Implementation Of Collaborative Governance Through Hexahelic Actor Synergy In Tuberculosis Combat Efforts In Makassar City

Riska Nuraisyah

Tuberculosis (TB) remains a public health problem in Makassar City and requires cross-sectoral collaborative governance. This study aims to analyze the hexahelic collaborative governance in TB control in Makassar City, involving government, academics, the business/philanthropic sector, the media, civil society, TB patient organizations, and donors. The study used a descriptive qualitative approach with a case study method. Data were obtained through in-depth interviews, observation, and documentation, then analyzed thematically using NVivo. The results show that collaboration has an initial foundation through the MoU, the Multisector Forum Decree, informal networks, and interdependence between actors. However, coordination still predominantly relies on the Health Office, while the Multisector Forum does not yet have a definitive chair and the Regional TB Action Plan has not been ratified. In terms of program achievements, the coverage of TB detection and treatment increased from 5,863 cases in 2022 to 7,314 cases in 2024, reaching 93%. The coverage of suspected TB screenings also exceeded the target, reaching 52,778 out of 43,119, or 122%. However, the success rate for drug-sensitive TB treatment declined to 73%, while the success rate for drug-resistant TB treatment decreased from 61% in 2022 to 39% in 2024. This study underscores the need for institutional strengthening, role allocation, funding, and capacity building of hexahelic actors.

Before the Beginning

Shania McFarlane

Abstract

Objective

To examine the role of pre-change as a phase in healthcare change management, using a full-day creative pre-implementation workshop as a single case example of intentional relational, creative and reflective groundwork.

Design

Qualitative document analysis of a program process report and its embedded participant feedback data, thematically coded and mapped to established change and collective care theories.

Setting

A full-day pre-implementation workshop occurred in the Illawarra Shoalhaven Local Health District, New South Wales, involving fourteen clinical staff, carers, researchers and student volunteers preparing for a multi-site healthcare kindness initiative.

Main outcome measures

Evidence of relational readiness, shared purpose, emotional grounding, collective care, and integration of creative and analytical processes ahead of implementation.

Results

Across seven phases of the day (grounding, introductions, program history, a researcher’s personal reflection, split working sessions, creative process work, and structured planning and data collection), participants showed signs consistent with psychological safety, emotional regulation, shared meaning and readiness for change. A grounding mandala activity was reported by participants as having “an incredible effect on the mind, heart, and body,” and an open-format introduction method allowed people to introduce themselves “as whole people, not just role-holders.” Independent small-group logo interpretation showed strong convergence on core symbolic meaning. All 12 respondents to the closing feedback survey rated the day highly, predominantly 9 out of 10, and thematic coding of open-ended responses showed engagement and connection themes present across most questions, ahead of measurement-related themes.

Conclusions

This case study suggests that creative pre-change work, including silence, story, creativity and data in this case example, deliberately sequenced, can help prepare a group intellectually, relationally and emotionally when deliberately sequenced before formal implementation begins.

Asia Pacific Journal of Health Management