power dynamics in shaping MSCs; development of a classification framework (or frameworks) of governance arrangements; exploring divergence of perspective and experience among MSC partners; identifying or generating theoretical frameworks for MSC that work across sectors and disciplines; developing intermediate indicators of collaboration; and increasing transferability of insights to other contexts. Collaboration with researchers outside of the health sector will enhance efforts in each of these areas, as will the establishment and strengthening of pluralistic MSC evidence networks also involving policymakers and practitioners