BACKGROUND:
This paper introduces a conceptual framework for evaluating capacity building (CB) for social participation in health sector governance (SP). SP is increasingly recognised as a component of health system strengthening (HSS) to promote accountability and equity(1–4). However, its actual effects remain understudied. SP is usually assessed based on the existence of participatory structures rather than on citizens achieving real influence(5). Where structures exist, studies highlight skills and resource constraints and unequal power dynamics(6–8), suggesting a role for CB, which is also under-studied in relation to SP. Saddi et al (2023) apply the policy capacity framework(9), prevalent in policy studies, to HSS. By distinguishing analytical, operational, and political capacities across policy networks – which could include SP – it foregrounds systemic and relational aspects of policy change, contrasting with more discrete, technical approaches dominant in HSS(10). Yet how these capacities should be assessed empirically remains unclear.

METHODS:
I propose that the effects of CB for SP can be evaluated through linking CB processes at individual, organisational, and systemic levels to changes in the configuration of ideas, interests, and institutions (III) sustaining policymaking status quos: how specific health systems operate, which actors dominate, and which reforms are feasible(11–14).

RESULTS:
Shifts in III constitute an intermediate mechanism by which CB could enable eventual policy change that sustainably enhances citizen influence. This paper presents the framework and illustrates its application to CB interventions with SP structures in Indian, Brazilian, and South African cities. Drawing on longitudinal, multi-stakeholder data, it shows how process tracing, outcome harvesting, and comparative analysis can assess CB-led change in III.

CONCLUSIONS:
The central contribution is to move CB evaluation for SP from a technocratic model of skills and structures toward a political theory of health systems change, where CB is understood as reshaping power relations embedded in III.