Towards a framework for multisector and multilevel collaboration: case of HIV and AIDS governance in South Africa

ABSTRACT

Background: While multisectoral action (MSA) is advocated as one of the strategies to address complex health and development challenges, there is limited clarity about the process of multisector collaboration in practice.

Objectives: Informed by the findings of the research on implementation of the multisectoral response to HIV in South Africa, and drawing from the existing literature; we propose a framework for multisector and multilevel collaboration. The framework describes key components of the process of multisector collaboration, and aims to inform policy and practice.

Methods: An integrative review and synthesis of existing frameworks, models and approaches on multisectoral action in public health, governance and health, and in public administration was conducted to inform the development of the proposed framework.

Results: There are seven key components that are critical in the process of multisector collaboration namely: preconditions; key drivers; structure; mechanisms; administration; execution and evaluation. Multisector collaboration is presented as an iterative process that allow for improvement and learning. The framework is presented through a visual representation which shows how the seven elements are connected, and how learning happens through-out the multisector collaboration process. Structure and mechanisms are the two central and interrelated elements of the proposed framework.

Conclusion: The framework does not suggest that multisector collaboration is a panacea, but that MSA remains critical to address complex health and development issues. Focus should be on finding innovative ways to inform and strengthen its implementation in practice. The framework can be used by practitioners and policy makers to inform design, implementation, and evaluation of multisector collaborations. It reflects on complexities of MSA, and brings to the fore critical information to assess readiness and to inform the decision whether to engage in MSA or not.

KEYWORDS:

• Multisectoral action
• HIV response
• framework
• collaboration
• South Africa

Responsible Editor

Jennifer Stewart Williams, Umeå University, Sweden

Responsible Editor

Jennifer Stewart Williams, Umeå University, Sweden

Acknowledgments

The authors thank all members of the South African National AIDS Council and AIDS Council members in Mpumalanga province, HIV coordinators in district and local municipalities, key informants from selected government departments, and technical advisors supporting implementation of the multisectoral response to HIV in the province for their participation in the study.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics and consent

This study is part of a large doctoral research project approved by the University of the Witwatersrand Human Research Ethics Committee (Medical), protocol (M120657).

Paper context

Multisectoral action is often recommended as a strategy to address complex challenges in society, yet there is limited reflection on its implementation in practise. Existing frameworks on MSA mainly describe prerequisites, with limited explanation of MSA implementation process. A framework for multisector and multilevel collaboration is proposed to advance knowledge about process. Key elements are preconditions, drivers, structure, mechanisms and processes, administration, execution and evaluation. The framework can be used to inform theory, policy and practice.

Additional information

Funding

The PhD is funded by the South African Medical Research Council (SA MRC) and the SARChi Chair in Health Policy and Systems Research, Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand. Data collection was funded by the African Population Health Research Center (APHRC) for the African Doctoral Dissertation Research Fellowship (ADDRF) in partnership with the International Development Research Centre (IDRC).

Notes on contributors

Pinky Mahlangu

PM conceptualised the study, collected and analysed the data. She also conducted the review and synthesis of existing frameworks, and wrote the article. JG contributed in the review, and in substantially revising and writing of the article. JV contributed in revising of the manuscript. All authors have read and approved the final version of the manuscript.