TGI COMPLUS reporting India, Brazil and South Africa are countries with public health care systems with forms of citizen participation in health care institutionalised in different ways (for example health committees). These systems are pluralistic when relying on combining public and private provision of services. This proposal addresses the implications of both, community participation and pluralistic health systems, for the goals of improving population health and wellbeing. We assume that citizen participation helps to align bureaucracies, politicians and health professionals around these goals. Therefore, this research program aims to enhance understanding of a) How citizen participation is working in these systems; b) How is it adapting to ongoing changes; c) What is needed in term of resources, institutional design, community involvement and training of public officials to fulfil its potential contribution.
This is a multi-country study focused on mapping and improving the state of community participation mechanisms in selected districts in Mumbai, Bengaluru, São Paulo, Fortaleza, Gqeberha and Cape Town, where pluralistic service models are either in place or being developed. This research seeks to understand the crucial role community participation can play in pluralistic health systems and how it could strengthen and enhance Universal Health Care with health system accountability. It seeks to identify a model for meaningful participation within pluralistic health systems. The overarching research question is “How can community participation, framed as a human right, facilitate the promotion of population health and wellbeing in pluralistic health systems?”
Objectives:
1. Identify and characterise the existing international evidence on the extent of community participation mechanisms, processes and structures under plural health systems and reasons for success or failure;
2. Map the current national and provincial policy context for urban health committees in three countries;
3. Characterise the extent to which states are able to extend their human rights obligations to ensure meaningful social participation in health, to non-state providers
4. Describe the contexts and identify the mechanisms that impede or facilitate intensified community engagement in pluralized health systems aimed at UHSs.
5. Explore how communities’ views, needs and perceptions of health service adequacy are and/or could be more adequately incorporated into contracting arrangements under pluralized health systems
6. Co-develop, test, and implement participatory approaches pilots to empower community voice in the policy cycle.
7. Evaluation of capacity building and implemented participation pilots
8. Compare and synthesize findings across different sites with a view to dissemination.

The following succinctly summarise the main overarching project objectives:
1.	Delineate policy, institutional and community contexts that facilitate or impede effective
community participation in urban pluralistic health systems through urban health committees
2.	Build ground up and implement context specific interventions in the three countries co-produced with marginalised communities in urban settings and health system stakeholders to facilitate participation and community voice 
3.	Trace relationships between contexts, mechanisms, and outcomes of implementation of the intervention and draw on the analysis to refine the intervention and propose measures that can facilitate and strengthen community voice
4.	Learn from the different country contexts and foster capacity strengthening of communities, health system stakeholders and global health researchers