Intersectoral Strategies in Low-Middle Income Countries (LMIC)
- LAST MODIFIED: 11 January 2017
- DOI: 10.1093/obo/9780199756797-0155
- LAST MODIFIED: 11 January 2017
- DOI: 10.1093/obo/9780199756797-0155
There is a growing literature demonstrating the need for intersectoral actions to address social inequities and improve population health and well-being. Public health has been based on effective interventions in two broad domains: the biomedical domain, responding to diseases and ill-health; and the social, economic, and political domains addressing the structural determinants of health. It is recognized in this article that less rigorous and systematic attention has been paid to health issues in social, economic, and political domains, which is reflected in the literature reviewed to develop this article. The task of implementing intersectoral actions demands structural changes, not only through policies targeted toward health and social protection systems but also in the way resources are organized, coordinated, and distributed. New policies, managerial approaches, and technologies are needed to respond to the demands and challenges to achieve and sustain intersectoral strategies. One of the most outstanding challenges is to deal with complex interventions, implemented in complex systems. Most of the literature reviewed addresses theoretical issues and strategies to implement intersectoral actions; however, there is a big gap between these orientations and the practice, political, and structural conditions needed, which are not present in most lower-middle-income countries. The interpretation of results of any study should be done taking into account both the scope and practical meanings of the terms used. It is imperative, therefore, to focus implementation strategies and mechanisms on creating and sustaining processes of change that fit the needs of political and economic contexts of lower-middle-income countries (LMIC). Few studies focus on the strengthening of country capacity to achieve expected changes and to respond to constraints such as the lack of structures and platforms for dialogue and consensus building, as well as to balance power relationships and creation of legislation-regulations to overcome the traditionally vertical, sectoral, and discipline-oriented programs. This review focuses on experiences to address the above challenges in low- and middle-income countries. It is meant to clearly indicate the need to reflect on our practice, answering questions such as the following: How can LMIC face the constraints and challenges to undertake intersectoral work to reduce health inequities? Can we reduce health inequities without reducing social inequities present in LMIC? Why is it that most of the successful experiences come from pilot projects? Why have we have not been able to scale up? How can LMIC cope with new agendas whose complexity demands a more complex practice? What is the role of the health sector? And finally, are we on the right track?
The social determinants approach, according to Victora, et al. 2011, implies that causal chains run from macro social, political, and economic factors, to the pathogenesis of disease. Blas, et al. 2008 (cited under Process, Results, and Impact Evaluation of Intersectoral Strategies in LMIC) classifies the interventions in three categories: upstream, midstream, and downstream. The first category refer to the reform of fundamental social and economic structures and involve mechanisms for the redistribution of wealth, power, opportunities, and decision-making; the second category is oriented to interventions that “seek to reduce risky behaviors or exposures to hazards by influencing health behaviors or psychosocial factors and/or by improving material working and living conditions.” The majority of experiences cited in this review correspond to “downstream interventions,” which, according to the Blas, et al. 2008, correspond to those that “occur at the micro and/or individual level and mitigate the inequitable impacts of upstream and midstream determinants” (p. 1684). Intersectoral actions require wide political and economic reforms, which are not present in most of LMIC. Readers interested in more structural reforms may review studies done in Brazil (Junqueira 2000 and Magalhães and Bodstein 2009) as well as in Chile (Junqueira 2000 and Solar, et al. 2009). Those interested in challenges and difficulties of intersectoral work to strengthen primary health care, health coverage, and health in all policy strategies, might review Victora, et al. 2011; Mladovsky and Mossialos 2008; Gomes, et al. 2009; and Labonté, et al. 2009. In the same vein, the World Health Organization, Government of South Australia 2010 and Gomes, et al. 2009 call attention to the need for a new social contract among all sectors to strengthen equity and human development, as well as a new form of governance to make sustainable programs.
Gomes, N. P., N. M. F. Diniz, C. C. Silva Filho, and J. N. B. Santos. 2009. Enfrentamento da violência doméstica contra a mulher a partir da interdisciplinaridade e intersetorialidade. Revista enfermagem UERJ – UERJ Nursing Journal 17:14–17.
Considers the multicomponent nature of domestic violence as the entry point to highlight the importance of intersectoral and interdisciplinary work. Authors conducted a literature review demonstrating that to address violence, isolated action should be avoided, and different sectors should work together to account for the complexity of this problem.
Junqueira, L. A. P. 2000. Intersetorialidade, transetorialidade e redes sociais na saúde. Revista de administração pública 34:35–45.
Described intersectorality as processes for integrating skills and experiences and places the Unified Health System in Brazil as a transectoral project: this is because its body of knowledge is not restricted to specific skills but extends to the guarantee of rights. Concepts to understand the complexity of social reality are needed.
Labonté, R., D. Sanders, F. Baum, N. Schaay, C. Packer, D. Laplante, and R. S. S. Pooyak. 2009. Aplicación, efectividad y contexto político de la atención primaria integral de salud: resultados preliminares de una revisión de la literatura mundial. Revista Gerencia y Políticas de Salud 8:14–29.
Analysis of the Primary Health Care (PHC) strategy after thirty years of Alma Ata declaration is the focus of this study, examining its impact on improving population health, reducing health inequities, and closing knowledge gaps. PHC is conceived as an integral approach oriented to reducing health inequities through community participation, as well as multidisciplinary and trans-sectoral actions.
Magalhães, R., and R. Bodstein. 2009. Evaluation of initiatives and intersectoral programs in health: Challenges and learning. Ciência & Saúde Coletiva 14:861–868.
The focus of this article is on the evaluation of intersectoral initiatives. Social mobilization networks, the profile of the players, types of incentives and levels of institutional integration are treated as crucial elements in the analysis. It is concluded that the interface and dialogue among researchers, evaluators, and decision makers, constitute the central axes for better social and institutional learning.
Mladovsky, P., and E. Mossialos. 2008. A conceptual framework for community-based health insurance in low-income countries: Social capital and economic development. World Development 36:590–607.
Implications of community-based health insurance (CBHI) and universal coverage for health care in LMIC are analyzed, considering contextual factors associated with social determinants. A framework based on social capital theories and economic development to reach sustainable levels of population coverage is used to organize and interpret existing evidence.
Solar, O., N. Valentine, D. Albrecht, and M. Rice. 2009. Moving forward to equity in health: What kind of intersectoral action is needed? An approach to an intersectoral typology. Partnership and Intersectoral Action Conference Working Document.
An intersectoral typology is described, considering the type and scope of intersectoral initiatives and their implications for the planning, management, and participation of different sectors involved. Discussed are types of engagement of sectors, ranging from information, cooperation, integration, and coordination activities, and the relationship of intersectoral actions to the societal vision of public health, as well as the patterns of social participation.
Victora, C. G., M. L. Barreto, M. do Carmo Leal, et al. 2011. Health conditions and health-policy innovations in Brazil: The way forward. Lancet 377:2042–2053.
In this series of six articles, the authors refer to many challenges closely related to the administration of a complex, decentralized public-health system, which competes with private insurance and institutions. The challenge is recognized as a political one, facing new barriers due to urbanization and social and environmental change, as well as old unresolved health issues.
World Health Organization, Government of South Australia. 2010. Adelaide Statement on Health in All Policies moving towards shared governance for health and well being. Health Promotion International 25:258–260.
The Adelaide Statement on Health in All Policies requires the joining-up and coordination of sectors, as well as the engagement of leaders and policymakers at all levels of government. This change in paradigm implies a new social contract, a new form of governance among all sectors, and leadership within governments to improve human development, sustainability and equity, as well as health outcomes.
Users without a subscription are not able to see the full content on this page. Please subscribe or login.
- Access to Health Care
- Action Research
- Active Aging
- Active Living
- Adolescent Risk-Taking Behavior in the United States
- Advocacy, Public Health
- Agricultural Safety and Public Health
- Air Quality: Health Effects
- Air Quality: Indoor Health Effects
- Alcohol Availability and Violence
- Alternative Research Designs
- Ambient Air Quality Standards and Guidelines
- American Perspectives on Chronic Disease and Control
- Antimicrobial Resistance (AMR)
- Asthma in Children
- Attachment as a Health Determinant
- Behavior Change Theory in Health Education and Promotion
- Behavioral Risk Factor Surveillance
- Bicycling and Cycling Safety
- Birth and Death Registration
- Birth Cohort Studies
- Board of Health
- Built Environment and Health, The
- Business and Corporate Practices
- Cancer Communication Strategies in North America
- Cancer Prevention
- Cancer Screening
- Capacity Building
- Capacity Building for NCDs in LMICs
- Capacity-Building for Applied Public Health in LMIC: A US ...
- Cardiovascular Health and Disease
- Child Maltreatment
- Children, Air Pollution and
- Children, Injury Risk-Taking Behaviors in
- Children, Obesity in
- Citizen Advisory Boards
- Climate Change and Human Health
- Climate Change: Institutional Response
- Clinical Preventive Medicine
- Community Air Pollution
- Community Development
- Community Gardens
- Community Health Assessment
- Community Partnerships and Coalitions
- Community-Based Participatory Research
- Complexity and Systems Theory
- Culture and Public Health
- Definition of Health
- Dental Public Health
- Design and Health
- Dietary Guidelines
- Directions in Global Public Health Graduate Education
- Ecological Approaches
- Enabling Factors
- Environmental Laws
- Environmental Protection Agency
- Ethics of Public Health
- Evidence-Based Public Health Practice
- Family Planning Services and Birth Control
- Food Safety
- Food Security and Food Banks
- Food Systems
- Frail Elderly
- Functional Literacy
- Genomics, Public Health
- Geographic Information Systems
- Geography and Health
- Global Health
- Global Health Diplomacy
- Global Health Promotion
- Guide to Community Preventive Services, The
- Health Administration
- Health Communication
- Health Disparities
- Health Education
- Health Impact Assessment
- Health in All Policies
- Health in All Policies in European Countries
- Health Literacy
- Health Literacy and Non-Communicable Diseases
- Health Measurement Scales
- Health Planning
- Health Promoting Hospitals
- Health Promotion
- Health Promotion Foundations
- Health Promotion Workforce Capacity
- Health Promotion Workforce Capacity
- Healthy People Initiative
- Hepatitis C
- High Risk Prevention Strategies
- Human Rights, Health and
- Immigrant Populations
- Immunization and Pneumococcal Infection
- Indigenous Peoples, Public Health and
- Indigenous Populations of North America, Australasia, and ...
- Indoor Air Quality Guidelines
- Internet Applications in Promoting Health Behavior
- Intersectoral Strategies in Low - Middle Income Countries ...
- Justice, Social
- Knowledge Translation and Exchange
- Knowledge Utilization and Exchange
- Law of Public Health in the United States
- Media Advocacy
- Mental Health
- Mental Health Promotion
- Migrant Health
- Motor Vehicle Injury Prevention
- Multi-Drug-Resistant Tuberculosis
- National Association of Local Boards of Health
- National Public Health Institutions
- Needs Assessment
- Needs Assessments in International Disasters and Emergenci...
- Obesity Prevention
- Occupational Cancers
- Occupational Exposure to Benzene
- Occupational Exposure to Erionite
- Occupational Safety and Health
- Oral Health Equity for Minority Populations in the United ...
- Ottawa Charter
- Parenting and Work
- Parenting Skills and Capacity
- Participatory Action Research
- Patient Decision Making
- Pesticide Exposure and Pesticide Health Effects
- Physical Activity and Exercise
- Physical Activity Promotion
- Polio Eradication in Pakistan
- Population Aging
- Population Determinants of Unhealthy Foods and Beverages
- Population Health Objectives and Targets
- Precautionary Principle
- Prenatal Health
- Program Evaluation in American Health Education
- Program Planning and Evaluation
- Public Health, History of
- Public Health Surveillance
- Public-Private Partnerships in Public Health Research and ...
- Public-Private Partnerships to Prevent and Manage Obesity ...
- Quantitative Microbial Risk Assessment
- Radiological and Nuclear Emergencies
- Randomized Controlled Trials
- Real World Evaluation Strategies
- Reducing Obesity-Related Health Disparities in Hispanic an...
- Research Integrity in Public Health
- Resilient Health Systems
- Rural Health in the United States
- Safety, Patient
- School Health Programs in the Pacific Region
- Sex Education in HIV/AIDS Prevention
- Skin Cancer Prevention
- Smoking Cessation
- Social Determinants of Health
- Social Epidemiology
- Social Marketing
- Statistics in Public Health
- STI Networks, Patterns, and Control Strategies
- Systems in the United States, Public Health
- Systems Modeling and Big Data for Non-Communicable Disease...
- Systems Theory in Public Health
- Traditional, Complementary, Alternative, and Integrative M...
- Translation of Science to Practice and Policy
- Traumatic Stress and Post-Traumatic Stress Disorder
- Tuberculosis among Adults and the Determinants of Health
- Unintentional Injury Prevention
- Urban Health
- Vaccine Hesitancy
- Violence Prevention
- Water Quality
- Water Quality and Water-Related Disease
- Weight Management in US Occupational Settings
- Welfare States, Public Health and Health Inequalities
- Worksite Health Promotion
- World Health Organization (WHO)