INTRODUCTION:
Many health systems are aspiring towards more unified, plural models of healthcare delivery with coordinated service provision to promote Universal Health Coverage(1–6). Community participation (CP) in governance is a promising mechanism to align public and private actors around public health goals and advance equity(7–10). Yet its implementation is not well understood. This workshop explores that gap, drawing on lessons from the NIHR-COMPLUS teams in India, South Africa, and Brazil.

METHODS:
A qualitative, comparative case study presentation and workshop.

RESULTS:
The first half of the session presents three cases. In Brazil, the team works with civil society to build capacities for monitoring and evaluation through co-production of metrics measuring equity and citizen-centredness of primary care, addressing shortfalls in municipal evaluation systems that inadequately track citizen perspectives and inequalities. In South Africa, the team explores CP in a plural health system envisioned under the National Health Insurance (NHI), co-designing a model for participation with users, health system actors and policymakers. It proposes a human rights-based model, testing the establishment of plural health forums at sub-district level for users of private and public services. In India, where the public health system is highly fragmented across levels of government, and the large private sector is not integrated into shared governance or accountability arrangements, the team works to strengthen and facilitate the work of existing CP platforms. Across cases, CP shows promise in improving accountability and responsiveness in plural health systems. Major challenges include skills gaps and unequal power dynamics that limit decision-making roles.

CONCLUSIONS:
In the second half, participants work in groups to workshop solutions to a specific CP problem using the country cases: evaluative capacities (Brazil); integration of public/private participatory structures (South Africa), and governance and policy capacities (India), to generate transferable lessons for strengthening CP in plural health systems.