BACKGROUND: Coordination and coherence hurdles are often experienced as particularly acute in the context of non-communicable diseases (NCDs). Barriers and facilitators for coordination and coherence in tobacco control governance were examined through a case study of the Conference of Parties (COP) of the Framework Convention on Tobacco Control (FCTC) in the context of World Health Organization South East Asia region (WHO SEARO) in contrast to the Scaling Up Nutrition (SUN) initiative in Bangladesh.
METHODS: Qualitative research examined the two multi-level case studies. Data collection involved semi-structured interviews of representatives from governmental, intergovernmental and non-governmental agencies, academia and private sector affiliates. Interview data were thematically analysed using an interpretative approach.
RESULTS: Findings from the tobacco case study suggested that SEARO countries sought to use the COP as a platform to promote vertical coherence. However, weak health leadership, lack of financial resources, poor in-country coordination and tensions between diverse sectoral goals raised challenges for coherent policy making in countries.
Prioritising tobacco control and building safeguards against tobacco industry interference, active health sector leadership, engagement of non-health sectors and setting up coordination systems for COP preparations enabled some of these countries in overcoming these hurdles.
In the nutrition case study, SUN’s advocacy was reported to have increased awareness, stimulated nutrition-sensitive initiatives, raised the need for funding and nutrition integration in Bangladesh's development agenda. However, the response was considered fragmented from tensions in reconciling health and economic goals and the involvement of food companies.
CONCLUSIONS: Findings illustrate how tobacco governance approach enabling vertical coherence, while the nutrition approach promoting coordination in countries. Coordination and coherence in health governance in low- and middle-income countries could be supported through enhanced resource allocation, improved sharing of information, frameworks to effectively address conflicts of interest and mechanisms for civil society contributions.