Part 2: A closer look at the “whole-of-government coordination and capacity” pillar
What does whole-of-government coordination and capacity do and why does it matter for innovation introduction?
In our first post of this series, we introduced ourselves – the ALIGN Consortium – and our goal to strengthen systems for more efficient and effective health innovation introduction. We also laid out four key pillars that we identified as necessary to achieve this goal. In this post, we will take a closer look at the first pillar: Whole-of-government coordination and capacity.
Government processes for innovation introduction at all levels can be better aligned to optimise efficiencies in priority-setting, regulatory review, financing, procurement, supply chain planning, and guideline development and implementation. Optimising these processes may avert four threats to effective, efficient introduction of innovations: delays, duplication, misalignment, and unpredictability. This is why whole-of-government coordination and capacity is one of the four interdependent pillars of a stronger health innovation introduction system. This does not mean adding committees or reporting layers. Rather, this pillar is the core system function that aligns roles, timelines, and information flows, ensuring decisions move smoothly from approval to delivery in a coherent manner across the system.
Why whole-of-government coordination and capacity matter
Introducing health innovations requires coordinated action across regulators, budget authorities, procurement agencies, technical programs, and implementers at national and subnational levels. Evidence across low- and middle-income countries (LMICs) shows that when these functions do not move in concert:
• Processes may be duplicative and inefficient.
• Products may be approved before budget lines are secured.
• Procurement may start without updated guidelines.
• National priorities may fail to align with subnational delivery timelines.
Over time, such misalignments erode trust and weaken the system’s responsiveness to emerging needs.
Several LMICs have piloted joint planning mechanisms that bring together ministries of health and finance, regulatory authorities, and implementing partners to align market approval, procurement, budgeting, and rollout timelines. While often ad hoc, these mechanisms have shown that deliberate joint planning can reduce duplication and better sequence introduction decisions. Some countries are also adopting whole-of-government approaches for addressing other health priorities, such as Ethiopia, with the integration of One Health principles into its National Action Plan for Health Security.
What whole-of-government coordination and capacity does
Whole-of-government coordination and capacity deliberately aligns and strengthens public-sector functions — regulation, budgeting, financing, procurement, training, and guideline development—across ministries and levels of government. Through formal and informal mechanisms, governments can coordinate timelines, budgets, regulatory approvals, and implementation plans to achieve shared goals and respond to cross-cutting challenges.
When coordination functions are strong, countries can:
1. Align regulatory and financing timelines: Coordinating financing decisions and regulatory timelines can reduce delays caused by misaligned cycles.
2. Sequence procurement, training, and rollout coherently: Routine coordination across procurement, supply chain, workforce trainings, and guideline updates can ensure system readiness before procurement begins – and does so more efficiently.
3. Reduce duplication and bottlenecks: Aligning planning cycles can prevent overlapping guideline revisions, multiple readiness assessments, and fragmented procurement efforts.
4. Strengthen national–subnational coherence: Coordinated planning gives subnational implementers timely information and clearer expectations, allowing time to adequately prepare and reducing rollout inconsistencies.
5. Build institutional memory and learning: Coordination mechanisms allow lessons to be captured, shared, and institutionalized, improving subsequent cycles and supporting future decisions.
Strengthening whole-of-government coordination and capacity does not necessarily require new institutions. Early progress often comes from repurposing and reorienting existing platforms—sector working groups, regulatory committees, or budgeting fora—toward shared timelines, clearer roles, and predictable information flow. Success depends on both political commitment and technical capacity.
What the ALIGN Consortium is doing
We hypothesize that if national and subnational governments strengthen coordination and technical capacity across public-sector functions, then innovation introduction will be more coherent, with fewer delays and greater alignment between prioritization and planned delivery. However, approaches to coordinating and capacitating whole-of-government require careful design to avoid increasing bureaucracy.
The ALIGN Consortium is investigating how coordination functions currently operate, both globally and within each pathfinder country (Kenya, South Africa, and Senegal), and identifying where strengthening these functions could have the greatest impact. Globally, we are conducting deep dives into how exemplar countries coordinate across government effectively to introduce health innovations.
Additionally, country teams are assessing:
• How roles and responsibilities for innovation prioritization and planning are distributed.
• Where coordination gaps or overlaps exist.
• What political and technical factors enable or constrain coordination across ministries and levels of government.
Conclusion & What’s Next
Strengthening the whole-of-government pillar can improve innovation introduction effectiveness by ensuring decisions reflect country priorities and delivery realities, and efficiency by reducing duplication, delays, and fragmentation. However, governments also need to effectively engage markets to ensure timely access, affordability, and sustainable supply. Our next post will explore the second pillar of a robust innovation introduction system: whole-of-market engagement.