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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
Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Emmanuel Hospital Association, New Delhi, Delhi, India.ORCID iD: 0000-0002-9607-9459
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2019 (English)In: BMJ Global Health, ISSN 2059-7908, Vol. 4, no 3, article id e001645Article in journal (Refereed) Published
Abstract [en]

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, nongovernmental 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.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019. Vol. 4, no 3, article id e001645
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-161544DOI: 10.1136/bmjgh-2019-001645ISI: 000471834400038PubMedID: 31263592OAI: oai:DiVA.org:umu-161544DiVA, id: diva2:1336846
Available from: 2019-07-10 Created: 2019-07-10 Last updated: 2019-07-10Bibliographically approved

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2223242526272825 of 1131
CiteExportLink to record
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