1.1. Institutional coordination and governance for equity-oriented local area management

Building robust local governance structures to foster equity-oriented management across sectors is crucial to advance health equity. This core area aims to formalize mechanisms that enable collaboration between government entities, civil society and populations in conditions of vulnerability, ensuring that decisions address the interconnected needs of diverse groups. By prioritizing equity and shared responsibility, this area of work promotes transparent, accountable and inclusive governance processes that empower local actors to lead change effectively. 

Examples from SIMASHE

Local Health Equity Tables for integration of  social determinants of health  in SIMASHE municipalities, Chile: Local health equity tables to sustain political dialogue among various local government sectors were established by mayors in the municipalities of La Cruz, Calle Larga, El Tabo, Lo Espejo, La Pintana, Renca and Perquenco. Aligning with local and subnational structures driven by ongoing health reform to promote integrated, equity-focused services, these tables aim to design and implement action plans to address SDH based on the theory of change devised in each municipality, with the participation of various policy sectors and representatives from community organizations. Sectors invited to take part included public works, education, environment, public transport, housing and culture. 
Support to the National Health Council and the District Health Committees in Peru: Technical support is being provided by PAHO via SIMASHE to the National Health Council and District Health Committees in Peru to strengthen their capacity for managing the SDH with an equity approach at the local level. This includes raising awareness among decision-makers and community leaders, in-person training courses on SDH and health inequities, and Theory of Change workshops in prioritized districts of La Libertad and Arequipa. These actions promote participatory planning, intersectoral collaboration and the integration of equity in local health policies and programmes.

 

Examples from related work and initiatives

Leveraging institutional coordination mechanisms in the Brunca Region, Costa Rica:  Efforts have been made in the Brunca region to strengthen coordination among local officials, the Costa Rican Social Security Fund, the Ministry of Health and other sectors, through Cantonal Institutional Coordination Councils. These councils improve collaboration among primary care teams, local governments and the community by identifying key priorities that address the SDH. These priorities include issues such as unemployment, community safety, adolescent drug use and multidimensional poverty, with a focus on initiatives aimed at developing life skills.

 

Advancing urban governance for health and well-being in Bogotá, Colombia: With support from the Urban Governance for Health and Well-being initiative, Bogotá is striving to become a “caring city” (ciudad cuidadora) by promoting inclusive and sustainable well-being through a participatory approach. A care promoters’ programme is being launched to strengthen integrated primary health care in collaboration with the local community and civil society. The project started in the Kennedy district, focusing on the participation of people with disabilities, where is supported by existing intersectoral committees led by the Secretary of Health and the Kennedy Local Council.

Learn more about the Urban Governance Initiative 
PAHO Bogota City brief
Promoting healthy urban development in Tunis, Tunisia: Through the Urban Governance for Health and Well-being initiative, Tunis is expanding green spaces in neighbourhoods in conditions of vulnerability, to support healthy lifestyles. Building on a national social dialogue mechanism, Tunis has held multiple meetings with community members to guide local planning. Two committees were established under the mayor’s leadership – one for multisectoral coordination and the other with local non-governmental organizations in the Sejoumi/Cité Helal delegation. Community consultations have focused on mechanisms for public participation in setting urban development priorities.

 

WHO Initiative on Urban Governance for Health and Well-being

Key intervention activities

SIMASHE is continuously seeking examples related to this area of work, including activities for:

  • formalizing local coordination mechanisms, such as commissions and councils, and frameworks for shared governance that include community representation.
  • strengthening governance structures for equity at the local level through decentralization, training and ongoing efforts of local commissions.
  • promoting and ensuring the deployment of coordination mechanisms with other levels of government, including regional and national.
  • strengthening local leadership and accountability for equity-focused decision-making.
  • engaging civil society and populations in conditions of vulnerability in formal governance roles.
  • integrating local area information systems for cross-sectoral decision-making.