Toward a more preventative healthcare systems: A Scoping Review of Proximity-Based and Intersectoral Governance Models.

Background: In contexts of health system reform, territorial reorganization, and rising complexity, proximity-based governance has emerged as a key approach to strengthening population-centered care, health democracy, and intersectoral collaboration. However, the concept remains inconsistently defined and poorly operationalized in the literature. This scoping review aims to clarify how proximity governance is conceptualized and implemented in health systems, and to identify mechanisms that support adaptability and resilience in territorial, collaborative, and population-accountable governance models.

 

Approach: We will conduct a scoping review following established methodological steps (Tricco et al., 2022): defining research questions, developing a protocol, identifying data sources, constructing search strategies, study screening, data extraction, synthesis, and expert validation. Databases will include PubMed, Scopus, Web of Science, and relevant grey literature. Key questions include: What is proximity-based governance? How is it conceptualized and operationalized within intersectoral territorial health systems? What mechanisms enable adaptability, resilience, and collaborative governance?

 

Results: Initial screening identified over 400 publications on healthcare governance. Filtering for proximity-based intersectoral governance (2018–2025) yielded approximately 150 relevant studies. Ten distinct definitions of proximity governance were identified. Emerging themes include: co-construction with communities, subsidiarity, relational proximity, territorial stewardship, and adaptive coordination mechanisms across sectors. The review is ongoing and will map conceptual dimensions, implementation strategies, identify mechanisms that support adaptability and resilience in territorial, collaborative, and population-accountable governance models, and gaps in the literature.

 

Conclusion: This review will contribute conceptual clarity and highlight international proximity-governance models capable of managing interdependence and contradictions in complex health systems. Findings will inform policy and practice for integrated care, offering guidance for territorial governance reforms that strengthen population accountability, resilience, and collaborative decision-making. Results will support jurisdictions seeking to operationalize proximity in integrated care strategies.