Introduction
The success of the Sustainable Development Goals (SDGs) is predicated on multisectoral collaboration (MSC), and the COVID-19 pandemic makes it ever more urgent to learn how this can be done better. Complex challenges facing countries, such as COVID-19, cut across health, education, environment, financial and other sectors. Addressing these challenges requires the range of responsible sectors and intersecting services – across health, education, social and financial protection, economic development, law enforcement, among others – transform the way they work together towards shared goals.
Existing challenges and inequalities experienced by women, children and adolescents, are and will continue to be exacerbated by COVID-19 and require a multisectoral response [
1]. The downstream effects of public health distancing measures, such as shutting down schools and non-essential businesses, quarantine and social isolation measures and avoiding large crowds, affect the poor and vulnerable the most and have a disproportionate effect on women, children and adolescents [
2]. For example, lockdowns and quarantine due to COVID-19 contributed to reported rises in domestic violence, requiring multiple sectors to work together to ensure appropriate care and support for survivors of violence [
3]. During COVID-19 restrictions health and social support services need to be reinforced and extended, such as emergency phones and 24-h hotlines and temporary shelters for survivors. First responders must also be adequately equipped to address violence against women and make prompt referrals to support services. The security and justice sectors need to promptly process complaints and protection orders and adjust security restrictions during the pandemic, such as in Spain where women who leave a situation of violence are exempt from lockdown. Partnerships with communication and private sector providers can help to expand technology-based solutions. One example is smart phone applications which can be used during lockdown restrictions to increase access to information on violence against women, service provision, and data collection [
4,
5].
The need for MSC is not only vital in the context of the COVID-19 pandemic. The SDGs are explicitly multisectoral and require a joined up way of working to tackle interconnected global health, environmental, social, economic, and institutional challenges [
6]. SDG 17 places partnerships and cooperation at the centre of sustainable development efforts. The need for establishing multi-stakeholder partnerships for sustainable development is explicitly encouraged at the SDG target level. Against this backdrop MSC is actively promoted as a central mechanism for the realization of the SDGs. Well before the SDGs, several important initiatives and policy frameworks considered partnerships as an effective instrument for realizing health and sustainable development, beginning with the 1978 Alma Ata Declaration on Primary Health Care [
7‐
10].
We use “multisectoral collaboration” to mean multiple sectors and stakeholders intentionally coming together and collaborating in a managed process (i.e. not ad hoc) to achieve shared outcomes and common goals [
11]. We used this definition for a series of multi-country studies conducted in 2018 by 12 low-, middle- and high-income country teams to identify “what works” in MSC at the intersection of health and sustainable development [
12]. Others have used a similar definition to allow for any combination of organizational types such as public–private partnerships, public–non-government partnerships, and whole-of-government initiatives working in specific policy and topical areas, including those relevant to the 17 SDGs [
13‐
15]. Multisector collaboration, cross-sectoral action and intersectoral action refer to a similar process and are often used synonymously.
While the necessity of MSC is recognized, research is needed to understand how sectors collaborate, inform how they could do so more efficiently, effectively and equitably, and ascertain similarities and differences across contexts. How it should be done in practice, or what works and does not work is not always clear both under conditions of an immediate crisis response and for sustainable development. To answer these key questions, research to strengthen the evidence-base on MSC is critical. Recent publications have looked at country case studies on how MSC works for health and sustainable development [
11], the governance of multisectoral action [
16], MSC research priorities on MSC for health and sustainable development [
13,
17] and methodological gaps in studies of MSC [
14]. To address these methodological gaps it is suggested more attention be given to the use of conceptual frameworks and mixed-methods, the organizational arrangements for collaboration, engaging non-traditional stakeholders, and the MSC context [
14]. However, these points appear to be more about research best practice overall than about what is unique to research on MSC.
This commentary builds on previous work to identify four considerations that are unique to MSC research and which will be of interest to other researchers undertaking studies of MSC. We draw primarily on the 2018 series of multi-country studies, with details on the 12 MSCs, actions taken and outcomes published elsewhere [
12]. In the discussion we reflect on the relevance of these considerations in the context of the COVID-19 pandemic and beyond.
Methods
This commentary is written by members of the 12-country study series research coordination and country teams. Issues were analyzed during the study period through ‘real-time’ discussions and structured reporting, as well as through literature reviews and retrospective feedback and analysis at the end of the study. We were able to reflect on what happened and why during the study, identify strengths and adaptations made, as well as areas for improvement.
For this paper we draw on four sources of information. First, the 12 country teams leading the development of each case study and seven international consultants provided ‘real time’ feedback during study coordination meetings and communication via email and phone calls. Second, towards the end of the study, eleven of the 12 country teams completed an online evaluation survey. The survey included both Likert scale and open answer questions about country teams’ experiences and learnings from the research process. A reporting template was also completed by six of the seven international consultants who provided technical and writing support to the country teams. Although time constraints prevented all the country teams and international consultants from completing the survey and reporting template, all had previously given ‘real time’ feedback. Lastly, retrospective post-study discussions were held by the country case study teams, the coordination team and partners during the launch of the series at the Partnership for Maternal, Newborn & Child Health (PMNCH) Partners’ Forum in New Delhi, India and subsequently by the authors in developing this paper. Three authors (RH, LS, JFV) analyzed the qualitative data and quantitative survey responses. Through discussions they identified emerging themes and key findings which were reviewed by co-authors.
Applying lessons for studying multisectoral collaboration in the context of COVID-19
The significant social, economic and political implications of the coronavirus pandemic demonstrate the interconnectedness of the SDGs and reminds us that building a robust evidence base on how to achieve effective MSC is an urgent priority. This paper contributes new knowledge on research methods for studying MSCs. To build the evidence, we propose four specific research considerations for future research on MSC.
Firstly, the knowledge base on MSC research, while limited, consistently highlights the overarching principle that one size does not fit all. Multisectoral collaborations are inherently context specific, complex and heterogenous [
11]. We therefore took a pragmatic approach to the development of the theoretical model for the case study series. We also propose a series of tools to support its application [
11]. The findings highlight the political nature of partnerships and collaboration, such as how MSCs are framed, coordinated, resourced and measured. We briefly reference the growing literature and other frameworks related to these issues, such as on network governance, interorganisational collaboration, joined- up government and HiAP, and as illustrated in Table
1. We encourage future research to further develop theoretical frameworks and engage with this literature on collaboration and partnerships and address the political dimensions of these efforts.
Because MSCs are forged in response to a unique problem or opportunity, this also determines the stakeholders and sectors involved [
11,
40]. In the context of COVID-19, an inclusive framing for MSC research would enable all sectors – health, water and sanitation, education, as well as cross-cutting areas such as gender, human rights, planning and finance among others – to see the relevance of the research, understand their respective roles and where they could best contribute their sectoral expertise in a coherent, connected way. These are important reasons to ensure that a research question and objectives are framed in a way to be relevant to all sectors.
Secondly, MSC is a dynamic process and stakeholders and their engagement may change across different components and contexts of the collaboration. MSCs also utilise a range of mechanisms and structures to support their collective action across sectors. We recommend future studies of MSC undertake a sectoral analysis to better understand these diverse ways of working, the structures that support or potentially discourage MSC, and different sectors’ contribution and actions. Assessing the co-benefits of interaction across sectors and the potential trade-offs can help to understand issues of authority and how conflict is managed as well as illuminate common interests and unexpected alliances through the MSC process [
29,
30]. These may also reflect the synergies and trade-offs between the 17 SDGs and 169 targets.
In response to COVID-19, many governments have set up multisectoral task forces to bring together sectors that are typically siloed. UN organizations such as the World Health Organization have also developed essential resources and good practices for coordinating a multisectoral response to COVID-19. A sectoral analysis is therefore critically important for research on MSCs in the context of COVID-19 to understand both the informal and formal mechanisms for collaboration, including if and how existing structures were built on, and if the MSC is robust and relevant enough to be useful moving forward. Exploring stakeholder assessments about the need to collaborate, or at least coordinate both during and beyond the pandemic is central to this analysis. In such a crisis, the situation is more complicated due to the speed of action required, the number of sectors and stakeholders involved and the decisions to make around the division of labor and funds to reach people during the pandemic. To maximize positive interactions for the MSC and mitigate negative ones [
30] it would be important to identify the ‘boundary spanning’ stakeholders who facilitate the sharing of information, build common understanding and manage relationships during the pandemic [
41].
Thirdly, we recommend a range of methods from diverse disciplines be employed to study MSC. A series of core questions should be considered in light of different theoretical frameworks and adapted to different contexts. A combination of qualitative and quantitative methods is also needed to produce the type of evidence and knowledge that can really inform decision-making. This point is exemplified in the context of COVID-19 as it would be necessary to consider key questions related to how approaches to MSC may have changed, during and beyond the pandemic. For example, the implications of restrictions on large gatherings may have contributed to novel and innovative forms of communication and mechanisms for collaboration across sectors and with the public. Democratic transparency and open information, supported by the technological deployment of public-health measures has been shown to be critical for citizen engagement in the COVID-19 response [
42].
Because the scope and nature of studies of MSC is diverse and contextual changes might occur, research questions and methods must be flexible and adaptable throughout the process to ensure the relevance of the findings. Understanding rigour in mixed-methods research is critical for multidisciplinary research teams. For future studies, researchers could benefit from practical guidance for establishing and assessing rigour for an integrated mixed-methods study of MSC, beyond addressing quantitative and qualitative quality criteria. These issues are especially critical for MSC research in the COVID-19 context where qualitative and quantitative data is being harnessed in multiple ways across relatively short timescales, including to predict and measure the spread of disease, track and monitor behaviour, coordinate volunteers, and identify the most vulnerable.
Lastly, the SDGs provide a shared framework with agreed health and sustainable development indicators beyond a single sector or discipline and which give consideration to cross cutting issues such as human rights and gender equality [
29]. Definitions of success in MSCs also go beyond standard health and development metrics and include the process and dynamics of the collaboration itself, for example on the dynamics and strength of relationships across sectors [
12,
29,
40].
This is particularly relevant in the context of COVID-19 given social distancing and lockdown interventions aimed at reducing COVID-19 transmission impact on other sectors such as the economy, education, safety and security, as well as other areas of health, such as mental health, domestic violence and treatment seeking and access to care for other health conditions. Therefore, MSC research impact could range from stemming the spread of the disease, to community knowledge and practice (e.g. of new social distancing norms), to measures of human rights and civic engagement. The strength and sustainability of the MSC itself should also be considered, such as measures of awareness and understanding among stakeholders about the need for effective MSC, during and beyond the pandemic.
This could help to help transform a study from reporting on indicators to exploring the “why” and “how” of related changes in the context of the MSC and that are translatable into action. Understanding what works and what does not work in MSC, especially during times of crisis, should also be analysed from multiple perspectives. It could also provide useful lessons on how to capture and report on common priorities across sectors for women, children and adolescents to inform future actions.
In attempting to understand and communicate the success factors of MSC, important contextual factors and stakeholder relationships which influence what does not work may be missed. Challenges and failures provide opportunities to improve ways of working and has longer term implications for the design, implementation and impact of MSCs, as emphasized in the editorial accompanying multi-country series [
12]. Areas for further work must focus on the development and standardisation of indicators, including measures of success and failure. The framing of studies explicitly around challenges as well as successes would encourage a genuine “learning society” approach. The MSC series shows that countries are willing to use these methods and generate new learning when the process is made inclusive and stakeholders can see the benefits of working together.
Researchers need to strike a balance between measures of progress and methodological processes that are as robust as possible from a research perspective but also feasible, timely and useful for capturing the reality of MSC and to inform decision making for policy and practice. The unprecedented nature of COVID-19 provides a valuable opportunity to design and test innovative research MSC approaches to track different measures of progress to inform the short and long-term response to the pandemic and its reporting. In doing so it would also be important to understand if the hard-learnt lessons of the multisectoral response to the Ebola epidemic have been taken on-board to avoid repeating the same mistakes [
43]. Similarly, to prevent entrenching social, health and environmental inequalities that followed the 2008 financial crisis, there are calls to ensure the response to the economic recession stimulated by the pandemic looks to the good of the whole of society, and especially women who make up the majority of the newly unemployed, and not just focus on the economy [
44,
45].
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.