Table 2

Summary of collaboration dynamics

Principled engagementShared motivationJoint capacity
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.

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.

  • Building trust between players a key short-term goal.

  • Importance of credible intermediaries and boundary spanners.

  • 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.

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.

  • Establishment of regular joint meetings.

  • Mobilising collective resources in existing networks and community structures to deliver SRH communication and services.

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.

  • Time taken to build trust and persistence from EHA ultimately led to productive relationships.

  • Legitimacy offered by involvement of an AIIMS professor and the long-standing presence of EHA.

  • 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.

  • AIIMS, All India Institute of Medical Sciences; CHA, Community Health Assistant; DOH, Department of Health; EHA, Emmanuel Hospital Association; USAID, United States Agency for International Development; VHR, virtual health rooms.