Unpacking participation in healthcare governance: Lessons from two local health councils in Brazil and Spain

This paper describes and compares the integration of cross-sector actors' participation into the governance of two local health councils, one located in Salvador de Bahia (Brazil) and the other in the Canary Islands (Spain). Based on the cross-national comparative research conducted as part of a doctoral thesis, a qualitative design based on secondary data analysis was proposed on the three stages of the organisational integration process of participation. We used information from individual semi-structured interviews (n = 70), situational observation, focus groups, literature review, and field notes to understand participatory processes of networking between multiple cross-sector actors and to show how such processes might be associated with innovative practices. For these innovations to be successfully implemented, stakeholders need to acquire adequate competencies in cross-sector collaboration, enabling them to learn about new organisational practices and to adapt the network of actors to the often unpredictable influences of contextual factors. This study delves into the participatory integration of various actors in the governance of local health councils, revealing innovative trajectories of cross-sector collaboration that transcend traditional dynamics of health systems management. Cross-sector collaboration processes enable the successful adaptation of socio-health networks, empowering health professionals, managers, policy-makers, and civil society to cope with complex contextual influences. Participatory networks facilitate synergy among multiple stakeholders, democratising decision-making processes and enhancing healthcare services, patient outcomes, and population well-being. Thanks to the international comparative approach of this research, global trends and local practices are interconnected, providing valuable insights for policy makers and managers in the search for effective strategies in the field of Global Health.