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Can Adopting a Priority-Setting Paradigm Help the Ministry of Health Effectively Promote Intersectoral Actions for Health?
Wafa Aftab,1,2 Ole Frithjof Norheim,2 Inger Lise Tieg,2 Sameen Siddiqi,3 Jesse Bump1
¹ Takemi Program in International Health, Harvard T.H Chan School of Public Health
² Department of Global Public Health and Primary Care, University of Bergen, Norway
³ Department of Community Health Sciences, Aga Khan University, Pakistan
Background
About 80% of modifiable determinants of longevity and quality of life pertain to social and economic factors, health behaviors, and the physical environment—i.e., the social determinants of health.1 Health policy agendas predominantly focus on healthcare, but given the profound influence of social determinants, must give attention to determinants outside the health sector.
Intersectoral actions, where health ministries collaborate with non-health sectors to address determinants of health, are crucial for improving population health and reducing health inequities. Health ministries commonly use priority setting methods to determine policy priorities for clinical care, but these methods have not been applied to intersectoral actions until recently.
Methods
A qualitative case study was conducted of an intersectoral priority setting exercise by the federal Ministry of Health in Pakistan. The objective was to understand if priority setting could be a useful approach for health ministries to steer intersectoral actions across sectors. In-depth interviews were conducted with fourteen policy makers and experts from health and other sectors. A reflexive thematic analysis was done.
Theoretical Support for the Analysis
We reviewed frameworks of priority setting and found that they can provide general guidance about principles and methods applicable to priority setting of intersectoral actions. But these frameworks do not consider the broader political landscape of intersectoral policies. Therefore, we further reviewed literature on political agenda setting to understand the political context of priority setting. The two sets of literature also informed our understanding of interactions between the technical process of priority setting and the political context across sectors.
Findings and Implications
Theme 1: Intersectoral preventive actions for health are not a priority for health, other sectors, or the public
Key findings:
- Intersectoral actions become a priority when there is an emergency, heightened media attention, high-level political support, or economic consequences.
- Reactive, short-term decision making and political pressures direct policy focus to immediate and visible problems rather than long-term health risks.
Conclusion: For political and systemic reasons preventive actions for health are not an investment priority.
Theme 2: Existing institutional mechanisms, mandates and norms do not facilitate intersectoral actions for health
Key findings:
- Increasing policy support for intersectoral actions due to sustainable development agenda, donor requirements, and fiscal constraints across multiple sectors.
- Existing institutional mandates, mechanisms and norms are organized along strictly sectoral roles and prevent effective intersectoral collaboration.
Conclusion: Policy making institutions and culture have yet to evolve to fulfill the perceived need for intersectoral policies.
Theme 3: Health ministry does not effectively operate in the broader political space
Key findings:
- Health ministry operates within its limited sectoral space rather than undertaking broader political engagement.
- Health ministry setting intersectoral priorities without meaningful and consistent engagement with other sectors is not seen as an effective strategy.
Conclusion: Unless health ministry has the capability to effectively steer an intersectoral agenda across sectors, choosing priority intersectoral actions in isolation is not seen as meaningful.
Theme 4: Health ministry has a central role in raising the priority of the social determinants agenda across sectors
Key findings:
- Work on intersectoral actions in health ministry is opportunistic and incidental rather than a core policy agenda.
- Health ministry and public health institutions lack the technical capacity to support adoption and implementation of intersectoral actions across sectors.
- Health ministry should frame action on social determinants as a human development agenda rather than focusing only on health objectives.
Conclusion: Health ministry must expand its core policy agenda to include intersectoral actions and strengthen its analytical capacity and communication with other sectors.
Theme 5: Priority setting can be a useful approach but needs to be developed beyond its application to healthcare
Key findings:
- A priority setting approach can allow the health ministry to identify its own priorities for intersectoral actions on social determinants.
- The health ministry struggled to identify which substantive criteria to use, how to apply them given the sparse evidence, how to appropriately capture the impact of intersectoral policies, and how to conduct an effective priority setting process involving different sectors.
Conclusion: Health ministries need theoretical and empirical support to inform normative choices, policy impact valuation, and coordinating priority setting across a wide range of stakeholders.
References
- Park, M. et al. (2015). Relative Contributions of a Set of Health Factors to Selected Health Outcomes. American Journal of Preventive, 49(6), 961–969.