Sammendrag
Background It is increasingly recognized that health issues cannot be tackled within the health sector. The comprehension have increased the focus on multisectoral action both within governments, across sectors and involving the full picture of multi-stakeholders. This thesis addresses whether the general focus on multisectoral action is reflected in the documents of the governing bodies of WHO during the last 15 years and if the new framework proposed by WHO on actions across sectors is in line with the existing knowledge base and to what extent national plans are utilizing perspectives aligned with this framework. Method The documents discussed at the World Health Assembly (WHA) in the period from 1999-2014 was analysed by a content analysis using a word count programme and statistically processed by the open source software "R statistics". The Second Draft of the Framework for Country Action Across Sectors for Health and Health Equity (WHO 2014) proposed to the World Health Assembly in 2015 was analysed and compared with other frameworks for actions across sectors. The framework was applied to national multisectoral plans developed as part of the implementation of the WHO Global Action Plan for the Prevention and Control of Noncommunicable diseases 2013-202. Results The word analysis gives reason to believe that there has been a dramatic increase in the use of the words expressing multisectoral action in the documents discussed in the World Health Assembly from 1999 - 2014. Noncommunicable diseases being the category of health programmes with the largest share of multisectoral action mentioned. There is a change of terms used to express multisectoral actions over the period which to some extent is related to conceptual frameworks developed at the same time. There is a co-existing increase in private sector and multisectoral action in the period from 1999-2014. This study do not allow any further conclusions about correlation between the expression private sector and multisectoral action. The frameworks for multisectoral action addressed in the study describes mainly key elements of a stepwise approach to what to do to establish multisectoral plans. The Global Capacity Survey on NCD contains most of the key components of the new framework and the survey seems well placed to monitor the existence of the steps described. The Intersectoral Action for Health Equity Case Studies database (ISAC database) provides elements to map in addition. The current framework proved to be a good tool to identify steps in the development of national multisectoral plans. The key components from this framework were in place, to some extent, in all 4 countries analysed (Bangladesh, Mozambique, Malta, Trinidad and Tobago). In general the plans contained less information about multisectoral implementation mechanisms or strategies. Management of conflict of interest was not mentioned in any of these plans but is suggested to be included in the newly proposed framework for actions across sectors from WHO. Discussion; The word analysis gives reason to believe that there has been a dramatic increase in the use of the words expressing multisectoral action in the documents discussed in the World Health Assembly from 1999 – 2014 and that there is an increased utilization of the concept of multisectoral action in WHO reflecting the need for action to be able to tackle NCDS. There may be necessary to differentiate future frameworks to different mechanisms for multisectoral actions, according to; targeted level, breadth or in depth approaches (the integrated NCD plan as such or only on tobacco), upstream, mid - or downstream interventions. Target setting and accountability beyond health sector might also be another issue to achieve multisectoral action and should be part of the discussion. It can be claimed that multisectoral action is a new area that are under development and that more deep understanding of most aspects is needed. The framework examined in this thesis is aligned with the current knowledgebase but there is obvious existing knowledge gaps that have to be filled.