Institutional Mechanisms Sustaining Fragmentation of Interdisciplinary Collaboration in Fragile Health Systems: Evidence From Palestine

Aqtam, Ibrahim

Institutional Mechanisms Sustaining Fragmentation of Interdisciplinary Collaboration in Fragile Health Systems: Evidence From Palestine

Articles in Press

Document Type : Original Article

Author

Ibrahim Aqtam

Department of Nursing, Ibn Sina College for Health Professions, Nablus University for Vocational and Technical Education, Nablus, Palestine

Abstract

Background
Although interdisciplinary collaboration (IDC) is widely promoted in health policy, little is known about the institutional mechanisms that may sustain fragmentation in fragile and conflict affected health systems. This study examines these mechanisms using Palestine as a case study.

Methods
Applying the Walt and Gilson Policy Triangle, this documentary health policy analysis systematically examined five Palestinian national policy and regulatory documents, along with six international frameworks and four comparator-country documents from 2004 to 2025 (search conducted January–March 2025). Stakeholder mapping of 11 actor groups assessed power, interests, and reform feasibility inferred from documentary evidence rather than direct stakeholder engagement. Comparative analysis of four comparator-country documents (Canada, the United Kingdom, Australia, and Jordan) identified transferable policy mechanisms for illustrative comparison rather than formal comparative evaluation.

Results
Analysis reveals patterns consistent with institutional fragmentation across all eight policy domains. Of the five Palestinian national documents, none explicitly mention IDC; across the full 15 document corpus, only 2 documents (13.3%) explicitly mention IDC, and 9 documents (60%) lack any relevant provisions. The findings suggest three institutional mechanisms that appear to sustain persistent policy fragmentation: (1) disciplinary path dependency, whereby historical governance arrangements reproduce siloed structures; (2) donor aligned institutionalisation, where vertical funding mechanisms reinforce professional divisions; and (3) fragmented sovereignty constraint, whereby political separation between West Bank and Gaza precludes unified policy implementation. These mechanisms are presented as the author’s analytical interpretation of documentary patterns rather than established causal findings.

Conclusion
The findings suggest that fragmentation may represent a structurally embedded feature of the current policy architecture rather than an isolated implementation problem. The evidence supports further investigation of a phased reform strategy targeting accreditation standards, interprofessional education (IPE), and governance mechanisms as a potentially realistic pathway. The mechanisms identified warrant further testing for transferability to other fragile health
systems.

Highlights

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Keywords

Interdisciplinary Collaboration

Health Policy Analysis

Institutional Fragmentation

Conflict-Affected Settings

Palestine

Policy Mechanisms