Sweden | Leadership from the Centre for Rural Medicine brought actors together around an ‘e-health innovation’. A recognised shared problem and responsibility between county council and municipalities. All stakeholders, including communities, engaged in setting up the VHRs.
| Trusting relationships already in place due to earlier collaborations. Interest from media generates profile and legitimacy. Incentive structures within the health system and community perceptions might be future barriers to shared motivations, requiring further trust building.
| Structures of decision making and participation established. Procedural and institutional arrangements still rest on a few highly motivated individuals. Further agreements on day-to-day management and information sharing needed. Funding from the Swedish Agency for Economic and Regional Growth.
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South Africa | Health sector players have had to set aside short-term focus on sector-specific goals in favour of jointly defined problems and negotiated solutions. Key design principles lay out values, principles of cocreation and modes of engagement. Use of USAID’s ‘Collaborating, Learning, Adapting’ Maturity Framework to monitor learning.
| | Distributed leadership achieved. Alignment of planning across local and provincial government spheres. Clear governance structures established. Spatial indicator framework and cross-sectoral data repository enable shared understanding and joint planning.
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Zambia | Coordinating roles of CHA endorsed by national, district authorities and community leaders. CHAs built informal relationships beyond the prevailing hierarchical modes.
| Instrumental, facility-based roles established legitimacy of CHAs. Trust built through regular communication. Use of official role to act as brokers for other players.
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India | Catalyst for collaboration through successful implementation research proposal. Limited by frequent transfers of senior decision makers in DOH. Finding willing stable primary care doctors and pharmacists key to partnership.
| | DOH infrastructure, supported by non-profit project management and community relationships and expert trainer from academia. Joint knowledge generation through implementation research. Absence of clear procedural arrangements involving DOH.
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