sectors (Rosenau 2000). The holistic understanding ofcontextual factors on a case-by-case basis may be paramount in identifying and addressingissues therefore helping overcome a number of challenges, especially in theHealth Sector.PPPsin health distinguish from others for their social nature, by whichexpectations are strongly defined in terms of outcomes for specific groups orcommunities. According to Buse and Walt(2000) there are key elements that must be in place when developing PPPs inhealth, such as transparency and accountability, common understanding, risk andresponsibility sharing, and clear definition of expectations. To evaluate the SuburbanHospital PPP five key features are considered relevant to this particularproject:- Transparencyand Accountability - Stakeholdersengagement- Risksharing- Costsand Quality- Equitableaccess Accountability and Transparency Rosenau (2000) suggests thatit is difficult to define which of the parties involved in PPPs is moreaccountable or that policies and regulations increases or decreasesaccountability, especially regarding social sensitive projects such ashealthcare, where the public sector is seen as the rescuer when projects fail. Notwithstanding, ensuringaccountability in healthcare PPPs is fundamental, therefore the public sectorneeds to be well informed about potential partners and their proposals, and theprivate sector have to be held accountable to the community by providingcomplete and equal information. Furthermore, if PPPs are to improve performance(Flinders 2005), partners need to be accountable to each other as well astransparent. Reports of performance indicators by the publicsector in Brazil, is not a common practice. Thus to ask the private sector toadhere to this idea, it is necessary that the state also release information tothe public, so the society can form concrete opinions about the public sectoractions. However, in many developing countries, including Brazil, thecommunication between the government and the community is ineffective and not wellsupported, for the fact that some information may indicate significant room forimprovement. Besides, corruption and frauds has been affecting theaccountability and transparency of many public sector initiatives in Brazil (Changingthe rules of the game: a diagnosis of corruption in Brazil 2011). Stakeholders EngagementKwak et al. (2009)suggest that good stakeholdercommunications is essential to ensure that people close to the project have theopportunity to have their views considered before decisions are made.Innovative approaches to communications and stakeholders management can helpPPP projects achieving sustainable outcomes. Furthermore, early engagement with stakeholders createsopportunities to build relationships, understand concerns, mitigate issues, andinvolve those who will be most affected by the PPP project. Yet, the outcomesof PPPs in health are difficult to predict, as they are dependent on the waythe internal stakeholders interpret policies and how the community react to them(Rosenau 2000). Fora better understanding of the tensions and pressures involved in PPPs, culturalperspectives and stakeholder analysis need to be considered. According to Flinders (2005)organizations that share value with their stakeholders and involve them intheir strategic decisions, could gain unmeasurable benefits. Bresnen (2007)mentions stakeholders as partners, with different perceptions, thoughts andfeelings, who can encourage knowledge sharing to generate both economic andsocial values. Besides, social capital may also be regarded, as it may clarifythe level of synergy as well as identify weaknesses or strengths ofrelationships and interpersonal connections. Moreover, breakdowns in therelationship between the parties involved in PPPs may represent a highstrategic risk for the project (Kwak