Background

In July and August, the Aligning Systems for Health team reviewed and synthesized learning about cross-sector alignment from the past year. Key documents, briefs, case studies, interviews, structured feedback, and other relevant information informed this first-round review of the Cross-Sector Alignment Theory of Change.

As intended at the project’s outset, the process of translating that learning led to a revised version, now called the Framework for Aligning Sectors. With each iteration, it is the team’s intent that the framework will be more and more evidence informed.

The following four design changes are noteworthy.

 

The Core Components Remain Relevant

• The review confirmed that the framework’s core components — shared purpose, data, governance, and financing — are appropriate.
• What changed is how the dynamism and interdependency among the components are illustrated. At one point governance might be a primary focus, while at other times, shared data and measures might be an area of intense focus.

Adaptive Factors Are Increasingly Recognized as Important

The synthesis and learning highlighted four factors that are key to successful implementation and sustainability of aligning across sectors — community voices, trust, power dynamics (both between sectors and between the sectors and community members), and the role of equity in the process and not merely as an endpoint. These factors are illustrated in the framework as integral to the function of the four core components.

 

There Can Be Shared Progress at Interim Points

Shared progress toward meeting communities’ goals and needs, health equity, and racial equity does not happen right away. First, there must be changes in mindsets, practices, and policies that support the more distal outcomes.

 

The Sectors Remain Distinct

The new framework illustrates that public health, health care, and social service sectors remain distinct. They do not integrate, but rather align in new and different ways that are accountable to the goals and needs of the individuals and communities they serve.

The Aligning Systems for Health Team at the Georgia Health Policy Center appreciates the on-the-ground experience of stakeholders that brought greater meaning and nuance to what was learned from the literature and research partners. We look forward to continued dialogue and feedback as this journey continues.