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Multisectoral Actions in Primary Health Care: A Realist Synthesis of Scoping Review

Resham B. Khatri ,Daniel Erku,Aklilu Endalamaw,Eskinder Wolka,Frehiwot Nigatu,Anteneh Zewdie,Yibeltal Assefa

Abstract

Multisectoral actions (MSAs) on health are key to implementation of primary health care (PHC) and achieving the targets of the Sustainable Development Goal 3. However, there is limited understanding and interpretation of how MSAs on health articulate and mediate health outcomes. This realist review explored how MSAs influence on implementing PHC towards universal health coverage (UHC) in the context of multilevel health systems.

Introduction

Intersectoral coordination is a fundamental principle of primary health care (PHC) depicted in the Declaration on PHC in Alma-Ata in1978. In the Declaration, intersectoral coordination on health was described essential dimension to address the underlying factors of health [1, 2]. This concept includes political, administrative, and technical processes to negotiate and distribute power, resources, and capabilities between and across sectors that improve population health [2, 3].
 
Methods

After preliminary discussion among authors, we developed an conceptual framework showing the interlinkage of MSAs, PHC, and UHC (Fig 1). This framework represented three levels of MSAs influencing the implementation of PHC towards UHC. The MSAs can operate at three levels: a) distal (strategic actions at the higher level), b) intermediary (contextualisation of strategic MSAs at the operational level), and c) proximal (implementation of MSAs to generate health service and delivery and utilisation). This initial program theory further helped to inform the eligibility criteria and develop the search strategy for a systematic search and explaining/interpreting the findings [21].

Results

Intersectoral coordination is a fundamental principle of primary health care (PHC) depicted in the Declaration on PHC in Alma-Ata in1978. In the Declaration, intersectoral coordination on health was described essential dimension to address the underlying factors of health [1, 2]. This concept includes political, administrative, and technical processes to negotiate and distribute power, resources, and capabilities between and across sectors that improve population health [2, 3]. 

Discussion

Three mechanisms of MSAs contributed to policy and implementation of PHC: working as strategic, operational and implementation levers. First, strategic macro-level actions contributed to all policy collaboration in governance, and health actions; second, the meso-level MSAs effectively addressed the spillover effects of other sectors by contextualising strategic levers. Third, micro-level MSAs were found to be engaging the community and services providers for health promotion, prevention of diseases and provision of integrated public health services.

Conclusion

Multisectoral actions can contribute to PHC by enabling policy actions of other sectors and a wide range of stakeholders involved in the processes influencing at macro, meso and micro levels of health systems. Macro-level MSAs ensure strategic policy actions on health by bringing actors and sectors together. Higher-level working groups, coordination committees, and multisectoral secretariat are some macro-level institutional arrangements that could collaborate for MSAs on health. Such arrangements could help to produce multisectoral policies, plans and strategies to address macro-level SDoH. At the meso-level, stakeholders of the non-health sector could fix the spillover effects of health, potentially reducing the collateral impacts on health systems

Citation: Khatri RB, Erku D, Endalamaw A, Wolka E, Nigatu F, Zewdie A, et al. (2023) Multisectoral actions in primary health care: A realist synthesis of scoping review. PLoS ONE 18(8): e0289816. https://doi.org/10.1371/journal.pone.0289816

Editor: Krishna Kumar Aryal, University of Bergen, NEPAL

Received: April 5, 2023; Accepted: July 27, 2023; Published: August 10, 2023

Copyright: © 2023 Khatri et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting Information files.

Funding: The author(s) received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0289816#abstract0


 

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