Leveraging Critical Realism to Advance the Study and Practice of Multisectoral Coordination for Health: Insights From Uganda

Multisectoral coordination (MSC) is essential for addressing complex health challenges. However, the forces that support or hinder MSC, particularly within government settings, are not fully explored in low-income countries. Critical realism (CR) focuses on causal explanations beyond observable events and has the potential to support a more comprehensive and nuanced study of MSC for health. However, the application of CR insights in health research is still under development. A bigger challenge relates to the limited, inconclusive and incoherent guidance on practical aspects of applying CR such as methodological operationalisation, analytical procedures (including retroduction and mechanism theorisation), and reporting standards for CR-informed health research in practice. This paper contributes to addressing this gap by advancing the operationalisation of CR for studying and informing practical approaches to MSC and other complex phenomena in health policy and systems research (HPSR). It elaborates the philosophical and conceptual underpinnings of CR. The paper shows how critical realism’s ontological and epistemological foundations enable a deeper analysis of the mechanisms, underlying structures, and contextual conditions shaping coordination processes. By emphasising ontological depth, CR moves beyond event-based explanations to uncover the deeply seated causal forces that shape coordination and governance dynamics. CR enabled deeper theorising and analysis (through retroductive reasoning, theorisation of causal mechanisms, and stratified ontological reasoning) of power dynamics, institutional arrangements and political processes that influence MSC in Uganda. In doing so, this paper demonstrates how CR can inform context-sensitive and politically grounded strategies, improve policy coherence, and strengthen governance structures that facilitate MSC. By linking philosophy, methodology, and practice, this paper demonstrates how CR can be operationalised to advance both the study and practice of MSC, with broader relevance for analysing and addressing complex challenges in HPSR. Practically, CR contributes to a more robust understanding of barriers, enablers, and strategic pathways for advancing MSC for health.