Transformative change takes leadership, partnerships, and multisectoral collaboration

Investment in systems to promote collaboration is vital for health, say Shri J P Nadda and Nikolai Astrup

Six million women, children, and adolescents die from preventable causes every year. [1-3] The 2030 Agenda and the sustainable development goals (SDGs) encourage new ways of tackling this and other challenges, through partnerships and multisectoral collaboration.

It is well recognised that progress across many sectors contributes to health and development goals. We know that outcomes in areas such as education, nutrition, water and sanitation, contribute to improved health outcomes, and vice versa. Health is not only a universal right for individuals but also a key driver of sustainable socioeconomic development, as we have seen in our countries. Some of our most intractable challenges can be solved only by public sectors working with the private sector, multilateral organisations, non-governmental organisations, and others. This integrated way of working is at the heart of the 2030 Agenda.

We know that funding for programme activities does not always extend to the collaborative processes that make them happen. We encourage greater investment in partnerships, and in joint planning, implementation, and accountability. An important initiative in this respect is the recently launched Global Action Plan for Healthy Lives and Wellbeing for All, which identifies three strategic approaches: align, accelerate, and account as well as cross-cutting areas where more innovative, synergistic efforts can greatly accelerate progress in global health. [4]

The real world examples in this BMJ series describing how countries have designed and implemented multisectoral collaborations enable us to learn about the commonalities as well as the challenges. [5] We would like to share some of our own examples of efforts to improve the lives of the most vulnerable through country-led initiatives and global and national partnerships.

Success in India

India has made progress, with an increase in its human development indicators from 0.427 in 1990 to 0.640 in 2017. [6] However, much more needs to done to improve human development outcomes. The Intensified Mission Indradhanush strategy described in the series is one example of how multisectoral participation can improve service coverage for hard-to-reach populations. [7] To build on this progress, the prime minister launched the “aspirational districts” initiative in January 2018. [8] A total of 117 districts in 28 states were identified as aspirational districts using a composite index comprising health, nutrition, education, basic infrastructure, and poverty. States are the main driver of the programme, which involves multisectoral collaboration at central, state, and district levels. Using real time monitoring, districts are encouraged to catch up with the best ranked district in their state, and aspire to be the highest ranking district nationwide. This spirit of competition, learning, and cooperation has resulted in a rapid rise in human development indicators. [8]

The Norway-India Partnership Initiative (NIPI), launched in 2006, aims to reduce maternal and child mortality by providing strategic, catalytic, and innovative support to India’s National Health Mission. A recent evaluation shows that it has strengthened health systems—for example, through higher quality nursing and midwifery education and improvements in home based healthcare for infants and young children. [9] We are proud that this collaboration has proved fruitful and provides a model for others to follow. A key factor in NIPI’s success is India’s commitment to, and investment in, maternal, newborn, and child health.

Global financing

We recognise that many countries face critical shortfalls in domestic resources for health, which threatens to push the SDG health goals out of their reach. There is also room for improving efficiency, as estimates show that 20-40% of all health resources are wasted. [9] Norway was one of the partners that launched the Global Financing Facility for Every Woman Every Child at the Addis Ababa summit on financing for development in July 2015. [11] The aim is to bring together multisectoral stakeholders to enhance investment in health and nutrition. In November this year, Norway co-hosted a replenishment conference that mobilised $1bn and several domestic resource pledges. [12] The next goal is to mobilise an additional $1bn for 2018-23. Working in partnership, we can jointly help to save 35 million lives by 2030. [13]

As these examples show, the SDGs give us a powerful stimulus for using multisectoral collaboration to work more effectively and achieve common goals. We can begin by investing in systems and mechanisms to promote partnerships with national stakeholders that endure through changing political landscapes. Political leaders must continue to show the political will to embrace new ways of working in partnership and to share our experience and achieve our goals.

Shri J P Nadda has served as the union minister for health and family welfare in the Government of India since 2014.

Nikolai Astrup is a Norwegian politician from the Conservative party who has served as minister of international development since January 2018.

Competing interests: We have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.

Provenance and peer review: Commissioned; not externally peer reviewed.


1 World Health Organization. Maternal mortality. Key facts. 2018.

2 Unicef. Under five mortality. 2018.

3 World Health Organization. Adolescents: health risks and solutions. 2018.

4 World Health Organization. Global action plan for healthy lives and well-being. WHO, 2018.

5 Making multisectoral collaboration work.

6 UNDP. Human Development Reports. 2018.

7 Gurnani V, Haldar P, Aggarwal MK, et al. Improving vaccination coverage in India: lessons from Intensified Mission Indradhanush, a cross-sectoral systems strengthening strategy. BMJ 2018;363:k4782. doi:10.1136/bmj.k4782

8 National Institution for Transforming India. About the Aspirational Districts programme. 2018.

9 Oxford Policy Management. The Norway-India Partnership Initiative Phase II: impact evaluation of five interventions. Norad, 2018.

10 World Health Organization. The World Health Report. WHO, 2010.

11 Global Financing Facility. About us. 2017.

12 Global Financing Facility. World leaders pledge US$1 billion to transform health and nutrition of world’s poorest women, children and adolescents. Press release, 6 Nov 2018.

13 Global Financing Facility. Study: GFF-supported countries can save as many as 35 million lives by 2030. Press release, 3 Oct 2018.