Towards a framework for multisector and multilevel collaboration: case of HIV and AIDS governance in South Africa

Background: While multisectoral action (MSA) is advocated as one of the strategies to address complex health and development challenges, there is limited clarity about the process of multisector collaboration in practice. Objectives: Informed by the findings of the research on implementation of the multisectoral response to HIV in South Africa, and drawing from the existing literature; we propose a framework for multisector and multilevel collaboration. The framework describes key components of the process of multisector collaboration, and aims to inform policy and practice. Methods: An integrative review and synthesis of existing frameworks, models and approaches on multisectoral action in public health, governance and health, and in public administration was conducted to inform the development of the proposed framework. Results: There are seven key components that are critical in the process of multisector collaboration namely: preconditions; key drivers; structure; mechanisms; administration; execution and evaluation. Multisector collaboration is presented as an iterative process that allow for improvement and learning. The framework is presented through a visual representation which shows how the seven elements are connected, and how learning happens through-out the multisector collaboration process. Structure and mechanisms are the two central and interrelated elements of the proposed framework. Conclusion: The framework does not suggest that multisector collaboration is a panacea, but that MSA remains critical to address complex health and development issues. Focus should be on finding innovative ways to inform and strengthen its implementation in practice. The framework can be used by practitioners and policy makers to inform design, implementation, and evaluation of multisector collaborations. It reflects on complexities of MSA, and brings to the fore critical information to assess readiness and to inform the decision whether to engage in MSA or not.