Non-communicable diseases prevention and control in Guyana: analysis of inter-sectoral collaboration among government ministries for the implementation of the Declaration of Port of Spain 2007
Prevenção e controle de doenças não transmissíveis na Guiana: análise da colaboração intersetorial entre ministérios governamentais para a implementação da Declaração de Port of Spain 2007
Publication year: 2023
Non-communicable diseases (NCDs) are the world's single leading cause of preventable morbidity and mortality, which cause both rich and poor nations to experience hardships. Globally, these diseases - particularly diabetes, cardiovascular diseases, cancers, and chronic lung disease have reached veritable epidemic proportions. Guyana is a lower middle-income country with a growing incidence of NCDs that seems to reflect the global trend and accounted for over 68% of all deaths. In an effort to reduce the burden of NCDs, countries of the Caribbean Community (CARICOM) including Guyana, signed the Declaration of Port of Spain 2007: Uniting to Stop the Epidemic of NCDs, in the quest to foster inter regional collaboration and facilitate multi-sector partnerships which were intended to serve as a model for nationallevel partnership platforms and multisectoral action aimed at reducing NCDs. Based on the context, the aim of this study is to analyse intersectoral collaboration among Government Ministries (Agriculture, Education, Finance, Health and Trade) for the implementation of the Declaration of Port of Spain 2007 in Guyana. Qualitative study, guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ). Participants were senior staff (programme managers, departmental heads) currently employed in one of the five selected Ministries and senior staff who worked at these Ministries after 2007, the year that the Declaration of Port of Spain was introduced. Participants were selected because of their decision-making roles and responsibilities related to implementation of prevention and control interventions, policies, and programmes for NCDs, and risk factors within their respective Ministries. Senior decision makers with responsibility for implementation of prevention and control policies for NCDs and risk factors were divided into strata according to sex. Selection of the participants from these two strata was done by purposive sampling. Data was collected through virtual interviews by an experienced research assistant using a semi-structured questionnaire. Thematic analysis was conducted guided by the elements of the Health Policy Triangle framework which was the theoretical underpinning of the study and the research questions.
Four themes emerged from content analysis:
awareness, earmarking of priorities, scoping of priorities and timing of implementation. All participants had some knowledge about the Declaration of Port of Spain 2007 or elements of it. All 13 participants (100%) noted that earmarking of priorities was administered by an inter-ministerial government agency with private sector/industry representation. Participants identified various positives to earmarking priorities which included the importance of alignment of priorities across ministries so that all actors could be focused on the same priority at the same time; make strategic budgetary allocations to health, and garner public and private support for policy action. There was general agreement that the health-related issues such as NCDs prevention and treatment were a major focus of inter-sectoral collaboration, with each ministry acting based on their unique ministerial portfolios and interests. Eight participants (61%) pointed to the adverse impact of political/government changeovers on policy momentum and prioritisation in the analysis of the policy context. The double burden of NCDs and communicable diseases experienced by Guyana was articulated as detrimental to NCDs' prioritisation. All participants (100%) highlighted the harmful impact of the COVID-19 pandemic which resulted stalled work on policy implementation stalled and halted momentum; and the important and diverse influence of international organizations on intersectoral collaboration. Regarding policy actors, all participants detailed the influence of political commitment and leadership on the design and implementation of the Declaration and highlighted the importance of inter-sectoral collaboration as a necessary, though insufficient condition for policy implementation. Four interviewees (31%) identified that turnover of senior health experts who had a more sustained commitment to measures than career politicians, and ad-hoc and reactive instances of policy support by politicians, led to under-resourced, conflicting and piecemeal policy responses, that undermined progress with the prevention and control of NCDs. Four participants described industries' use of pre-emptive action to stave off regulatory measures of products that had seen economic growth, as a major cause of NCDs. Intentional framing of industry activity as a significant source of employment and contributor to economic growth was a common tactic used to influence public and political opinion of fiscal measures and was evident in the implementation of tobacco and sugary beverages control measures. Most of the participants viewed industry involvement as a barrier to intersectoral collaboration. Nine of the 13 participants (69.2%) identified civil society engagement as integral to successful implementation of the Declaration that were specifically related to lifestyle/behavioural changes and the implementation of fiscal measures. Most of the participants (11 of 13 or 85 %) identified the direct support by bilateral agencies and multilateral agencies as critical enablers to the implementation of the Declaration of Port of Spain 2007. The common forms of support included provision of technical cooperation and financing, linking multi-sector agencies with local counterparts, supporting multi-sectoral consensus building, and supplementing Guyana's economic, technical, and legal capacities to overcome capacity constraints. Overall, the results showed that intersectoral collaboration has happened and is still taking place among the various ministries (MoA, MoE, MoF, MoH and MoT) for the implementation of the Declaration of Port of Spain 2007. All five of the ministries were also collaborating for the implementation of education and awareness programmes on prevention of NCDs and risk factors. The results showed various collaborative mechanisms with the Ministry of Health playing a major role in coordination and functioning.Factors that aided collaboration include:
the country's commitment/obligation to implement the CARICOM Declaration at country level; knowledge of each ministries mandate and understanding the linkages with other ministries to achieve the overall goal; and the sustained support from international organisations for conceptualization, implementation of the Declaration. The barriers to collaboration were competition among ministries, limited financial and human resources, high level of dependency on international organisations and lack of political will. There were factors that aided and hindered collaboration among the five ministries for implementation of the Declaration of Port of Spain 2007 in Guyana.
As doenças não transmissíveis (DNTs) são a principal causa mundial de morbidade e mortalidade evitáveis, que fazem com que nações ricas e pobres passem por dificuldades. Globalmente, essas doenças - particularmente diabetes, doenças cardiovasculares, cânceres e doenças pulmonares crônicas atingiram verdadeiras proporções epidêmicas. A Guiana é um país de renda média baixa com uma incidência crescente de DNTs que parece refletir a tendência global e foi responsável por mais de 68% de todas as mortes. Em um esforço para reduzir o ônus das DNTs, os países da Comunidade do Caribe (CARICOM), incluindo a Guiana, assinaram a Declaração de Port of Spain 2007: Unindo-se para parar a epidemia de DNTs, na busca de promover a colaboração inter-regional e facilitar parcerias setoriais que deveriam servir de modelo para plataformas de parceria em nível nacional e ações multissetoriais voltadas para a redução das DCNT. Com base no contexto, o objetivo deste estudo é analisar a colaboração intersetorial entre os Ministérios do Governo (Agricultura, Educação, Finanças, Saúde e Comércio) para a implementação da Declaração de Port of Spain 2007 na Guiana. Estudo qualitativo, orientado pelos Consolidated Criteria for Reporting Qualitative Research (COREQ). Os participantes eram funcionários seniores (gerentes de programas, chefes de departamento) atualmente empregados em um dos cinco ministérios selecionados e funcionários seniores que trabalharam nesses ministérios depois de 2007, ano em que a Declaração de Port of Spain foi introduzida. Os participantes foram selecionados por causa de seus papéis de tomada de decisão e responsabilidades relacionadas à implementação de intervenções, políticas e programas de prevenção e controle para DNTs e fatores de risco em seus respectivos ministérios. Os altos decisores responsáveis pela implementação de políticas de prevenção e controle de DCNT e fatores de risco foram divididos em estratos de acordo com o sexo. A seleção dos participantes desses dois estratos foi feita por amostragem intencio nal. Os dados foram coletados por meio de entrevistas virtuais por um assistente de pesquisa experiente, usando um questionário semiestruturado. A análise temática foi realizada guiada pelos elementos do referencial do Health Policy Triangle que constituiu a sustentação teórica do estudo e as questões de pesquisa.
