Key Element 6: Collaborate Across Sectors and Levels

A population health approach calls for shared responsibility for health outcomes with multiple sectors and levels whose activities directly or indirectly impact health.

What is collaboration across sectors and levels?

Intersectoral collaboration is the joint action taken by health and other government sectors, as well as representatives from private, voluntary and non-profit groups, to improve the health of populations.

Intersectoral action takes different forms such as cooperative initiatives, alliances, coalitions or partnerships.

Successful intersectoral initiatives have early engagement of potential partners from sectors outside health, as well as from different disciplines and levels within the health sector.

Effective collaboration is more likely to occur when participants have a clearly stated purpose, based on shared values and interests. It is important to recognize that participating partners often place value on different things; the aim of collaborative work is to find common ground and to generate collective action to improve health.

Establishing this shared purpose allows partners to see how participation will help them to achieve their own mandate, as well as contribute to the larger good. Intersectoral action should be viewed as a “win-win” situation, whereby each party gains something, as opposed to a competitive exercise based on sectoral “imperialism,” where one sector is seen as benefiting from the work of others in fulfilling its own purpose or mandate.

Resources to Increase Understanding:

What are the different kinds of collaborations and alliances?

Key question

  • What is the ideal nature of the developing alliance?

A) What is the ideal nature of the developing alliance?

Alliances can vary in a number of ways:

  • The concentration along the horizontal dimension (i.e. between sectors) and the vertical dimension (i.e. within sectors)
  • The choice of champions
  • Resource allocation
  • The role of the health sector as either a leader or a facilitator
  • The connection to the political level

The concentration along the horizontal and vertical dimensions

Intersectoral collaboration can be defined as existing along two dimensions, the horizontal and the vertical.

The horizontal dimension links the health sector with different sectors. This can be with other government sectors, such as finance, justice, environment and education, as well as with non-governmental representatives from the voluntary, non-profit and private sectors.

The vertical dimension links different levels within a given sector. Collaboration along the vertical dimension helps to ensure better coordination and alignment of purpose between, for example, different levels of an organization such as front line workers and centralized policy makers, different levels of government such as municipal and provincial counterparts, or different geographic regions of a country such as Atlantic and Central Canada.

Both horizontal and vertical relationships and collaboration are important to achieve health gains under a population health approach.

The choice of champions

Successful intersectoral collaboration requires a champion; as was discussed in Key Element Four, political support is key to encouraging action on many of the determinants of health which fall outside the direct influence of the health sector. Although “champion” typically refers to an individual, it may also take the form of a group or collection of individuals. Champions are the public face. They generate interest and excitement and rally support to move a population health agenda forward. An effective champion:

  • is trusted, respected, non-partisan (that is, not attached to any particular political agenda), and works effectively with political leaders
  • is strongly committed to the determinants of health philosophy
  • welcomes, encourages and successfully brokers multiple and varying perspectives to shape a population health agenda.

Resource allocation

Collaborative work requires personnel and money. Partners must have the ability to commit resources if the collaboration is to be effective. Personnel should be well-trained, specifically assigned to population health work, and drawn from a multitude of disciplines and professions. Dedicated time to undertake this work is also important. Collaborative work requires:

  • a human resource plan that is documented and agreed to by all partners
  • the identification of skill requirements and opportunities for training and development
  • the sharing of examples of innovative working methodologies.

In terms of finances, intersectoral collaboration requires consensus on a cost sharing plan.

The role of the health sector as either a leader or a facilitator

The health sector can assume one of two roles in intersectoral action for health: leader or facilitator. Typically, the health sector assumes a leadership position in those population health initiatives that relate most directly to its mandate and fall within its realm of expertise. These include, but are not limited to: health promotion, disease and injury prevention, health protection, population health assessment, health surveillance, and health services. The health sector takes the role of facilitator when population health initiatives extend beyond established health interests or capacities, for example, education, transportation or employment issues. The facilitation role would include supports for advancing the case for action, providing ideas, identifying resources, etc.

The connection to the political level

A population health approach is dependent upon political support and a public policy environment that supports collective action.

The success of intersectoral initiatives is greatly improved by a direct link to the political level. This can be accomplished through the involvement of politicians (e.g. membership on a committee) or through a clear liaison to senior administrative officials. Visible political support and commitment motivates and sustains partner participation and ensures access to necessary supports.

How will collaboration across sectors and levels take place?

6.1 Engage partners early on to establish shared values and alignment of purpose

This step is best done meeting face to face, where partners can speak to values and purpose, using stories and narrative, as well as making reference to more formal documents. It is important to identify common core values early on, as this is the foundation upon which the collaboration is based.

6.2 Establish concrete objectives and focus on visible results

Many group methods, preferably face to face, can be used to generate objectives. Focus first on identifying objects of change, including populations, organizations and policies. Once that is done, identify the most important changes to be made. Finally, establish targets for the change, including the amount of change and milestone dates. It is best to have a small number of people write the actual objectives, while using the large group of partners to identify possibilities and help in appraising the final product.

6.3 Identify and support a champion

Frank and open discussion, in which promising choices are considered against the chosen criteria, is the best way to select a champion, be it individuals or a group.

The champion can be supported by providing them with background information highlighting important message concepts, key facts and statistics, stories, and compelling ways to make the points), and by assisting them in preparations for key communications, as well as evaluations and de-briefings.

6.4 Invest in the alliance building process

A sound partnership clearly outlines mutual expectations and obligations in the areas of personnel and money. Partners may have other costs, such as foregoing other opportunities and exposing themselves to potential risks.

6.5 Generate political support

Working with decision-makers and those that influence them can help generate support for your issue. Where appropriate, public support can be built through paid and earned media; one way to do this is by staging events. A variety of communication methods is ideal, beginning with relatively low profile correspondence and developing into meetings. Medium and high profile tactics to gain support may also be needed over time.

6.6 Share leadership, accountability and rewards among partners

Planning for the alliance must include carefully outlining responsibilities in terms of roles. Roles can vary and may relate to things both inside and outside of the operation of the alliance. For instance, leadership of the alliance can be shared through distributed roles or by changing roles (e.g. a rotating chairpersonship). There are many tools for assigning roles and identifying who is responsible, who is accountable, who is supporting, who is approving, and who is being informed as work proceeds. Mechanisms for monitoring progress and accountability are essential, as are plans for sharing anticipated gains.

Resources that Build Capacity:

What decision-making frameworks or guides can help facilitate the development of effective partnerships?

What do you have at the end of Key Element 6?

  1. A shared understanding regarding the undertaking’s vision, its goals and objectives, its structure, the roles assigned, and the resources to be provided.
  2. This understanding reflected in written documents, such as terms of reference and letters of understanding.

How does this Key Element relate to the others?

  • It allows for the implementation of a range of investments, interventions and strategies (Key Elements 4 and 5)
  • It opens the door for public involvement (Key Element 7).

Why is this Key Element important?

  • It makes possible the joining of forces, knowledge and means to understand and solve complex issues whose solutions lie outside the reach of a single sector.
  • It builds effective working relationships, which are vital to the successful implementation of many health programs, policies and services.

Examples Illustrating Application:

What is an example of an intersectoral collaboration to improve health?