Business not as usual: how multisectoral collaboration can promote transformative change for health and sustainable development

Shyama Kuruvilla and colleagues present findings across 12 country case studies of multisectoral collaboration, showing how diverse sectors intentionally shape new ways of collaborating and learning, using “business not as usual” strategies to transform situations and achieve shared goals

Mood and anxiety disorders in very preterm/very low-birth weight individuals from 6 to 26 years

Background Very preterm (<32 weeks’ gestational age; VP) or very low–birth weight (<1,500 g; VLBW) birth has been associated with increased risk for anxiety and mood disorders and less partnering in adulthood. The aim was to test whether (a) VP/VLBW are at increased risk of any anxiety or mood disorders from 6 to 26 years compared with term-born individuals; (b) social support from romantic partners is associated with protection from anxiety and mood disorders; and (c) VP/VLBW adults’ lower social support mediates their risk for any anxiety and mood disorders. Methods Data are from a prospective geographically defined longitudinal whole-population study in South Bavaria (Germany). Two hundred VP/VLBW and 197 term individuals were studied from birth to adulthood. Anxiety and mood disorders were assessed at 6, 8, and 26 years with standardized diagnostic interviews and social support via self-report at age 26. Results At age 6, VP/VLBW children were not at increased risk of any anxiety or mood disorder. At age 8, VP/VLBW more often had any anxiety disorder than term comparisons (11.8% vs. 6.6%, OR = 2.10, 95% CI [1.08–4.10]). VP/VLBW adults had an increased risk for any mood (27.5% vs. 18.8%, OR = 1.65 [1.02–2.67]) but not for any anxiety disorder (33.0% vs. 28.4%, OR = 1.27 [0.82–1.96]). None of the significant differences survived correction for multiple testing. Social support was associated with a lower risk of anxiety or mood disorders in both groups (OR = 0.81 [0.68–0.96]) and mediated the association of VP/VLBW birth with any anxiety or any mood disorders at age 26. Conclusions This study does not show a persistently increased risk for any anxiety or mood disorder after VP/VLBW birth. Low social support from a romantic partner mediates the risk for anxiety or mood disorders after VP/VLBW birth

Expanded Quality Management Using Information Power (EQUIP): Protocol for a Quasi-experimental Study to Improve Maternal and Newborn Health in Tanzania and Uganda.

Maternal and newborn mortality remain unacceptably high in sub-Saharan Africa. Tanzania and Uganda are committed to reduce maternal and newborn mortality, but progress has been limited and many essential interventions are unavailable in primary and referral facilities. Quality management has the potential to overcome low implementation levels by assisting teams of health workers and others finding local solutions to problems in delivering quality care and the underutilization of health services by the community. Existing evidence of the effect of quality management on health worker performance in these contexts has important limitations, and the feasibility of expanding quality management to the community level is unknown. We aim to assess quality management at the district, facility, and community levels, supported by information from high-quality, continuous surveys, and report effects of the quality management intervention on the utilization and quality of services in Tanzania and Uganda. In Uganda and Tanzania, the Expanded Quality Management Using Information Power (EQUIP) intervention is implemented in one intervention district and evaluated using a plausibility design with one non-randomly selected comparison district. The quality management approach is based on the collaborative model for improvement, in which groups of quality improvement teams test new implementation strategies (change ideas) and periodically meet to share results and identify the best strategies. The teams use locally-generated community and health facility data to monitor improvements. In addition, data from continuous health facility and household surveys are used to guide prioritization and decision making by quality improvement teams as well as for evaluation of the intervention. These data include input, process, output, coverage, implementation practice, and client satisfaction indicators in both intervention and comparison districts. Thus, intervention districts receive quality management and continuous surveys, and comparison districts-only continuous surveys. EQUIP is a district-scale, proof-of-concept study that evaluates a quality management approach for maternal and newborn health including communities, health facilities, and district health managers, supported by high-quality data from independent continuous household and health facility surveys. The study will generate robust evidence about the effectiveness of quality management and will inform future nationwide implementation approaches for health system strengthening in low-resource settings

Business not as usual: how multisectoral collaboration can promote transformative change for health and sustainable development.

• We present a model of enabling fac-tors for effective multisectoral collabo-ration for improvements in health and sustainable development. • Drive change: assess whether desired change is better off achieved by mul-tisectoral collaboration; drive forward collaboration by mobilising a critical mass of policy and public attention. • Define: frame the problem strategi-cally and holistically so that all sec-tors and stakeholders can see the benefits of collaboration and contri-bution to the public good• Design: create solutions relevant to context, building on existing mecha-nisms, and leverage the strengths of diverse sectors for collective impact. • Relate: ensure resources for multi-sectoral collaboration mechanisms, including for open communication and deliberation on evidence, norms, and innovation across all components of collaboration. • Realise: learn by doing, and adapt with regular feedback. Remain open to redefining and redesigning the collaboration to ensure relevance, effectiveness, and responsiveness to change. • Capture success: agree on success markers, using qualitative and quan-titative methods to monitor results regularly and comprehensively, and learn from both failures and successes to inform action and sustain gains