Examining dynamics and factors influencing the collaborative process during implementation of multisectoral public health action plans: A case study of the Uganda Nutrition Action Plan

Abstract

Introduction: Multisectoral nutrition programs have been globally adopted to address malnutrition in all its forms. Malnutrition has various causal pathways that necessitate participatory design, implementation, monitoring and evaluation (P-DIME) of actions. However, effective participation - to the level of collaboration - requires alignment and/or tradeoffs in interests, values, and powers of the collaborating entities. In addition to the growing interest and investments in P-DIME, there is demand for information on the processes of delivering the participatory development plans. These processes remain less studied and undocumented. The Uganda Nutrition Action Plan (UNAP) is a multisectoral plan that has contributed significantly to the reduction in undernutrition in Uganda. This study examined the dynamics and factors that influence collaborative processes during implementation of the UNAP as a case of multisectoral health action plans. Methods: Twenty Key Informant Interviews and 28 documents provided information for this study. The interviews were conducted among representatives of key Ministries Departments and Agencies (MDAs) implementing the UNAP and representatives of the Scaling Up Nutrition Networks. Borrowing from public administration literature, this study utilized the integrative framework for collaborative governance to assess the dynamic processes (principled engagement, shared motivation and capacities for joint action) as well as the factors influencing them (drivers for collaboration and the system context) during UNAP implementation at national level. Results: Under principled engagement: Multisectoral technical coordination meetings were avenues for accountability and joint planning and, conflicts for mandates emanating in exclusion of some participants in UNAP activities stood out. Regarding shared motivation: trust, transparency and commitment varied across sectors with financial resources and individual’s characters being the fulcrum on which they revolved. Capacities for joint action revealed weak knowledge management, monitoring and evaluation systems which made continuous improvement hard to achieve. At sectoral and multisectoral levels also: financial, technical and human resources for UNAP implementation were limited with most being provided by donors. Factors influencing the collaborative processes included: policy and legal frameworks which were supportive; UNAP coordination which was lacking in crucial aspects and lax in exercising its political power over the collaboration; and the socio-political climate which was conducive but much underutilized. Conclusion: UNAP implementation processes lacked critical necessities such as impromptu conflict resolution measures, orientation of new members, monitoring and evaluation systems, etc. for sustainability and greater effectiveness of the plan. Improvements could be achieved through strengthened coordination of implementation using reforms in structural, financial, technical and human resource arrangements. Also, creatively addressing the interpersonal relations among representatives of collaborating institutions was requisite.