Examining intersectoral integration for malaria control programmes in an urban and a rural district in Ghana: a multinomial multilevel analysis

Abstract

BackgroundIntersectoral integration is acknowledged to be essential for improving provision of health care and outcomes, yet it remains one of the main primary health care strategic challenges. Although this is well articulated in the literature, the factors that explain differentials in levels of intersectoral integration have not been systematically studied, particularly in low and middle-income countries. In this study, we examine the levels and determinants of intersectoral integration amongst institutions engaged in malaria control programmes in an urban (Kumasi Metropolitan) district and a rural (Ahafo Ano South) district in Ghana.MethodsInterviews were conducted with representatives of 32 institutions engaged in promoting malaria prevention and control. The averaging technique proposed by Brown et al. and a two-level multinomial multilevel ordinal logistic regression were used to examine the levels of integration and the factors that explain the differentials.ResultsThe results show high disparity in levels of integration amongst institutions in the two districts. Integration was higher in the rural district compared to the urban district. The multivariate analysis revealed that the district effect explained 25% of the variations in integration. The type of institution, level of focus on malaria and source of funding are important predictors of intersectoral integration.ConclusionAlthough not causal, integrated malaria control programmes could be important for improving malaria-related health outcomes in less developed regions as evident from the rapid decline in malaria fatality rates observed in the Ahafo Ano South district. Harmonisation of programmes should be encouraged amongst institutions and the public and private sectors should be motivated to work in partnership.

Intersectoral collaboration for the prevention and control of vector borne diseases to support the implementation of a global strategy: A systematic review

“…Of 50 studies analysed in this review as shown in S4 Table , there were only three studies that measured the intersectoral collaboration in VBDs program [ 55 , 74 , 75 ]. No study undertook a component analysis (for different sectors or different activities).…”

“…One study in Ghana measured the level of intersectoral integration in malaria control and factors associated with differentials in the levels of intersectoral integration. By using scoring interview results from 32 different institutions to calculate the level of integration, the findings revealed that level of disparity among institutions, the type of institution, level of focus on malaria and source of funding, district effect (rural vs urban) were important predictors associated with the level of intersectoral integration [ 74 ].…”

“…It is concerning that only three studies measured the indicators of ISC with a different method of analysis. Two studies [ 74 , 75 ] used qualitative methods, and one study [ 55 ] used quantitative methods with RCT design to compare areas with and without ISC involvement and/or ISC involvement plus community participation. So, based on the evidence from this review we cannot make recommendations on indicators of ISC that best fit these approaches although some examples of what have been used have been identified [ 74 ].…”

“…Two studies [ 74 , 75 ] used qualitative methods, and one study [ 55 ] used quantitative methods with RCT design to compare areas with and without ISC involvement and/or ISC involvement plus community participation. So, based on the evidence from this review we cannot make recommendations on indicators of ISC that best fit these approaches although some examples of what have been used have been identified [ 74 ]. However, there is framework for the vector control aspect of monitoring and evaluation ISC in IVM that can be use incorporated into the evaluation of ISC in broader VBDs prevention and control [ 82 ].…”

Organizational leadership perspectives in implementation of the One Health approach: A case of the Zoonotic Disease Unit and core One Health implementers in Kenya

“…Various authors have stated the need to generate more evidence to inform concrete policy shifts toward adoption of OH approach at these levels [2,13]. Diverse factors such as awareness, leadership, technical capacities, and policies influence intersectoral collaboration [14][15][16]. Knowledge of how these factors influence implementation of the OH approach can contribute to the evidence that is needed to inform policy shifts toward practical adoption of the approach.…”