Challenges in strengthening multi-sectoral action for optimum preparedness and response for public health emergencies in Sri Lanka.

Sri Lanka is a lower-middle-income island-nation that often contends with multiple public health emergencies (PHEs) such as floods and disease epidemics. In preparing and responding to these PHEs, different units of the Ministry of Health (MOH) take responsibility for the functions of a typical National Public Health Agency in Sri Lanka. This study was done to describe current approaches within multisectoral action and to explore the challenges to multisectoral action involving the MOH in preparedness for and response to PHEs. The study included a risk assessment, stakeholder-mapping, a desk- review of literature and documents available with stakeholder institutions. Additionally, we conducted qualitative interviews with key informants relevant to PHE response covering nine provinces. The risk assessment was done to identify potential PHEs followed by stakeholder mapping. The desk review aimed to identify the deficiencies of the existing major policy documents for multisectoral action. The study team conducted 51 KIIs from April to May 2025 to synthesise challenges using a semi-structured questionnaire with purposively selected team members involved in different aspects of multisectoral action. The US CDC model on public health linkages served as the conceptual framework, including four domains: 1) policies/agreements/legislation, 2) infrastructure, 3) governance/funding/logistics, and 4) people-organization culture. Thematic coding analysis of qualitative data was performed. The main challenges imposed by public policy weaknesses related to multisectoral action included: lack of inclusive engagement of stakeholders in policy formulation, not having a strong policy architecture for collaboration, non-adaptive policies and vague terminology. Challenges imposed by policy-deficiencies related to other three domains included: sub-optimum data management, delayed fund mobilization, lack of mediation of activities of NGOs, less-customized risk communication, and ad-hoc collaborative efforts between stakeholders. The study recommends adapting existing policy documents, clarifying decentralization and sub-national implementation arrangements, establishing inter-stakeholder operational guidelines, and strengthening intersectoral awareness of roles and communication mechanisms.