The Role of Intersectoral Action in Response to COVID-19: A Qualitative Study of the Roles of Academia and the Private Sector in Colombia

Abstract

Background: The integration of health services with other sectors is hypothesised to support adaptation of health systems in response to coronavirus disease 2019 (COVID-19). This study identified barriers and enablers associated with intersectoral coordination at an early stage of the pandemic. The study focused on the roles played by the academic and private sector in different areas of public health planning and delivery concerning COVID-19 in Colombia. Methods: A qualitative approach was used to understand stakeholders’ experiences and perceptions of intersectoral working in response to COVID-19 in three Colombian cities (Bogotá, Cali and Cartagena). Between March and November 2020, data was collected via semi-structured interviews conducted online with 42 key actors, including representatives of governmental bodies, universities, and professional associations. The dataset was analysed thematically using a combination of inductive and deductive methods. Results: Organizations adjacent to the health system, including universities and the private sector, supported responses to COVID-19 by providing evidence to inform decision-making, additional service capacity, and supporting coordination (eg, convening intersectoral "roundtables"). The academic and private sector involvement in intersectoral coordination was stimulated by solidarity (being the "right thing to do") and motivation for supporting local companies (reopening the economy). Intersectoral working was influenced by pre-existing (substantive) and emerging (situational) enablers and barriers. Conclusion: This study showed that intersectoral coordination has played an important role in responding to COVID-19 in Colombia. Coordination was influenced by substantive and situational enablers and barriers. Based on our findings, policy-makers should focus on addressing substantive barriers to coordination, including the pre-existing tensions and mistrust among national and local healthcare actors, strict regulations and limited financial and human resources, while providing support for situational enablers, including alignment of public and private actors’ interests, intersectoral government support and establishing frequent communication channels and formal spaces of interaction among sector, in processes of decision-making.

Intersectoral Collaboration: What Works and What Doesn’t

“… 3 This work has found that higher performing communities (in terms of lower hospitalization rates and costs and lower obesity rates) also have had superior coordination between healthcare and social service sectors. Consistent with Turner and colleagues, 4 this work 1 - 3 has also showed the importance of pre-existing relationships, strong norms of association, and neutral or “backbone” organizations that have been trusted and able to effectively convene a range of institutions across sectors.…”

Tuberculosis service disruptions and adaptations during the first year of the COVID-19 pandemic in the private health sector of two urban settings in Nigeria—A mixed methods study

“…Several studies have highlighted the potential telemedicine offers in increasing healthcare access in low and middle income countries, particularly since the onset of the pandemic [34,35], even though its usage might be more suited to high-income settings with adequate access to smart phones, internet connectivity and constant electricity [17,36]. Intersectoral collaboration incorporating the private sector has also been highlighted as an important element of pandemic outside a TB context in Colombia [37], which indicates that PPM could benefit management of various diseases, not only TB.…”

Challenges for implementation of inter-sectoral efforts to improve outbreak response using consolidated framework for implementation research; Iran’s COVID-19 experience

“…According to our participants, the main relationship of organizations was about exchanging information, developing protocols and guidelines, consulting and providing medical services. In the study by Turner et al, the collaboration of organizations adjacent to the health system (universities and private sectors) to COVID-19 pandemic response, included providing evidence for decision-making, service capacity and supporting coordination [16].…”

“…Although, the necessity of ISC in management of COVID-19 has been highlighted in literature [11,13], efforts to implement ISC have often been described as challenging [14,15]. Some existing challenges are lack of commitment and/or poor leadership, tensions and mistrust between actors, holding the own power and refusing to compromise, strict regulations, lack of knowledge on inter-sectoral issues, inadequate coordination and communications, and limited financial and human resources [15][16][17][18][19].…”