Sexual Health

Strengthening intersectoral collaboration for adolescent sexual and reproductive health: a community-embedded intervention in Ebonyi state, Nigeria.

TL;DR

This research underscores the potential of community-embedded interventions to strengthen intersectoral collaboration for the acceptability and adoption of ASRH strategies through three predominant collaboration models: horizontal integration between healthcare and education sectors, horizontal integration between governmental and non-governmental organizations, and diagonal integration bridging community stakeholders and service providers.

Key Findings

Three predominant collaboration models emerged in implementing the community-embedded ASRH intervention in Ebonyi State, Nigeria.

  • Model 1: Horizontal integration between healthcare and education sectors
  • Model 2: Horizontal integration across various governmental agencies (formal providers) and non-governmental organizations (informal providers)
  • Model 3: Diagonal integration bridging gaps between community stakeholders and service providers
  • These models were identified through 30 in-depth interviews and 18 focus group discussions with diverse stakeholder groups

Trust-building, shared goals, and clear communication were identified as the core processes underpinning successful intersectoral collaborations for ASRH.

  • These process factors were identified across all three collaboration models
  • Data were collected from policymakers, health service providers, teachers, community gatekeepers, parents, and adolescents
  • Transcripts were coded using NVivo 12 and analyzed via thematic analysis
  • Findings were presented as narratives following thematic analysis

Champions and intermediaries played a pivotal role in facilitating intersectoral collaboration for ASRH implementation.

  • The study specifically identifies the role of champions and intermediaries as central to facilitating collaboration
  • A supportive institutional framework was identified as a necessity alongside these individuals
  • This finding emerged from qualitative data across multiple stakeholder groups including policymakers and community gatekeepers
  • The study was conducted in Ebonyi State, Nigeria, a specific low-resource sub-Saharan African context

Enabling factors for intersectoral collaboration included robust leadership commitment, dedicated funding mechanisms, and a favorable policy environment.

  • These three enabling factors were identified as key facilitators of collaboration across sectors
  • Data were drawn from 30 in-depth interviews and 18 focus group discussions
  • Participants included policymakers, health service providers, teachers, community gatekeepers, parents, and adolescents
  • Findings were generated through thematic analysis of NVivo 12-coded transcripts

Resource constraints, conflicting interests, and organizational silos were identified as key barriers that hindered intersectoral collaboration efforts.

  • These three challenge categories were found to constrain collaboration across all identified models
  • Organizational silos were specifically named as a structural impediment to cross-sector work
  • Conflicting interests among stakeholders were identified as a distinct barrier separate from resource limitations
  • These barriers were identified qualitatively across multiple stakeholder perspectives including policymakers and service providers

A qualitative study design employing in-depth interviews and focus group discussions was used to explore types, processes, and factors enabling or constraining intersectoral collaboration.

  • 30 in-depth interviews and 18 focus group discussions were conducted
  • Participants included policymakers, health service providers, teachers, community gatekeepers, parents, and adolescents
  • The study was conducted in Ebonyi State, Nigeria
  • Interview transcripts were coded in NVivo 12 and analyzed using thematic analysis, with outputs presented as narratives

What This Means

This research suggests that improving adolescent sexual and reproductive health (ASRH) in resource-limited settings like Ebonyi State, Nigeria, requires different groups — such as healthcare workers, teachers, government agencies, community leaders, parents, and young people themselves — to actively work together. The study found that these collaborations tend to take three forms: partnerships between health and education sectors, partnerships between government and non-governmental organizations, and partnerships that bridge formal service providers with community members. The success of these collaborations depended heavily on building trust, agreeing on common goals, and communicating clearly, with certain key individuals acting as 'champions' or go-betweens to keep different groups connected. This research also suggests that strong leadership, dedicated funding, and supportive government policies are critical ingredients for making cross-sector collaboration work. On the other hand, limited resources, competing priorities among different organizations, and rigid institutional boundaries all made collaboration harder to achieve. These findings highlight that no single sector — health, education, or community — can effectively address adolescent sexual and reproductive health on its own. The practical implication of this research is that policymakers and program designers working on adolescent health in similar contexts should deliberately build structures that encourage different sectors to work together, identify and support champions who can bridge organizational divides, and secure dedicated funding for collaborative efforts. Community-embedded approaches — where interventions are designed with and for local communities — appear to be a promising way to make these cross-sector collaborations more sustainable and acceptable to the populations they serve.

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Citation

Mbachu C, Eze I, Onwujekwe O. (2025). Strengthening intersectoral collaboration for adolescent sexual and reproductive health: a community-embedded intervention in Ebonyi state, Nigeria.. Reproductive health. https://doi.org/10.1186/s12978-025-01994-3