Table 1

Context, focus of collaboration, key actors involved and evidence used in constructing the case studies

Case studyKey contextual factorsFocus of collaborationActors collaboratingEvidence for case study
Increasing access to care through virtual health rooms, northern Sweden
  • Sparsely populated, vast geographical areas.

  • +25% are older than 65 years of age.

  • Problems of access and distance.

  • Split responsibility for care of the elderly between county (regional) councils and municipalities.

  • Lack of coordination between authorities.

  • Availability of high-speed internet.

  • e-Health champions and presence of an innovation hub (Centre for Rural Medicine).

Establishment of virtual health rooms in community settings with e-health technologies able to conduct remote consultations and follow-up of elderly patients without the presence of professionals.
  • Centre for Rural Medicine (initiator).

  • County councils (political and administrative).

  • Municipalities.

  • Community entrepreneurs.

  • Employment service.

  • Community hospitals.

  • Community members.

  • Ongoing evaluation of virtual health rooms at a local university (Umeå) involving observations, interviews and document reviews.

Whole of Society Approach (WoSA) in the Western Cape Province, South Africa
  • Rapid urbanisation, widening inequalities, unemployment, poverty and increasing needs for infrastructure.

  • Complex disease burden rooted in social determinants—HIV/TB, NCDs, injury and violence.

  • High levels of substance abuse, drug and gang-related crime.

  • Threat of climate change.

  • High levels of mistrust of government.

Multisectoral collaboration in four learning sites in the province bringing together provincial and municipal authorities, civil society and the private sector to address community needs in four local areas.
  • Provincial government (13 provincial departments, from head office to frontline providers) (initiator).

  • Municipalities.

  • External agency as facilitator.

  • Civil society and communities.

  • Private sector.

  • Documented reflective processes within WoSA and with local universities in a governance think tank.

  • Interviews conducted by doctoral student.

Community-based adolescent sexual and reproductive health (SRH) services in Nyimba District, Zambia
  • High levels of maternal mortality, 30% due to unsafe abortions, 80% of which are performed in adolescents.

  • Low access to SRH services for adolescents.

  • Religious taboos on sexuality.

  • Community health assistants (CHAs) mandated to coordinate a plethora of community actors around adolescent SRH.

Coordinated action in the community health system, led by CHAs, to address social norms and increase access to adolescent SRH.
  • National and district authorities (initiator).

  • Nurses and environmental health officers.

  • CHAs.

  • Community-based distributors.

  • Safe motherhood action groups.

  • Neighbourhood and health centre commitees.

  • Traditional, elected and other community leaders.

  • Community health volunteers.

  • Teachers and police.

  • Participatory action research project with University of Zambia.

Primary care (PC) epilepsy health systems project—Dehradun District, Uttarakhand, India
  • National Mental Health Programme since 2016, mandating epilepsy care in PC facilities.

  • Federal system involving national, state and district levels of decision making.

  • Very rapid turnover of key managers at state and district levels and doctors in PC facilities.

  • Culture of non-decision making, deferral to higher levels.

  • Epilepsy stigmatised, most cases untreated.

  • Mistrust of and reluctance to use government facilities.

  • Accredited Social Health Activitists (ASHAs) were stable and committed players.

Integration of epilepsy care into primary healthcare facilities; ensuring availability of drugs; building community awareness and healthcare seeking behaviour.
  • Emmanuel Hospital Association (EHA) (initiator).

  • Uttarakhand Department of Health.

  • District authorities.

  • All India Institute of Medical Sciences – Delhi.

  • Primary care doctors.

  • ASHAs (government-incentivised community health workers).

  • School teachers.

  • Implementation research project conducted by EHA.

  • NCDs, non-communicable diseases; TB, tuberculosis.