The governance of local health systems in the era of Sustainable Development Goals: reflections on collaborative action to address complex health needs in four country contexts

Abstract

This analysis reflects on experiences and lessons from four country settings—Zambia, India, Sweden and South Africa—on building collaborations in local health systems in order to respond to complex health needs. These collaborations ranged in scope and formality, from coordinating action in the community health system (Zambia), to a partnership between governmental, non-governmental and academic actors (India), to joint planning and delivery across political and sectoral boundaries (Sweden and South Africa). The four cases are presented and analysed using a common framework of collaborative governance, focusing on the dynamics of the collaboration itself, with respect to principled engagement, shared motivation and joint capacity. The four cases, despite their differences, illustrate the considerable challenges and the specific dynamics involved in developing collaborative action in local health systems. These include the coconstruction of solutions (and in some instances the problem itself) through engagement, the importance of trust, both interpersonal and institutional, as a condition for collaborative arrangements, and the role of openly accessible information in building shared understanding. Ultimately, collaborative action takes time and difficulty needs to be anticipated. If discovery, joint learning and developing shared perspectives are presented as goals in themselves, this may offset internal and external expectations that collaborations deliver results in the short term.

Exploring Community Mental Health Systems – A Participatory Health Needs and Assets Assessment in the Yamuna Valley, North India

“…18,33 The participatory dialogue led to the establishment of preliminary partnerships, as observed elsewhere. [5][6][7] The findings surfaced and also underline the complexity of power dynamics in the health system, such as for ASHA workers who are central in help-seeking but with little power. 11 Data collection by community-based team members increased dialogue and included voices of those typically excluded.…”

“…1,3,4 Identifying and describing community mental health needs and assets can increase partnerships, responsiveness and community agency to allow excluded citizens to shape systems and policies. [5][6][7] Describing the resources communities draw on to respond to mental ill-health acknowledges communities as experts in their own right, and as active agents promoting 'community mental health competence. ' 4 Ongoing contact with and use of trusted local providers (both allopathic, traditional and complementary systems) can increase accessibility and acceptability of healthcare facilities.…”

The Potential Role of Community Actors in The Response Against COVID-19: Lessons From Three African Countries, Tanzania, Uganda and Zambia

“…Use of the community actors and structures is also important as it may trigger collective action and responsibility towards addressing COVID-19 [38]. This may among other aspects create a better appreciation of the non-discriminatory nature of the pandemic and therefore calling for a consorted ght to defeat it.…”

"Not Just a Journal Club – It’s Where the Magic Happens": Knowledge Mobilization through Co-Production for Health System Development in the Western Cape Province, South Africa

“…The personal leadership lessons derived from the JC discussions and our way of organising it, have changed our practice 'in the spaces we hold and the way we hold them' (May 2019 author reflections). For example, in processes of organizational renewal and in inter-sectoral engagements to address the social determinants of health led by WCG:H (Figure 1), 21,22 or in new CityHealth processes of engaging front-line managers and staff to develop everyday health system resilience. 23 As noted in the October 2014 JC reflection session, 'many of the lessons learnt from the JC are put into practice by managers … within their respective working environments' (see also S. Soal, unpublished data, 2015).…”

“…4. A range of publications involve shared authorship among those involved in the JC, 22,27 or draw on ideas discussed in the JC. 23,26,28 Although the macro, societal-level impacts of the JC and linked engagements are inevitably harder to discern, it can be argued that they are likely to flow from the sorts of policy and organizational changes initiated within the WCG:H and CityHealth discussed above.…”