This briefing looks at six case studies from the POTENCIAR programme, implemented in Mozambique’s health sector. It highlights lessons for governance programmes and discusses how POTENCIAR’s interventions facilitated knowledge-sharing, participatory planning, institutional coordination, and mutual accountability, leading to enhanced health service delivery (for the full report, see Alexander et al. 2025, forthcoming).
There is an urgent need to scale up participatory governance models, support context-specific implementation approaches, embed collaborative structures within national systems, and ensure flexible financial models for civil society support within adaptive programmes.
Key messages
- Collaborative, inclusive, and participatory practices should be institutionalised across government agencies, civil society organisations, and private sector actors. This reduces silos, pools resources, streamlines decision-making, and engages diverse stakeholders, leading to better governance outcomes.
- Management approaches and strategies should be adaptive in response to complex conditions. This includes flexible funding models that allow for programme adjustments based on real-time monitoring.
- Sustained relationship-building through regular joint planning and problem-solving fosters long-term partnerships and enhances coordination, though initial mistrust and competition complicate efforts.
- Formalising collaborative structures through Memoranda of Understanding (MoUs) and accountability mechanisms ensures sustainability beyond donor funding cycles.
‘Flexible, responsive programming that can adjust to changing political, economic, and social contexts is crucial for navigating complex governance environments.’
Mozambique’s governance landscape is characterised by centralised decision-making, weak institutional capacity, and limited citizen participation. These challenges hinder effective resource allocation and service delivery. The health sector faces financial and technical constraints, with heavy reliance on donor funding and fragmented coordination among stakeholders. Addressing these issues requires a collaborative approach that involves all relevant actors and seeks to establish new rules of the game for the governance of service delivery systems.
The POTENCIAR programme, funded by the UK Foreign, Commonwealth & Development Office (FCDO), was implemented in Nampula Province to address governance constraints in Mozambique’s health sector. The programme focused on enhancing accountability mechanisms, strengthening coordination, and fostering participatory governance models. POTENCIAR brokered relationships, facilitated knowledge-sharing platforms, funded more inclusive multisectoral planning processes, and institutionalised feedback mechanisms in support of more structured and formalised collaboration between government institutions, civil society organisations (CSOs), and other non-state actors. This contributed to improvements in decision-making, resource allocation, and service efficiency, despite systemic barriers such as centralised governance and financial constraints.
The following six case studies illustrate collaborative practices supported, expanded, or initiated by POTENCIAR and its partners. Each case study highlights a specific type of collaboration, and demonstrates how diverse stakeholders – including government institutions, CSOs, private sector actors, and development partners – engaged in joint efforts to improve service delivery. The case studies outline the situation before POTENCIAR’s intervention and how the programme unblocked barriers to collaboration by facilitating engagement, trust-building, and institutional reforms. The case studies offer lessons on how investment in support of structured collaboration contributed to systemic improvements in governance and service provision in Mozambique’s health sector.
‘There should be collaborative, inclusive, and participatory practices across government agencies, civil society organisations, and private sector actors.’
Effects of POTENCIAR’s collaborative practices
Knowledge-sharing: exchange visits between health centres
Before POTENCIAR’s intervention, health facility directors in Nampula and Monapo districts operated in isolation, lacking structured knowledge-sharing mechanisms and formal training on key health-care practices. POTENCIAR introduced exchange visits, enabling directors to observe different practices, identify challenges, and collaboratively develop solutions. This initiative created a peer-learning network, enhancing social accountability and decision-making. Discussions with staff and patients during visits helped document service delivery challenges and successes, while WhatsApp groups facilitated ongoing knowledge exchange. Despite challenges in implementing shared lessons, the initiative improved efficiency, patient care, and collaboration between health units. By fostering professional networks, leveraging digital communication tools, and encouraging continuous learning, this initiative provided a scalable approach to enhancing collaboration within Mozambique’s health sector.
Participatory planning: planning and monitoring meetings
Before POTENCIAR’s intervention, planning and monitoring in Mozambique’s health sector were centralised, excluding CSOs and local actors from annual meetings. This limited diverse input and hindered effective policy implementation. POTENCIAR facilitated a shift towards inclusive planning by mapping key health actors and integrating CSOs and community-based organisations (CBOs) into meetings. This ensured diverse voices in health sector discussions, supported workshops for joint objective setting, and reinforced monitoring mechanisms such as Co-Management and Humanisation Committees (CMHCs). Despite challenges with financial sustainability, this approach enhanced accountability and service delivery. Embedding participatory approaches into health-planning structures enabled the recognition of CSOs and CBOs as legitimate stakeholders in health governance. Their continued involvement increased transparency and accountability, reinforcing a culture of collective responsibility. However, sustaining these gains will require further institutional support, particularly in securing financial resources for continued CSO participation.
Coordination: working with training institutes
Before POTENCIAR’s intervention, health-training institutes in Nampula Province operated independently, with an inefficient distribution of interns and misaligned curricula. POTENCIAR facilitated coordination between the public health-training institute, the Instituto de Ciências de Saúde (ICS) and private institutions, supporting the mapping of health centres, the development of a rotating internship schedule, and collaboration through regular meetings. This improved the equitable distribution of interns and standardised training practices. Systematic mapping enabled progress, but governance fragmentation posed challenges. Improvements in coordination between training institutions have the potential to endure beyond the lifespan of POTENCIAR, provided that key enablers remain in place. Sustainability will depend on formalising institutional agreements between ICS, private training institutions, and district health and social action services, embedding coordination mechanisms within standard operating procedures.
Collective sense-making: Holistic Vision Conference
POTENCIAR facilitated the Holistic Vision Conference, bringing together stakeholders from the Provincial Health Directorate (DPS), CSOs, academia, and the private sector. Before this, Mozambique’s health sector operated in silos with minimal cross-sectoral dialogue. The formation of a scientific committee, involving DPS, POTENCIAR, and the Coordination Development Unit of Nampula (UCODIN), placed an emphasis on evidence-based and inclusive discussions. The conference incorporated perspectives from various sectors, including education, water and sanitation, and social protection. Despite challenges around diverging institutional visions, the conference fostered cross-sectoral engagement and problem-solving. It laid the groundwork for a more integrated approach to health governance in Nampula, fostering relationships between government institutions and non-state actors. However, sustaining this model will require institutionalising multisectoral forums within provincial health-planning processes.
Collective implementation: the legislative process for addressing obstetric violence
POTENCIAR provided support to the Humaniza Moz campaign, an advocacy initiative by a cross-section of CSOs seeking to formalise legal protections against obstetric violence. Before the Humaniza Moz campaign, there were widespread reports of mistreatment during childbirth and no formal accountability mechanisms. POTENCIAR supported the campaign by commissioning a study to identify legislative gaps and organising multi-stakeholder workshops to draft a bill of law. This inclusive process involved activists, health-care professionals, law enforcement, and the Prosecutor’s Office, ensuring that the proposed legislation reflected diverse perspectives. The campaign’s success was driven by effective advocacy, though civil society fragmentation posed challenges. A key next step is embedding enforcement mechanisms within the health sector, including training for health-care providers and awareness campaigns for patients. Additionally, long-term engagement with the Ministry of Health and legal bodies will be essential to operationalise the law effectively.
Mutually accountable collective action: the development of the Grievance Redress Mechanisms (GRM) platform
Before the development of a consolidated GRM platform, Mozambique’s health sector grievance mechanisms were fragmented and ineffective, with citizens lacking a unified system to report complaints. POTENCIAR facilitated the creation of a multisectoral GRM platform by mapping existing mechanisms, sponsoring technical discussions, and engaging stakeholders to improve coordination and accountability. This process included co-developing the platform’s structure and operational framework. Early mapping of grievance mechanisms enabled progress, though initial mistrust between civil society and government posed challenges. The long-term effectiveness of the GRM platform will depend on whether stakeholders continue to lead platform-related activities independently, rather than relying on external facilitation from programmes such as POTENCIAR.
Catalysing more accountable governance
The POTENCIAR programme demonstrated the potential for collaborative practices to improve governance and accountability in Mozambique’s health sector, despite the challenging political and economic context. The programme’s focus on maternal health services in Nampula Province was pivotal, aligning with the interests of diverse stakeholders, including government officials, CSOs, and development partners. The study confirms that thinking and working politically, where teams and partner actors identify tangible issues with broad support for change, are both effective and cost-efficient in closed or closing contexts. Issue-based work supports incremental approaches to problem-solving through brokering relationships, convening diverse actors, and understanding and working with incentives and power dynamics.
The findings illustrate that initiatives aimed at improving collaboration play a crucial role in fostering more inclusive, accountable, and effective governance structures. Collaborative practices help break down institutional silos, allowing actors to pool resources, expertise, and networks. When government agencies, CSOs, and private sector actors coordinate their efforts, they can avoid duplication, streamline decision-making, and implement solutions more effectively. Collaborative approaches can build long-term institutional capacity, increasing the sustainability of interventions beyond the duration of external funding. Unlike isolated, donor-driven projects that often fade once funding ends, collaboration fosters co-ownership among stakeholders, leading to greater commitment to maintaining initiatives and reinforcing mutual accountability.
The case studies from POTENCIAR offer replicable, scalable approaches as part of adaptive programmes designed to strengthen governance and accountability in adverse contexts. Adaptive management approaches proved crucial for navigating complex governance environments. The ability to adjust strategies in response to shifting political, economic, and social conditions, such as the Covid-19 pandemic and political instability, was essential for the effectiveness of interventions. However, weak enforcement of health-care quality standards and centralised governance structures can slow down bottom-up initiatives and reduce the urgency for reforms.
Building trust among stakeholders emerged as another critical factor. Sustained relationship-building through regular joint planning and problem-solving fostered long-term partnerships and enhanced multi-stakeholder coordination. Yet initial mistrust between civil society and government, along with institutional competition for control over accountability mechanisms, complicated coordination and reduced effectiveness. The inclusion of diverse stakeholders, including marginalised groups, enhances collaboration, although fragmentation within civil society and unequal power dynamics can limit their influence.
Institutionalising collaboration through formal structures such as MoUs, joint planning frameworks, and accountability mechanisms helps ensure long-term sustainability beyond donor funding cycles. Financial constraints and institutional inertia, however, can hinder the full embrace of participatory planning and collaborative mechanisms. Additionally, recognising the value of small, incremental changes in governance practices can drive meaningful progress. Supporting initiatives that promote knowledge-sharing and peer-learning networks can lead to improvements in service delivery and accountability, despite limited capacity to implement shared lessons and weak monitoring systems at facility level.
‘Formalising collaborative structures through MoUs, joint planning frameworks, and accountability mechanisms helps ensure sustainability beyond donor funding cycles.’
Finally, engaging with and activating flexible funding mechanisms is essential for addressing emerging challenges and adapting to changing contexts effectively. Offering funding mechanisms that allow for programme adjustments based on real-time monitoring, and recognising the need for flexibility in catalytic fund provision to partners, can enable programmes to be responsive and proactive. Funding uncertainty and resource scarcity operate as both enabling and disabling factors. They can limit the implementation of reforms and reduce the sustainability of collaborative initiatives. Yet they can also encourage collaboration and innovation where groups are committed to shared problem-solving. These factors need to be considered to ensure the success and sustainability of governance and accountability initiatives, with potential applicability to other settings.
The findings from the research suggest that there is value in future governance programmes and initiatives building on POTENCIAR’s successes and failures to contribute to more resilient, inclusive, and accountable service delivery in closed, authoritarian contexts. By institutionalising dialogue platforms and embedding accountability mechanisms, POTENCIAR has helped bridge gaps between communities, civil society, and government institutions, ensuring that citizens’ concerns are more effectively addressed. Continued investment in adaptive management, trust-building, inclusivity, institutionalisation, multisectoral collaboration, and flexible funding will be essential for sustaining the positive impact of new ways of working as a pathway to governance reforms.
Policy recommendations
There is scope for the FCDO to build on the findings to strengthen their approach to adaptive management and leverage limited funding envelopes to contribute to more responsive, transparent, and citizen-centred governance.
- Support adaptive management: continue to fund and support flexible, responsive programming that can adjust to changing political, economic, and social contexts. Incorporating political economy analysis and adaptive management practices into programme design remains crucial for navigating complex governance environments.
- Promote inclusivity: ensure governance programmes are inclusive and participatory, engaging a broad range of stakeholders, including marginalised communities and grass-roots organisations. This will enhance the legitimacy, responsiveness, and sustainability of governance initiatives.
- Institutionalise collaborative mechanisms: leverage programme initiatives to demonstrate the value of formalising collaboration through MoUs, joint planning frameworks, and structured accountability mechanisms. This sustains long-term partnerships and prevents fragmentation and duplication of efforts.
- Support incremental changes: FCDO should recognise the value of small, incremental changes in governance practices. Supporting initiatives that promote knowledge-sharing and peer-learning networks can drive meaningful progress in governance and accountability.
- Activate flexible funding mechanisms: FCDO should continue to offer and develop innovative funding mechanisms and models that allow for programme adjustments based on real-time monitoring and learning. In addition, there is a need to recognise and allow for flexibility in catalytic fund provision to partners, giving managing agents scope to be proactive in supporting partners to overcome barriers to change.
Further reading
Alexander, K.; Alcorta, L.; Shankland, A.; Shutt, C. and Robertson do Santos, C. (2025, forthcoming) ‘Succeeding in the Snakes and Ladders Game of Development in Mozambique: The Role of Collaborative Approaches’, IDS Working Paper, Brighton: Institute of Development Studies
Darumurti, A. (2022) ‘Increasing the Role of Non-State Actors in Collaborative Governance’, Proceedings of the International Conference on Sustainable Innovation on Humanities, Education, and Social Sciences (ICOSI-HESS 2022): 743–53, DOI: 10.2991/978-2-494069-65-7_60 (accessed 19 April 2025)
Faustino, J. and Booth, D. (2014) Development Entrepreneurship: How Donors and Leaders Can Foster Institutional Change, Working Politically in Practice Series, Case Study 2, San Francisco CA and London: Asia Foundation and Overseas Development Institute
Schneider, H. et al. (2021) ‘Intersectoral Collaboration Before and During the COVID-19 Pandemic in the Western Cape: Implications for Future Whole-of-Society Approaches to Health and Wellbeing’, South African Health Review 2021.1: 1–8 (accessed 19 April 2025)
Credits
This IDS Policy Briefing was written by Ludovico Alcorta (Postdoctoral Researcher at the Institute of Development Studies, and Research, Evidence and Learning Lead, POTENCIAR), Karin Alexander (Governance and Accountability Lead at FHI 360 UK, political economy analysis (PEA) Lead on POTENCIAR), Cecília Robertson dos Santos (specialist in gender and social development, consultant for the POTENCIAR programme), Cathy Shutt (monitoring, research, learning, and power analysis practitioner on participation, transparency, and accountability programmes including POTENCIAR), and Alex Shankland (Senior Fellow in the Power and Popular Politics Research Cluster at the Institute of Development Studies, adviser to the POTENCIAR programme). It was funded by UK International Development from the UK government. The views expressed are those of the authors and do not necessarily reflect those of IDS or the UK government.
The authors extend their gratitude to all the participants of this study and acknowledge the support of the POTENCIAR Programme Management Unit, and the contributions of the Chemonics Group UK and consortium partners (COWI/Austral, the Centre of Learning and Capacity Building of Civil Society (CESC), IDS, and FHI 360 UK). We would also like to express our appreciation to the British High Commission staff and the FCDO Senior Responsible Officer for POTENCIAR, Jonas Pohlmann, for their valuable reflections and support throughout the process.
© Institute of Development Studies 2025. This is an Open Access briefing distributed under the terms of the Creative Commons Attribution 4.0 International licence (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original authors and source are credited and any modifications or adaptations are indicated.
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