Prioritising and including children in intersectoral policymaking: uncovering Immunity to Change in Ghana

Despite strong commitments to improving children's well-being, nearly a third of Ghanaian children aged 36-59 months are not developmentally on track, with additional challenges due to the COVID-19 pandemic. Improvements in children's health and well-being rely on effective intersectoral policies, however, not enough is known about how to achieve this in practice, particularly in low- and middle-income countries. We report on a case study of participatory intersectoral policymaking for child health in Ghana in 2021, feeding into the national Early Childhood Care and Development Policy. We used systematic methods to analyse policy documents from 22 Ministries, Departments and Agencies; procedural outputs from national policy convenings; and children's inputs via a national competition, worksheets at a policy convening and video interviews. Data sources were analysed separately using content analysis for real-time application of findings into the policy process. Subsequently, data were re-analysed together, using an 'insider-outsider' approach, to provide a holistic view of the policy process. Beyond traditional child-centred policy areas (ie, health, education, youth and sports, social protection), most ministries lacked budgeted child-specific policies, partly because policymakers felt this was outside their mandate. Analysing children's inputs to the policy process showed they had substantive policy ideas on their health and well-being that were intersectoral in nature. While underlying social and cultural assumptions about children's place in society impeded their participation in policymaking, stakeholders nonetheless expressed their commitment to amplifying and institutionalising children's contributions. Our study adds evidence on how to operationalise intersectoral partnerships, including by mapping mandates, budgets and roles across different functions and levels of government, with the mobilising participation of civil society. We also report on new mechanisms for including children's perspectives in policymaking. Our findings have implications for child health policy and for other health initiatives that require effective intersectoral, participatory approaches.