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P&R Publishes Qualitative Research on Multisectoral Coordination and One Health Outcomes

March 2019

Drawing on its implementation experience in 16 countries and a qualitative analysis of key informant interviews, the  P&R project developed a publication series to compile illustrative examples of One Health activities and outcomes and identify key dimensions of effective multisectoral coordination to improve health security. The series shows how formal multisectoral mechanisms contribute to improved health security, and highlights an emerging body of evidence supporting the value of One Health. It also provides evidence of effectiveness and sustainability of One Health coordination in preventing, detecting, and responding to public health threats, and promising intermediate results and outcomes of One Health activities in a variety of contexts.

METHODOLOGY

The research focused on learnings from three questions:

• What factors enable or support effective multisectoral coordination?
• What factors are essential to sustain multisectoral coordination?
• How does a One Health approach lead to improvedhealth outcomes?

P&R conducted a review of the literature and its implementation experience in 16 countries, and then analyzed interviews with 59 key project staff, implementers, and government directly involved in One Health implementation. Questions for international donors and agencies captured global perspectives. The impressive degree of convergence across respondents provided confidence that the findings were broadly representative.

FINDINGS AND CONCLUSIONS

To begin to answer the first question above, the first publication, Multisectoral Coordination That Works, identified five dimensions of effective multisectoral coordination.

  • Political Commitment: A legal mandate is essential to establish a formal multisectoral coordination mechanism and help it survive political changes. Continuous advocacy is needed to help national decision-makers to understand the mechanism’s value in prevention, detection, and response.
  • Institutional Structures: Primarily, the structure helps ensure mechanisms are functional, effective, and sustainable. However the mechanism is structured, clarity in organization and terms of reference is central to secure government ownership, build stakeholder engagement, and develop capacity to prepare and respond to a public health event.
  • Management and Coordination Capacity: Coordination mechanisms need to be well managed, and “soft skills” should not be overlooked. Management and coordination capacity at all levels are critical, while annual work plans, communications guidelines, and monitoring and evaluation frameworks support it.
  • Joint Planning and Implementation: Joint planning and collaborative implementation of technical activities build relationships and strengthen trust among partners. They also demonstrate the value of multisectoral coordination, as resulting plans and activity reports document the benefits gained.
  • Technical and Financial Resources: Sustained multisectoral coordination requires national government ownership, leadership, and resources. National governments can also mobilize and coordinate investments from development partners, research institutions, and the private sector.

The publication concludes with two policy recommendations related to coordination. First, organizations interested in comprehensively addressing disease threats should explicitly support One Health and multisectoral coordination mechanisms. Partners should commit resources for establishing, institutionalizing, and sustaining these mechanisms, and recognize the practice of multisectoral coordination requires time to establish.

Second, to foster effective and sustainable coordination mechanisms, partners should support development of all five dimensions, because the evidence is that robust mechanisms demonstrate strength in all these areas.

In the second publication, One Health: An Assessment of Outcomes, participants were asked to discuss outcomes of One Health and multisectoral coordination. While most respondents pointed to non-health outcomes such as the establishment of formal coordination mechanisms, greater awareness of One Health among stakeholders, expansion of One Health coordination to the subnational level, and joint preparedness and response, many stressed the importance of building on these accomplishments to achieve health or health security outcomes.

While greater appreciation and awareness of One Health and improved coordination mechanisms are intermediate outcomes, they also facilitate multisectoral activities to prevent, detect, and respond to public health threats, whether through assessments, planning, or the dispatch of multisectoral rapid response teams to investigate outbreaks. P&R’s analysis identified numerous examples of countries applying and benefiting from a One Health approach, from more robust preparedness and response plans to quicker response times to disease outbreaks. Moreover, there are indications that the practice of One Health is being institutionalized, whether in the formalization of multisectoral coordination mechanisms or national adoption of multisectoral coordination guidelines.

Fully institutionalizing a One Health approach, however, requires sustained commitment and investment. There is still much to be done to strengthen multisectoral coordination in countries before definitive evidence of improved health outcomes can be documented. While multisectoral coordination offers promise of efficiency gains, further research is needed to better document gains in health outcomes and impact.

P&R Experts

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