Community Voices in Health Governance

Community Voices in Health Governance – Translating Community Participation into Practice in a World of Pluralistic Health Systems” (COMPLUS)


The countries of Brazil, India and South Africa have mixed health systems wherein public and private providers operate side-by-side to deliver the same set of services. The health administrations in these countries are increasingly purchasing services from the private sector for delivering care. There is some evidence to suggest that the purchase arrangements could contribute to quick expansion of health access. But at the same time, community participation rooted in the human rights framework hitherto has largely been envisaged as part of the public health system for better responsiveness and accountabilities. But the changing scenario, of the governments actively engaging private providers (both private for-profit and private non-profit), is making health systems pluralistic. In such a pluralistic scenario does the conventional understanding of Community participation hold and whether community participation can still aim for better health system effectiveness?


To strengthen the participation and voice of communities and community structures in urban pluralistic health systems for better alignment of health system actors around the common goals of accountable, responsive, and inclusive health systems.

Research Methodology

The project employs a multi-country, multi-city consortium approach, involving a diverse group of researchers and community organisations. The study design proposed combines landscape analysis, in-depth qualitative research, and tracking of selected indicators derived from available secondary data. An actor-centred implementation analysis combined with complex adaptive systems approaches will be employed in the project. This framework perceives implementation as a series of interactions and negotiations between actor groups within intricate social and organisational contexts.

The study sites span multiple locations, including Cape Town and Gqebhera in South Africa, Sao Paolo and Fortaleza in Brazil, and Mumbai and Bangalore in India. Specifically, The George Institute India team leads the implementation in Bangalore. This diverse geographical spread is crucial in capturing a comprehensive understanding of community participation across different urban contexts within pluralistic health systems.

Current Status


The project is currently active. The project formally started in October 2022. The entire team came together during the inception meeting held in Cape Town from 27th February to 3rd March 2023. Visit the COMPLUS website for more details.


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