Analysis of partnerships for actions intra-sectoral and inter-sectors for health in areas of high socio-environmental vulnerability in the city of São Paulo/Brazil: a mixed method study

Since poverty areas are socioeconomic complex and limiting environments, there is a need to develop intra-sectoral and inter-sectoral actions in the health territory in order to achieve the economic and social well-being of people and society. This research aims to understand the relationship between inter-sectorial and inter-sectoral actions for health and socio-environmental groupings of the most vulnerable health territories in the city of São Paulo, identify which are the most frequent partners of these actions and how professionals experience these partnerships in their daily lives.Method We adopted the mixed sequential and explanatory method. In the first phase, an online form is applied and identifies the Basic Health Units (BHU) that take place as intersectoral actions with more partners. In the second phase, we explored how the professionals consider the characteristics of the territory where they act to seek partnerships and how they carry out the actions.Results Analysis of quantitative data indicated that: a) More than 98% of BHUs conduct intra- and inter-sectoral partnerships and b) there is no relationship between the indices of the most vulnerable groupings and the presence of intra- and inter-sectoral actions with statistical significance p <0.05. The content analysis of literal transcriptions pointed out that: intra-and inter-sectoral practices developed in the health territories were driven by the needs of the treatment of diseases or by the precarious conditions of life of individual or collectivities. However, in order to assist different types of violence, health professionals avoid seeking partnerships, including with the Tutelary Council and the Center for Human Rights, as they fear they will suffer reprisals by those who cause this violence. There was consistency between quantitative and qualitative data, except for partnership with education, other BHUs, environment, and the Tutelary Council.Conclusion

The construction of personalized partnerships for individual and collective health, in order to cope with social inequalities; of chronic diseases and by phases of the life cycle involved in socioeconomic fragilities that generate more poverty is part of the job from BHU's professionals.

Background
Inter-sectoral action on determinants of the health-disease and care process has long been recognized as an important factor in improving the health of the population. Facing health problems requires the search for partners and the implementation of effective intra-sectoral and inter-sectoral actions. Many experiences in different countries demonstrate the value of inter-sectoral action, where health efforts have been reinforced by involvement with other sectors, although few countries knowingly incorporate this action into their national health strategies (1).
Intra-sectoral actions are practices that arise from the need to improve the lives of people who are cared for by the health care network (2). Inter-sectoral actions aim to "achieve health outcomes in a more effective, efficient or sustainable way than the health sector could achieve by itself" (3). They seek to act within the social determinants of the healthdisease and care process.
The social determinants of health (4) in the spaces of vulnerability are too complex to be defined by any single parameter and are difficult to study because of the numerous geographic and social barriers. In these spaces, there are health problems that are transmissible, non-transmissible, and in addition, people suffer from violence and lack of presence of public authority responsible, which highlights the importance of intra-sectoral and inter-sectoral actions to address the diversity of these determinants (5). Partnerships between public health and other sectors effectively improve access to services for marginalized populations (6). Jone and Barry's definition of partnership conjecture with these studies by stating that partners can achieve more by working collaboratively so that partners' resources and complementary expertise produce effective solutions (7).
This research was developed in the city of São Paulo(SP)/Brazil, a multifaceted metropolis that despite being the largest Brazilian economy, presents a marked social inequality between its territories (8). It has 12,038,000 inhabitants and is the eleventh largest population in the world. It has one of the highest densities in the world with 21.24 inhabitants/m2 and is the most populous in the American continent (9). Given the diversity of this mega-metropolis, the intra-and inter-sectorial actions need to be evidenced in order to direct public policies to face health problems.
In this article, the concept of vulnerability is circumscribed by dynamic, social and multigenerational modes, based on both the risk intensity and the resilience of people considered beyond the risk perspective, allowing the dialogue with the intersectoriality (10). We have adopted the synthetic vulnerability indexes known as Socioenvironmental Groupings in Health Territories (SGHT) because we understand that they are important tools in the active management of territories. These synthetic vulnerability indexes of the city of SP were elaborated by the Epidemiology and Information Coordination (CEInfo) with the objective of analyzing the health and life conditions and to know the possible factors associated to the population and health phenomena to subsidize the planning and management of health territories and other management levels of the Brazil's National Health System. In 2014 socio-environmental groups of 449 health areas of the Basic Health Unit (BHU) were created considering the economic, social, urban and environmental dimensions. After significant factor analysis, a total of seven homogeneous groups were identified (8).
The scope areas of BHU are unique health territories where Primary Health Care (PHC) professionals can implement comprehensive network assistance (intra-sectoral actions) and with different sectors (inter-sectoral actions), guaranteeing the integrality of care and prioritizing the health promotion (11), although trust may be fragile between partners (12).
In the type of Family Health Strategy (FHS) from the BHU, the professionals attend residents of a coverage area that are constituted by micro areas. Therefore, the micro area is the smallest territorial units in which the Community Health Agents (CHA) members of the FHS teams are mid-level health professionals who live and work in health promotion and surveillance practices in line with the multi-professional team (11).
International studies with different methods presented important conclusions on intersectoral practices. The World Health Organization conducted a study on inter-sectoral action for health in local government in low-, middle-and high-income countries and identified that these governments could provide a single scenario for the implementation of inter-sectoral activities, especially because of their proximity to people (13).
In another study, Kang aimed to analyze the characteristics and scope of inter-sectoral actions between physical activity programs in Healthy Cities compared to unhealthy Korean Cities and identified that Healthy Cities had a greater number of partners (14). The Healthy Cities local development strategy had a social pact as an intersectoral approach to address health determinants by committing to health promotion and improving the quality of life of the population(15). Tooher and colleagues sought to understand the processes and factors that influence inter-sectoral partnerships and point out that collaboration between complex systems, such as education and health, was a skilled enterprise that relied on a solid foundation of communication and interpersonal professional relationships to deliver expected results (16).
Studies on intersectorality in vulnerable areas in large Brazilian metropolises analyze different types of partnerships, for example, in Florianópolis, Heidemann and colleagues evaluate the achievements of the experience of community empowerment and point out that there are limitations to the integration of health promotion as an essential basis of community participatory practice (17). Becker and coauthors in Rio de Janeiro, analyze the work process in a BHU and conclude that professionals maintain curative, fragmented and individual care (18); and in the same metropolis Cohen and collaborators report experiences of health professionals as protagonists in the articulation between citizens and public housing policies in the search for healthy housing (19).
Despite the importance of inter-sectoral actions, the number of partners is still small. In a descriptive study of educational practices in the city of Belo Horizonte, Carneiro and coauthors indicate that only 9% carry out inter-sectoral actions (20). Moretti and collaborators using the mixed method showed that of the 67 BHU of the city of Curitiba, 97% of the teams report inter-sectorial actions, however the content analysis carried out by the authors identifies that only 23.1% of the teams performed actions with intersectoral characteristics (21), which indicates that these professionals adopt different definitions of inter-sectoral actions, then those adopted by the authors of the study. Sá and collaborators conducted qualitative research in the BHU of the metropolitan region of João Pessoa and report the scarcity of these actions by FHS members (22).
Unlike other studies, this research aimed to understand the relationship between intrasectoral and inter-sectoral actions for health and the socio-environmental groupings of the most vulnerable health territories in the city of São Paulo, identify which are the most frequent partners of these actions and how Professionals experience these partnerships in their daily lives through a two-step sequential mixed method.
Since poverty areas are complex and limiting socioeconomic environments, there is a need to develop intra-sectoral and inter-sectoral actions in health territory in order to achieve the well being of people and communities. In this way, we hypothesize that there is a relationship between the socio-environmental groups of the most vulnerable health areas and the existence of actions.
The present research is relevant for Primary Health Care, for scientific knowledge in poverty areas and for society, since its results can subsidize practices among different sectors in health areas of the high vulnerability of large metropolises which presents an increasing tendency of these areas. It also points out potential partners to be conquered in complex contexts of high socio-environmental vulnerability.

Methods
The research method adopted, called explanatory sequential mixed was adapted from Jonh Creswell and Plano Clark (2011) having the following representation QUAN → qual (23). The adoption of the QUAN → qual strategy provided a more complete understanding of the research problem and the results of the quantitative phase were explored in the next phase. In the first phase, with the quantitative research, we identified the accomplishment or not of the inter-sectoral actions and the partnerships established for this purpose. The units that performed inter-sectoral actions were considered for the qualitative phase. In this second phase, we conducted observations and also focal groups (24) to explore how professionals characterize the territory in which they work, their potential partners, and how they perform intra-sectoral and inter-sectoral actions for health. Figure 01 below represents the research design of the sequential explanatory and mixed method adopted. The question of the mixed method leads to the question that was answered by the quantitative method and after the data collection and first analysis of this phase, leads to the question that was answered by the qualitative approach, followed by data collection and analysis, and finally the data articulation and QUAN and qual analysis(23)(25).

Data collect
Primary data were collected from February to October 2018. Initially, we conducted a pilot study to adjust the multiple-choice form, which after the revision was used in the quantitative phase. From the analysis of the responses to the form, the BUH that met the selection criteria to start the qualitative phase was identified. The selection criteria were: BUH who have been developing intra-sectoral and inter-sectoral practices for over two years and having the largest number of partners.

Quantitative Phase: Pilot Test
The multiple-choice form to be answered online was developed by the researchers. This instrument consisting of fifteen questions was divided into four parts. The first part addressed the characteristics of the BUH types in the city: Traditional BUH, Family Health Strategy BUH, School Health Center, Mixed BUH and Integrated BUH. The second part aimed to identify which partnerships were made for intra-sectoral and inter-sectoral actions for health.
The third part points to the results of the partnerships, such as improved monitoring of pregnant women, reduction of communicable diseases, control of drug abuse, environmental improvements and collaborated to the development of healthy habits. And the fourth part was elaborated based on the studies by Hope Corbin and collaborators (26) that showed in a wide scope review the constitutive elements of the best partnerships.
They found nine constituent elements from which we selected five, as they answer the research questions: a)the development of shared mission to the objectives of the partnership; b)partnerships with various sectors; c)leadership that inspires trust and inclusion of new partners; d)building trust between partners and; e)the maintenance and evaluation of partnerships for continuous improvement.
The form was analyzed according to face validity and content validity (27). Face validity is determined by a sample of respondents who said whether the instrument appears to measure the characteristic of interest. We validate through the opinion of twenty-nine managers. They answered if the questions were clear and if the answers contemplated the characteristics of the BUH and the existence or absence of intra-and inter-sectoral actions.
Pilot test participants were the managers of social and environmental groupings ranked from one to four, 18.4% of managers out of scope answered the form. The analysis of the pilot test pointed to the need to reformulate some statements to submit the Likert scale (28) from the second to the fourth part of the form. We have added an answer option to some questions in the first part to address the diversity of contexts and understanding of the participants.
Content validity responds to what extent the instrument items effectively collect the information one wants to gather. We use smart PLS (Partial Least Square) 2.0 software and calculate Composite Reliability (CR) which is a more robust indicator of accuracy when compared to the alpha coefficient (29). To assess whether a sample is free of bias or if the set of answers are reliable we use CR. CR is a type of assessment of the relationships between indicators and constructs. Reliability values between 0.60 and 0.70 are considered adequate in exploratory research, while values of 0.70 and 0.90 are considered satisfactory for other types of research (30). We calculate the collinearity statistics: Internal and external Variance Inflation Factor (VIF) which detect multicollinearity. The VIF quantifies the extent of correlation between a predictor and the other predictors in a model. In this study in the proposed model, the CC was > 0.7 and the external VIF ranged from 1 to 3.2.

Quantitative Phase: Multiple Choice Form
The variables were classified by the types of qualitative nominal and ordinal. The variable socio-environmental groupings in health territories were of the dependent type. At the beginning of the form, we present the concept of "inter-sectoral actions" adopted in this research in order that the professionals understood how we were defining them.
The validated online form was emailed to UBS managers from March to August 2018. The manager who was agreed to participate clicked in a web link entered a contact email, read the Informed Consent Form(ICF), and what if I agreed to participate then, would begin to answer the questions. The form had six questions about the BHU tips and its composition and statements followed by a five-point Likert scale (1 = strongly agree, 5 = strongly disagree) to assess the level of agreement with 11 statements: three about action practice intra-sectoral and 8 statements about inter-sectoral practices and the respective time of partnerships, constitutive elements of the partnerships and results achieved to identify the relationship between the nonexistence or existence of these practices with socioenvironmental groupings in health territories.

Qualitative phase: Focus groups
At the end of the quantitative phase, we selected the BHU according to the selection criteria and invited professionals to participate in a focus group according to Van Den Hoonaard that considers it as open debate and an exchange of views (24). The groups were held in a BHU room, at a time previously agreed with the management, so as not to disturb the flow of care. We conducted a focus group in each of the 4 BHU selected and agreed to participate.
The focus group began with the presentation of the researcher who said she was also the manager of an emergency service in the city center, presented the research objectives and what would be the group's dynamics. She also requested the reading and signing of the ICF and the authorization to turn on the audio recording equipment, and the researcher made notes in the field diary during and after the talks with the group.
Then each member introduced himself, said his name and the characteristics of the micro areas and areas covered by BHU in which he operates. The researcher presented the concept of inter-sectoral actions and proposed to the participants to talk about "How inter-sectoral actions happen in the coverage area". As Van Den Hoonaard(2018) points out, this question worked as a guiding topic and whenever necessary the researcher asked for clarification to maintain the focus of the discussion(24).

Research Context
The research fieldwork was crossed by outbreaks of yellow fever, the resurgence of H1N1 influenza and low vaccination coverage in the municipality, which further increased the workload of professionals and contributed to lower availability to participate in this study.
In this context, it was necessary to increase the time taken to collect and redo calls for managers to participate in the pilot test and the first quantitative phase, as well as to redo calls to request authorization for the focus group in the second phase.

Participants: quantitative phase
Health service management is the segment of service management for which numerous ordinances and operating procedures are produced. It is the most complex link in the health system management structure and it can creatively mobilize resources to overcome everyday problems (31). According to this understanding, all BHU managers from the most vulnerable social and environmental groups were invited to respond to an online form indicating the existence of intra-sectoral and/or inter-sectoral actions as well as their respective outcomes and constitutions.

Participants: qualitative phase
The work of a multi-professional team advocated by Brazil's National Health System for comprehensive care is configured in the reciprocal relationship between the multiple technical interventions aimed at developing disease prevention and health promotion actions (32). In the second phase "which" we asked managers to nominate team members who work directly on inter-sectoral actions to participate in this survey. The twenty-six nominees were invited, but although they agreed to participate, two did not have time to attend the focus groups.

Data Analysis: Quantitative phase
Quantitative form data was entered into a Microsoft Excel spreadsheet automatically after responses in the Google Docs tool. The identification of the BHU was requested for the selection of the second phase of research. Data were transferred to Jasp Statistic software (version 0.10) (33) for statistical analysis. We applied chi-square distribution technique to quantitatively assess the relationship between two nominal and ordinal variables.
Univariate analyses were performed by socio-environmental groupings relating to the existence of intra-sectoral and inter-sectoral actions and the partnerships of the territory. P values < 0.05 were considered significant.

Data analysis: qualitative phase
The literal audio transcripts were submitted for comment and approval by the survey

Mixing of quantitative and qualitative data
We articulated the quantitative and qualitative data (Table 1) for the integration of these analyzes (25) which were represented in figure 2.

Phase one: Quantitative
A total of 191 managers answered the email inviting them to participate in the survey, and four managers did not want to participate and seventeen answered the form twice.
After excluding the duplicates, 170 forms were analyzed, corresponding to 60.9% of the BHU managers of the social and environmental groupings of the highly vulnerable health territories (classified as five, six and seven respectively). Table 2 next presents the distribution of the number and percentage of participation by grouping. Participants who stated that they perform intra-sectoral actions correspond to 98.8% and those who perform inter-sectoral actions correspond to 99.4%. The chi-square analysis revealed that there is no relationship between vulnerable SGHT and the existence of intrasectoral and inter-sectoral actions( Table 3).
About intra-sectoral partners, the analysis demonstrates the relationship of the groupings with the following intra-sectoral partners: Other BHU (p = 0.009) and mental health services (p = 0.007)( Table 4). There is also a significant relationship with some intersectoral partners: social assistance (p = 0.007), environment (p = 0.007) and Guardianship Council (p = 0.007)( Table 6).   Table 5 shows the results of univariate analyses using the chi-square test. There are statistically significant relationships between intersectoral actions and the following

Phase two: Qualitative
The researcher observed fragile housing, few cars on the streets, many people waiting for public transportation, poor sanitation, tangled wiring; and in the BHU, as a general feature, walls with many posters that draw readers' attention to disease prevention or health promotion.
Ten BHU were invited to participate in the focus groups, four of which accepted. In each BHU, a single focus group was carried out, with an average duration of 50 minutes indicates that the groups were representative and relevant to the research. There were no individual drop-outs or refusals to participate in focus groups or people present who did not participate in inter-sectoral actions. In the fourth group, we detected theoretical saturation because the data obtained started to present repetitions (27).
The themes that emerged from the qualitative data presented in table number 6 related to the characterization of the territory and relationship with the partners of intra-sectoral and inter-sectoral practices in health territories included:

Theme 1: Social Inequalities and the Epidemiological Profile
In this theme, two sub-themes were identified: chronic conditions by life cycle phases and social inequality between micro areas within the same territory.

Chronic conditions by life cycle phases
Participants described their territory at the beginning of the focus group. The context of

Social inequalities between micro areas
Participants point to demographic and social inequalities between micro areas within the same coverage area. They show that the population suffers from different health problems that go beyond the walls of the health sector. While a micro area has no sanitation and children play in the contaminated stream exposed to epidemic phenomena, the elderly, hypertensive and diabetic are affected by violence in another micro area.

Theme 2: Building expanded health partnerships: individual and collective
From this theme, two sub-themes were built: intra-sectoral and inter-sectoral arrangements established for people and intra-sectoral and inter-sectoral actions for collectivities.

Intra-sectoral and inter-sectoral arrangements for people
A set of complex problems experienced by a single person can lead to the formation of intra-sectoral and inter-sectoral partnerships in highly vulnerable territories. Intra-sectoral partnerships are built according to individual diagnostic and treatment needs while only inter-sectoral partnerships are those built because of socioeconomic vulnerability. While when professionals seek both intra-sectoral and inter-sectoral partnerships, they are mostly for people with chronicity and surrounded by complex socioeconomic situations, as long as the partnerships are not established and the socio-economic problem is managed.
It is not possible to advance effective treatment and maintenance of well-being. To guide this work, the professional teams of some territories elaborate on the Singular Therapeutic Project (STP).
The problem case of Magali, described in focus group number 3, clearly demonstrates this situation, as she is a transsexual living with HIV and syphilis, worked as a sex worker and had no documents, which demanded the partnership with a specialized service in STDs/AIDS, as well as the social assistance that guided her in the making of documents, which were even necessary for her to receive antiretroviral treatment. In addition, the partnership with education made it possible for her to return to school and with the Specialized Referral Center for Social Assistance (CREAS), which offered a benefit so she could support herself while studying and looking for another profession because she wanted to stop prostituting herself.
Health professionals reported that they use other sectors, just as other sectors seek the BHU to solve installed problems. The most described intra-sectoral partnerships were with the CAPS and the inter-sectoral one was the school and social assistance equipment: Reference Center for Social Assistance (CRAS) and CREAS.

Intra-sectoral and inter-sectoral actions for collectivities
The professionals to constitute partnerships for collectives go beyond the established actions, they too innovate in the search for new care practices in the territory, such as for   (Focal group number 4).
"...now we have a partnership with Afromix people who are also helping there on the walk they will even cover the court there, do you know?" (Focal group number 4).
Students and older people benefit most from partnerships that are often inter-sectoral.
Intra-sectoral and inter-sectoral partnerships are aimed at groups of people in psychotic distress or family members of drug users with the largest partners being CAPS, CRAS and CREAS. In addition, the children and youth groups are covered by the Brazilian Program Health in School (PHS) and receive actions to promote oral health and prevention of immuno-preventable diseases.
"It is also the group that is a partnership with education, which is with oral health that leads to health in education that is the PSE. That enters both the medical part, as the nursing part and also the dental part. In the dental part, there is a new program we go to school to do the dental treatment of children called ART [Atraumatic Restoration]" (Focal group number 2).
"We have a lot of support from them [school] so, whenever they have a problem they come to us, we also delivery some demands to them" (Focal group number 1).

Discussion
This study of the two-phase sequential mixed method explored the relationship between intra-sectoral and inter-sectoral actions for health and the socio-environmental groupings of the most vulnerable health territories in the city of SP, presented the frequency of partnerships and the understanding of BHU professionals who experience these partnerships in their daily lives.
We identified that professionals perform intra-sectoral and inter-sectoral arrangements There was consistency between quantitative and qualitative data except for partnership with education, other BHU, environment, and the Guardian Council. The percentage of the education partnership was 88.23%, being higher in the socio-environmental grouping number seven in the quantitative study, although it was not statistically significant. Unlike the qualitative study where professionals narrate the reciprocal search between schools and BHU. The opposite occurred in relation to partnerships with other BHU and the environment which were statistically significant in quantitative studies but were not cited in focus groups, which may indicate that these partnerships happen heterogeneously in some health territories and not in others.
There is a partnership with CAPS, which was also described by Mendel and collaborators who conducted evaluative research using a mixed-method and pointed to the effectiveness of networking to address depression care in underserved communities(42).
This partnership happens, despite the difficulties, great demand for health services and lack of institutional guidelines for the realization of the partnership (43).
The environment sector in this study was considered by 83.9% of managers as one of the important partners of the BHU. This partnership can be justified by the adoption of the Environment, Green and Healthy Program (EGHP) by the city of SP, which since 2005 seeks to implement health promotion strategies considering the potential for the development of local and regional community projects that express an agenda of protection and promotion of green and healthy environments in the area where BHU operates (44).
In this study, the search for the Guardian Council as a partner was identified in more than sixty-nine percent of high-vulnerability groups, but professionals report fears of violence in seeking such a partnership, including combating child maltreatment. This fear probably permeates the medium-high score, which indicates the low search for partnerships with the sectors of Public Security and the Human Rights Center (CDHU), because professionals consider that there is no guarantee of anonymity of those who report, which makes them vulnerable to the perpetrators of such violence. This was also described by Egry and collaborators in an integrative documentary review and interview with health professionals from a highly vulnerable area of the city of SP where they point out the difficulties and weaknesses of the care network in addressing issues, the need for intersectoral actions and training of professionals to deal with situations of violence (45).
To meet the complexity experienced by users of BHU, professionals resorted to various partners, inside and outside the health. We found that while professionals are looking for partners to solve complex cases associated with illnesses and life situations, community leaders seek help with home visits to bedridden people, going to leisure spaces and sewing clothes for needy pregnant women. This was also described by Peters and colleagues who conducted a multi-method survey in the Netherlands, which points out that as broader objectives were agreed, more integration was visible and more partners and sectors were involved(46).
Rasanathan and colleagues can help to understand this by suggesting that low-and middle-income countries, including Brazil with unequally distributed middle income, where institutions are generally weak, and fragmentation, including the health sector, can ruin coordination of intersectoral policies (47).
In territories with high vulnerability, there are communicable and noncommunicable health problems, and people also suffer from violence and the ineffective presence of public authority, as also described by Unger and Riley (5). In this study, we conclude that specific intersectoral arrangements are constructed in the spaces of vulnerability that are focused on biomedical and sectorial logic. These arrangements are made, undone and redone as problem cases are known. In addition, intra-sectoral and inter-sectoral actions are carried out for communities that remain and transform to sustain disease prevention and health promotion actions.

Limitations
A limitation of this study that we recognize in the interpretation of the results. Some participants considered several practices that were not included in the definition of intersectoral partnerships indicating a high percentage of actions. The difference in conceptual interpretation has enriched the study because we can differentiate inter-sectoral actions, with sustainability for collectivities, from arrangements that are punctual and generally designed for people. Convenience sampling for the quantitative study may have generated clippings of territories that do not perform intra-sectoral and/or inter-sectoral actions or that do but in the context of the epidemic mentioned above, could not answer the form, but the participation was over 60%.
Another limitation was that quantitative data were collected online. In addition, a selection bias may have affected our data due to the lack of participation in the Environmental Promotion Agent (EPA) focus groups, and its role is to work on intersectoral projects in the territory. Health Promotion and the results of the quantitative research points the environment sector one of the potential partners of the BHU.

Conclusions
The intra-sectoral and intersectoral practices developed in the health territories were We confirm that we have obtained consent to publish and report individual patient data.

Availability of data and materials
The data sets used and analyzed during the current study are available from the corresponding author upon reasonable request.

Funding
The authors received no financial support for the research, authorship, and/or publication of this article.

Figure 1
The research design of the sequential mixed method adopted Elaborated according to Creswell and Plano Clark, 2011(23) and Santos et al, 2017 (25).

Figure 2
Integration of quantitative and qualitative data: Context of intra-sectoral and intersectoral arrangements and action partnerships