Unpacking intragovernmental coordination : an interdisciplinary exploration to advance the multisectoral approach to universal health coverage in Uganda
Advancing a multisectoral approach to universal health coverage in Uganda and similar contexts is crucial for enhancing overall health and wellbeing. This PhD research focuses on intragovernmental coordination, exploring the complexities and ongoing challenges of coordinating actions among different government entities across various sectors, to advance multisectoral efforts, particularly towards health Sustainable Development Goals espoused under universal health coverage. The study adopts an interdisciplinary and theoretical-empirical approach, comprising theory development, empirical inquiry, and synthesis of findings. The theory development phase created conceptual tools like a multidimensional coordination framework, a typology of coordination instruments, and a multitheoretical framework. Empirically, a single-embedded case study of Uganda’s national government was conducted using qualitative methods like narrative reviews, stakeholder engagements, interviews, and document reviews. The findings reveal that intragovernmental coordination is a multifaceted process involving external-internal and vertical-horizontal relationships aimed at achieving short, medium, or long-term outcomes. The government's bureaucratic structure, historical legacies, power dynamics, and external influences all play crucial roles in shaping coordination efforts. The study highlights the impact of factors such as coordination costs, institutional arrangements, and political dynamics on the coordination process. The research identifies the influence of neoliberal principles promoted under New Public Management and donor agendas on government coordination strategies, as well as the challenges posed by fragmented governance structures and counter-reforms. Coordination is achieved through structural tools and management processes underpinned mainly by hierarchy and network mechanisms. It emphasizes the need for instrument mixes to promote coordination, taking into account contextual factors and actors' behaviors. Horizontal coordination between the health and other sectors is influenced by technical and political considerations, highlighting the importance of addressing asymmetrical interests, political dynamics and fostering mutual understanding among stakeholders. The study concludes that achieving multisectoral goals like universal health coverage requires effective intragovernmental coordination, which necessitates a nuanced understanding of the complexities involved. It advocates for interdisciplinary approaches drawing from fields like public administration, organizational theory, development studies and political science to inform policy and practice. Policy actions should incentivize alignment of interests, manage coordination costs, and navigate historical institutional political and power contexts. Additionally, it stresses the importance of ongoing theory -informed research, iterative learning, time and resources to guide institutional change and promote shared visions of coordination across government sectors. It underscores the interaction dynamics among coordination instruments. Finally, it suggests that the health sector's role in multisectoral efforts should be adaptable based on specific contexts and needs.
Antwerp : University of Antwerp, Institute of Development Policy , 2024
359 p.
Supervisor: Titeca, Kristof [Supervisor]
Supervisor: Van Belle, Sara [Supervisor]
Supervisor: Criel, Bart [Supervisor]
Supervisor: Ssengooba, Freddie [Supervisor]
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Creation 02.04.2024
Last edited 03.04.2024
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