Roles played by Locally Elected Representatives in Facilitating Multi-Sectoral Action for Health: Evidence from Kerala, India.

IF 3.2 4区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Annals of Global Health Pub Date : 2025-07-28 eCollection Date: 2025-01-01 DOI:10.5334/aogh.4716
Devaki Nambiar, Jaison Joseph, Hari Sankar D, Gloria Benny
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Abstract

Background: Multi-Sectoral Action (MSA) for health involves the collaboration of various stakeholder groups within and beyond the health sector and is seen to be critical for the attainment of the Sustainable Development Goals. In Kerala, India, decentralisation reforms have been in place for some time, and we sought to characterise the roles specifically played by locally elected representatives or Local Self-Government (LSG) members, in relation to MSA. Methods: Between July and October 2021, we conducted in-depth interviews with 80 participants from four districts in the southern Indian state of Kerala. Participants were community leaders, healthcare professionals, public health officials and elected members of LSG bodies. After obtaining written informed consent, participants were interviewed about the roles of various stakeholders in implementing primary care reforms with a particular focus on MSA at the grassroots level. The interviews were recorded, translated into English, and thematically analysed by the research team using ATLAS.ti 9.1 software. Results: Participants ranged in age from 35 to 60 years. LSGs played a number of critical MSA roles, including being a gatekeeper for local action; coordinator of departments, sectors and actors (departments of health, revenue, labour, and education departments as well as volunteers); custodian of community, particularly those 'left behind,' crisis manager, team builder and advocate even for communities for which they did not have direct responsibility. Conclusion: LSGs were widely seen by implementers as central figures in coordinating MSA for health in Kerala, before and during the COVID-19 pandemic, and in relation to 'left behind' groups. The multiplicity of roles played by LSGs suggests the need for flexibility on the one hand as well as the plurality of roles on the other hand, which may be necessary to enable convergence and MSA, particularly at local levels.

地方选举代表在促进多部门卫生行动方面发挥的作用:来自印度喀拉拉邦的证据。
背景:卫生领域的多部门行动涉及卫生部门内外各利益攸关方群体的合作,被认为对实现可持续发展目标至关重要。在印度喀拉拉邦,权力下放改革已经进行了一段时间,我们试图描述地方选举代表或地方自治政府(LSG)成员在MSA方面具体发挥的作用。方法:在2021年7月至10月期间,我们对来自印度南部喀拉拉邦四个地区的80名参与者进行了深入访谈。与会者包括社区领袖、保健专业人员、公共卫生官员和LSG各机构的当选成员。在获得书面知情同意后,参与者接受了关于各利益相关者在实施初级保健改革中的作用的访谈,特别关注基层的MSA。这些访谈被记录下来,翻译成英语,并由研究小组使用ATLAS进行主题分析。Ti 9.1软件。结果:参与者年龄从35岁到60岁不等。lsg扮演了许多关键的MSA角色,包括作为本地行动的看门人;各部门、部门和行为者(卫生部、税务局、劳工部和教育部以及志愿人员)的协调员;社区的守护者,特别是那些“掉队者”,危机管理者,团队建设者,甚至为他们没有直接责任的社区辩护。结论:在2019冠状病毒病大流行之前和期间,以及与“留守”群体有关的群体,LSGs被实施者广泛视为协调喀拉拉邦卫生保健MSA的核心人物。地方政府团体发挥的多种作用表明,一方面需要灵活性,另一方面也需要多种作用,这可能是实现融合和管理服务体系的必要条件,特别是在地方一级。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Annals of Global Health
Annals of Global Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-
CiteScore
5.30
自引率
3.40%
发文量
95
审稿时长
11 weeks
期刊介绍: ANNALS OF GLOBAL HEALTH is a peer-reviewed, open access journal focused on global health. The journal’s mission is to advance and disseminate knowledge of global health. Its goals are improve the health and well-being of all people, advance health equity and promote wise stewardship of the earth’s environment. The journal is published by the Boston College Global Public Health Program. It was founded in 1934 by the Icahn School of Medicine at Mount Sinai as the Mount Sinai Journal of Medicine. It is a partner journal of the Consortium of Universities for Global Health.
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