Background Complex challenges in health are often addressed through the concerted effort of multi-sectoral action coalitions (MAC), but not enough is known about how they are organized and how they function.
Methods The study was carried out in the Brazilian cities of Fortaleza and Sao Paulo in August and September 2019. We addressed the following questions: 1) How are they organized? 2) How do internal diffusion channels evolve? 3) What types of knowledge diffuse through them? Using survey and key informant interview data, this study leverages the power of social network analysis (SNA) to understand the underlying dynamics that shape programmatic and policy outcomes.
Results A total of 16 and 32 road safety organizations were identified in Fortaleza and Sao Paulo, respectively. Fortaleza had more direct links between its organizations than Sao Paulo (network density 0.56 vs 0.17). However, Sao Paulo had organizations that acted as centralized brokers (high betweenness centrality 0.53) that shared coordination, access to decision makers, data, and resources. In both cities, the lead agency had the most influence throughout the network (closeness 0.85).
Conclusion SNA is an innovative tool to gain insight into the governance of MAC and advocate for evidence-informed public policy.
Learning Outcomes The type of centralized organizational role that we observed in Sao Paulo is useful in early stages of a network development process because it fosters interactions between organizations until the network is formally established
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