Conceptual and institutional gaps: understanding how the WHO can become a more effective cross-sectoral collaborator

Abstract

BackgroundTwo themes consistently emerge from the broad range of academics, policymakers and opinion leaders who have proposed changes to the World Health Organization (WHO): that reform efforts are too slow, and that they do too little to strengthen WHO’s capacity to facilitate cross-sectoral collaboration. This study seeks to identify possible explanations for the challenges WHO faces in addressing the broader determinants of health, and the potential opportunities for working across sectors.MethodsThis qualitative study used a mixed methods approach of semi-structured interviews and document review. Five interviewees were selected by stratified purposive sampling within a sampling frame of approximately 45 potential interviewees, and a targeted document review was conducted. All interviewees were senior WHO staff at the department director level or above. Thematic analysis was used to analyze data from interview transcripts, field notes, and the document review, and data coded during the analysis was analyzed against three central research questions. First, how does WHO conceptualize its mandate in global health? Second, what are the barriers and enablers to enhancing cross-sectoral collaboration between WHO and other intergovernmental organizations? Third, how do the dominant conceptual frames and the identified barriers and enablers to cross-sectoral collaboration interact?ResultsAnalysis of the interviews and documents revealed three main themes: 1) WHO’s role must evolve to meet the global challenges and societal changes of the 21st century; 2) WHO’s cross-sectoral engagement is hampered internally by a dominant biomedical view of health, and the prevailing institutions and incentives that entrench this view; and 3) WHO’s cross-sectoral engagement is hampered externally by siloed areas of focus for each intergovernmental organization, and the lack of adequate conceptual frameworks and institutional mechanisms to facilitate engagement across siloes.ConclusionThere are a number of external and internal pressures on WHO which have created an organizational culture and operational structure that focuses on a narrow, technical approach to global health, prioritizing disease-based, siloed interventions over more complex approaches that span sectors. The broader approach to promoting human health and wellbeing, which is conceptualized in WHO’s constitution, requires cultural and institutional changes for it to be fully implemented.Electronic supplementary materialThe online version of this article (doi:10.1186/s12992-015-0128-6) contains supplementary material, which is available to authorized users.

Institutionalising an evidence-informed approach to guideline development: progress and challenges at the World Health Organization

“…Both authors have previous experience working with processes informing WHO guidelines and strategies, 24–26 and conducting and publishing studies involving qualitative methods to explore research questions on the role of national and international institutions in global health. 27 28 …”

Barriers to global health development: An international quantitative survey

“…Survey questions were extracted from previous articles discussing barriers to global health [ 2 , 3 , 6 , 7 , 11 , 12 , 13 , 14 ]. Items were then refined with the assistance of several global health experts.…”

“…Items were then refined with the assistance of several global health experts. Barriers for specific health areas (e.g., cancer [ 6 ]) or barriers focused on specific agencies (e.g., the WHO; [ 7 ]) were reworded to have a common structure and to focus upon global health broadly. The barriers also were reviewed more generally for wording and comprehensiveness with suggested additional barriers from the experts included after review.…”

“…A third type of analysis has examined broader, more systemic barriers to health care development but within a relatively limited organizational focus. Gopinathan et al [ 7 ], for instance, interviewed senior WHO staff to assist the organization improve cross-sectorial collaboration and concluded in part that the WHO’s cross-sector involvement is hampered internally by over-emphasis on a biomedical perspective on health.…”

Global governance and the broader determinants of health: A comparative case study of UNDP’s and WTO’s engagement with global health

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