Operationalising Multisector partnerships: A Theory of Action and Reflection tool for zoonotic influenzas.

Zoonotic influenzas are major, ongoing public health policy challenge, not the least because of the importance of functional multisector partnerships (MSPs) for their prevention and control. However, despite years of investment in developing them, many countries have found multisectoral approaches, such as One Health, difficult to operationalise at national and sub national levels. One explanation for the lack of uptake is the limited nature of guidance on the design and adaptation of MSPs that consider local institutional dynamics. In this paper, we describe the process of developing a practical framework for assessment and characterisation of MSPs. We use findings from an earlier review of academic and programmatic literature to develop a Theory of Action for multisector One Health partnerships that can nest into the Short-term Outcomes identified in the Theory of Change for One Health developed by the One Health Quadripartite. This comprises of five elements: Characteristics; Starting conditions; Collaborative process; Outputs; and Responsiveness. We develop additional attributes to undertake a detailed characterisation of different 'levels' of One Health partnerships. In addition, this Theory of Action allows for multiple outcomes of interest to be recognised and addressed. We then use the Theory of Action to develop a reflection tool to help country programme managers identify the specific characteristics of their respective One Health partnerships; recognise the differences in capacities and expectations of different partners; and use these insights to identify specific ways to strengthen the collaborative process. To our knowledge this is the first time a detailed characterisation of MSPs based upon programmatic attributes has been developed. Such a conceptualisation of MSPs can facilitate the design, implementation and evaluation of One Health and other multisector programmes and increase their relevance to the needs of the local context within which these are based.