Intersectoral coordination in India for health care

advancement

By Dr Monisha Mary
 Specific Learning Objectives

At the end of the session the audience should be able to ;

Explain the concept of Inter-Sectoral Coordination (ISC) and

its need in development

Describe the mechanism of ISC in the health sector

Explain how inter-related sectors can contribute to improve

community health

Explain the strategies for implementing ISC in health

programmes and schemes 2
 Contents

Definition Need for ISC in

Health care
development

Benefits and
Strategies to
challenges of ISC
implement ISC implementation in
healthcare

3
Every piece
matters to
complete the
picture in a
jigsaw puzzle

4
 Determinants of health

Genetic Environment Societal Structures

Biological Culture Policies

Lifestyle

5
Health in All Policies in the European Union and its member states : 2006
 Definition of ISC

A recognized relationship between part or

parts of the health sector with part or parts of
another sector which has been formed to take
action on an issue to achieve health outcomes
In a way that is more effective, efficient, or
sustainable than could be achieved by the
health sector acting alone.

Proceedings of International Conference on intersectoral Action for Health. World Health Organization,
6
Halifax, Canada, April 1997
 Effective Health Sector Coordination =

Recognized Relationship Action on an Issue Achieve Health Outcomes

Education + Health
School Health Programme Healthier lifestyles
Department

Greater Effectiveness, Efficiency, and Sustainability ​

7
 Evolution of ISC Action in Public Health

WHO hosts a special

International Conference on Primary Health
1978 Care in Alma-Ata, Kazakhstan (Soviet Union)
conference on IA in 1990s
1997
Introduction of the Bangkok Charter for
concept of Intersectoral Health Promotion in
Action (IA) 2000

European Union
The Ottawa
introduces Health in All
1980 Charter Policies directive 2006
Underscored the
need to work Health in all Policies
between sectors to
realise health gains

8
 Sectors suitable for ISC for healthcare advancement
Rural Development, Cooperatives, Industries,
Panchayats and Voluntary Organizations

Animal
Agriculture, Husbandry
Irrigation Education

Food, Social and Housing and

Women's Welfare Public Works,
Communication

9
Supply of Safe Water in Ira Village

Agriculture Co-ordinating and co-

operating with public health
sectors

Education School health education

Supply of Safe Water
Panchayati Raj Finance for maintenance of
water sources

Social Organising women self help

Welfare/Women groups
and Child
Development 10
 Prevention and Control of Locally
Endemic Diseases

Animal husbandry Immunisation of cattle

and domestic animals
Education Education in early
diagnosis and
Prevention and Control of Locally Endemic Diseases:
prevention
Panchayati Raj wall painting,
posters and folk
media.
Social Welfare/Women self-help groups,
and Child mothers’ committees
Development
11
 Model A

Enormous
Village level wastage of
resources

Model A is
integrated and
lack intersectoral
coordination
12
Model B

Cost
Effective

Model B is
integrated and encompass
intersectoral coordination

13
 Beti Bachao Beti Padhao(BBBP)
scheme incorporates ISC to address son preference at the
family and community levels

Beti
Identify
Bachao
Son
Beti ISC in
Preferenc Normative
Padhao" BBBP Evaluation
e as a Behavior
(BBBP)
Barrier
Beti Bachao Beti Padhao" scheme incorporates intersectoral coordination to address son preference at the family
andScheme
community levels

14
14
 BBBP, in collaboration with other sectors

Give your girl child a pencil, not to wash your utensils.

Education Media Communtiy

sector Sector sector
\

15
 Intra-sectoral Co-ordination
Family
Welfare

Nursing Health Sector AYUSH

Intra-sectoral Co-ordination

Homeopathy
16
 Inter-Sectoral Co-ordination
Women / Child Education
Welfare

Animal Food / Civil

Husbandry
Health Sector Supplies
Intra-sectoral Co-ordination

Rural Development
/ Panchayati Raj Public Health Agriculture

17
 National Health Mission

Health System Communicable

Strengthening Diseases

National Rural Health Mission

Reproductive,
Non-
Maternal,
Communicable
Newborn, Child,
Diseases
and Adolescent
(NCDs)
Health

18
 Swachh Bharat Mission (SBM)

Environment
Urban
, Forest and
Develop
Climate
ment
Change

Involves coordination between the Ministry of Women and Child Development, Department of Health and Family
Welfare, Department of Education, Department of Rural Development, and others. The goal is to improve the
health, nutrition, and education of children and
Rural mothers.
Ministry
Develop
Objective: Address complex of Jalholistic development outcomes.
issues that intersect multiple sectors to achieve
ment
Implementation: Collaborative efforts such asShakti
providing

Health
and
Education
Family
Welfare
19
 Guiding Principles

Development is basic to
01
health

02 Equity

Promoting Economic
03 Capacity of the Poor People

20
 Importance of ISC

25%
ISC & primary health care (PHC)

01

20%
ISC & Sustainable
development goals (SDGS)
02

03 25% ISC & Health care advancement

04

30% ISC & Mental health promotion

21
 ISC & primary health care (PHC)

ISC is one of the

principles of primary
healthcare

22
 Ayushman Bharat - Health and Wellness Centres (HWCs)

Implementation of HWCs

Support infrastructure
development
and community
engagement.

Promote health education

and awareness in schools.

Integrate maternal and

child health services
with HWCs
23
23
ISC : A Key Strategy for Achieving SDGs in
Health

24
ISC & Health care advancement

• Nutrition and Agriculture

• Education Sector
• Water and Sanitation
• Housing and
Infrastructure
• Media and Legislation

25
 Promotion of Nutrition

Organise
02 sessions on
03
01 food, food
Education hygiene
Social Welfare
Agriculture nutritional
Pulses, oil supplements
seeds, to grow kitchen

04
Primary health
vegetables gardens , reward centres
and local fruits the best garden
Panchayat and healthy
Raj mother and baby
26
 Promotion of Nutrition

Co-operative
To store agricultural
Animal produce Banks
Husbandry
Financial assistance to
monitoring health of villages
animals

27
ISC and Mental health promotion

28
 National Mental Health Programme (NMHP) in
India
Integration of Cross-Sectoral
Services Partnerships
District Mental Health
Ministry of Social
Programmes (DMHPs)
Justice and
Ministry of Health and
Empowerment
Family Welfare

Community Capacity
Participation Building and
Training
Health workers,
Academic institutions
volunteers, and local
and professional bodies
organizations
NGOs

29
 APPROACHES
TO ISC in
HEALTH

General strategy Alternative approach

Identify Issue-centered
approaches and strategy
opportunities

30
 APPROACHES TO
ISC ON HEALTH
(Examples)

Swachh Bharat Abhiyan Kudumbashree in Kerala

Driven by Central Initiated by the
Authorities: Initiated Government of Kerala
and led by the central but driven by local self-
government help groups (SHGs).

31
 Steps to implement ISC

Listing out the

01 programmes

Identifying the
02 areas

Knowing the
03 categories

Locating the
04
levels

32
 Steps to implement ISC

Forming co-ordination
05 committees

Forming of
06 operation teams

List out names of

07
sectors

Identify the non-

08 governmental

33
 Steps to implement ISC

Constitute co-
ordination committees

Formulate specific
9 task-forces

Come up with an
10 action plan

Develop a plan of
action

34
 Requisites for effective ISC

Establishing Defining common

an overall limits by setting
inter-sectoral parameters for
strategy sectoral activities

Establishing
commonly Resolving of
agreed or inter-sectoral
binding differences
priorities
35
 Requisites for effective ISC

Avoiding policy
Information
divergences Consultation with
exchange among
among sectors and others
sectors
seeking consensus

36
ISC in POSHAN
Abhiyaan

37
 POSHAN Abhiyaan: Integrated Nutrition Initiatives
Take-Home Rations Pradhan Mantri Surakshit Matrutva
from Anganwadi Centres Abhiyaan
Pradhan Mantri Matrutva
Vandana Yojana

Anaemia prevention and Janani Suraksha

control via Anaemia Mukt Yojana
Bharat (AMB) Janani Shishu Suraksha
Karyakram

Abhiyaan P. PRESERVING PROGRESS ON NUTRITION IN INDIA 2021 38

POSHAN Abhiyaan conceptualized convergence at two levels

Two levels

Governance Impact level

level

39
Abhiyaan P. PRESERVING PROGRESS ON NUTRITION IN INDIA 2021
 Governance level

Institutional mechanisms
01 for coherent engagement

Quarterly review meetings

02 - Development of
Convergence Action Plan

Implementation challenges
03 and gaps identified

40
Abhiyaan P. PRESERVING PROGRESS ON NUTRITION IN INDIA 2021
 Impact level
Coordination challenges
Effective convergence for
at frontline (Anganwadi,
addressing under-nutrition
ASHA, ANMs)
|

Success measured by reach

to same household, woman,
and child in the 1,000-day period

Abhiyaan P. PRESERVING PROGRESS ON NUTRITION IN INDIA 2021 41

 A ‘Call to Action’ for Poshan

Recognized as
a key
development Poshan
issue affecting Maah
body, brain, and
mind.

42
Poshan Abhiyaan - Jan Andolan. Available at: https://poshanabhiyaan.gov.in:443
 Poshan Maah and Intersectoral Coordination

Partnership Partnership
with Women Partnership with Community with Private
Partnership Media
Collectives Youth Sector
with Media
Collectives
43
Poshan Abhiyaan - Jan Andolan. Available at: https://poshanabhiyaan.gov.in
44
45
Operational Challenges Solution

Generic discussions

Optimize reporting
structures and
platforms,
Empowerment issues at improve frontline
lower levels
coordination
through clear
directives

Data reporting challenges

46
Poshan Abhiyaan - Jan Andolan. Available at: https://poshanabhiyaan.gov.in
Benefits of Inter-Sectoral Co-ordination (ISC)

01 03

to achieve goals which Reduce the cost of

cannot be achieved alone implementation of schemes

02 04

Timely achievement of Inbuilt monitoring and quality

target goals. assurance measures
47
It’s all about different parts of society coming together to make
sure everyone can be healthy

48
References
1.WHO. Declaration of Alma-Ata. International Conference on Primary Health Care, Alma-Ata, USSR, 6-
12 September 1978.
2.WHO (1997) Intersectoral action for health: a cornerstone for health-for-all in the twenty-first century.
Proceedings of International Conference on intersectoral Action for Health. World Health Organization,
Halifax, Canada, April 1997.
3.N.I.H.F.W. (1981), Health for All, (Report of Working Groups), Governmentof India, New Delhi.
4. Khan, A.M (2004), Panchayat in Health Sector, Social Change, Vol.34, No.4:pp. 47-60.
5.Irwin A, Scali E (2007), Action on the Social Determinants of Health: AHistorical Perspective, Global
Public Health, 2(3): pp.235-256.
6.Scharpf, F.W. (1993), Co-ordination in Hierarchies and Networks. In:Scharpf, F.W. (Hg.): Games in
Hierarchies and Networks. Westview Press,Boulder. pp.125-166.
7.Kishore.J. National Health Programmes of India.11th edition.New Delhi. Century publication.2005.
p.219-220.
8.CSDH: Closing the gap in a generation: health equity through action on the social determinants of
health. 2008, Geneva: World Health Organization. Final Report on the Commission on Social
Determinants of Health.

49
Thank you