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Multisectoral action for health in low-income and middle-income settings: how can insights from social science theories inform intragovernmental coordination efforts?
  1. Aloysius Ssennyonjo1,2,3,
  2. Sara Van Belle2,
  3. Kristof Titeca3,
  4. Bart Criel2,
  5. Freddie Ssengooba1
  1. 1School of Public Health, Department of Health Policy Planning and Management, Makerere University College of Health Sciences, Kampala, Uganda
  2. 2Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
  3. 3Institute of Development Policy, University of Antwerp, Antwerp, Belgium
  1. Correspondence to Dr Aloysius Ssennyonjo; ssennyonjo{at}


There is consensus in global health on the need for multisectoral action (MSA) to address many contemporary development challenges, but there is limited action. Examples of issues that require coordinated MSA include the determinants of health conditions such as nutrition (malnutrition and obesity) and chronic non-communicable diseases. Nutrition, tobacco control and such public health issues are regulated separately by health, trade and treasury ministries. Those issues need to be coordinated around the same ends to avoid conflicting policies. Despite the need for MSA, why do we see little progress? We investigate the obstacles to and opportunities for MSA by providing a government perspective. This paper draws on four theoretical perspectives, namely (1) the political economy perspective, (2) principal–agent theory, (3) resource dependence theory and (4) transaction cost economics theory. The theoretical framework provides complementary propositions to understand, anticipate and prepare for the emergence and structuring of coordination arrangements between government organisations at the same or different hierarchical levels. The research on MSA for health in low/middle-income countries needs to be interested in a multitheory approach that considers several theoretical perspectives and the contextual factors underlying coordination practices.

  • health policy
  • health systems
  • public health
  • review

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  • Handling editor Seye Abimbola

  • Twitter @assennyonjo

  • Contributors AS wrote the initial draft as part of his PhD in Development Studies. SVB, KT, BC and FS provided intellectual content to the various drafts. All authors read and approved the final manuscript.

  • Funding This paper is a product of a PhD study supported by a DGD PhD grant at the Institute of Tropical Medicine, Antwerp, Belgium.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.