Table 4

Lenses and levels for examining drivers of multisectoral action for adolescent health

Health systems drivers with a governance focusHealth system levels
Service delivery lens
  •  Policy mandate

  •  Coordination mechanisms

  •  Service delivery readiness

  •  User capacity

  •  Policies across different sectors recognising adolescent health (Adolescent Health in All Policies approach)84

  •  Policies across different sectors recognising multisectoral action for adolescent health

  •  Existence of adolescent health committee/unit85

  •  Constitution and functioning of committee/unit

  •  Location and linkages of the committee/unit within sectoral hierarchies

  •  Availability and authority to deploy resources

  •  Profile of policy champions: profession, seniority, age, gender

  •  Competency of all stakeholders in adolescent health and multisectoral actions

  •  Capacity to generate and use evidence on mutlisectoral action86

Society lens
  •  Political prioritisation

  •  Accountability dynamics

  •  Interpersonal dynamics

  •  Adolescent leadership and participation and mobilisation overall

  •  Social determinants of health including, gender, diversity and socioeconomic and political context

  •  Framing and alignments of sector goals

  •  Incentives and constraints of stakeholders, including adolescents

  • Leadership and organisational cultures supporting multisectoral action40

  •  Social networks and histories between policy advocates

  •  Trust, communication and credibility between policy advocates

Systems lens
  •  Dis/equilibria

  •  Feedback loops

  •  Eventuality of change

  •  Emergence

 (Dynamics can link across micro, meso and macro levels)
  •  Policies that prohibit adolescent girls from being pregnant while being in school, inhibits early care seeking for pregnancy care by these adolescents and has a negative impact on their future education and health38

  •  Not including adolescents in leadership and participation during the design, implementation, monitoring and evaluation of adolescent health programme will contribute to a negative feedback loop in terms of nature, quality and impact of the programme87

  •  Initial gains on collaborating on health education or HPV at schools, builds trust and relationships between sectors, that enables further work on more complex mutual aims such as mental health or comprehensive sexual and reproductive health programmes or violence prevention38

  • HPV, human papilloma virus.