Conceptual and institutional gaps: understanding how the WHO can become a more effective cross-sectoral collaborator
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Original versionGlobalization and Health 2015, 11 10.1186/s12992-015-0128-6
Background:Two themes consistently emerge from the broad range of academics, policymakers and opinion leaderswho have proposed changes to the World Health Organization (WHO): that reform efforts are too slow, and that theydo too little to strengthen WHO’s capacity to facilitate cross-sectoral collaboration. This study seeks to identify possibleexplanations for the challenges WHO faces in addressing the broader determinants of health, and the potentialopportunities for working across sectors.Methods:This qualitative study used a mixed methods approach of semi-structured interviews and document review.Five interviewees were selected by stratified purposive sampling within a sampling frame of approximately 45 potentialinterviewees, and a targeted document review was conducted. All interviewees were senior WHO staff at thedepartment director level or above. Thematic analysis was used to analyze data from interview transcripts, field notes,and the document review, and data coded during the analysis was analyzed against three central research questions.First, how does WHO conceptualize its mandate in global health? Second, what are the barriers and enablers toenhancing cross-sectoral collaboration between WHO and other intergovernmental organizations? Third, how do thedominant conceptual frames and the identified barriers and enablers to cross-sectoral collaboration interact?Results:Analysis of the interviews and documents revealed three main themes: 1) WHO’s role must evolve to meet theglobal challenges and societal changes of the 21st century; 2) WHO’s cross-sectoral engagement is hamperedinternallyby a dominant biomedical view of health, and the prevailing institutions and incentives that entrench this view; and 3)WHO’s cross-sectoral engagement is hamperedexternallyby siloed areas of focus for each intergovernmentalorganization, and the lack of adequate conceptual frameworks and institutional mechanisms to facilitate engagementacross siloes.Conclusion:There are a number of external and internal pressures on WHO which have created an organizational cultureand operational structure that focuses on a narrow, technical approachtoglobalhealth,prioritizing disease-based, siloedinterventions over more complex approaches that span sectors. The broader approach to promoting human health andwellbeing, which is conceptualized in WHO’s constitution, requires cultural and institutional changes for it to be fullyimplemented.